Created by Charles Kelman in the late 1960’s, Phaco also referred to as phacoemulsification is used to restore vision in patients whose vision has become cloudy from cataracts.  Kelman created phacoemulsification surgery as a variation to extracapsular cataract extraction to remove the cataract with a smaller incision, less pain, and a shorter recovery time.

In traditional cataract surgery, during phacoemulsification, the eye’s internal, cloudy lens is emulsified (broken up) with an ultrasonic hand piece and aspirated from the eye.  Once the fluids are aspirated from the eye, they are replaced with irrigation of balanced salt solution that maintains the eyes anterior chamber.  In most cases, the insertion of an intraocular lens immediately follows phaco surgery.

With today’s technology, lasers are used in addition to ultrasound to soften and break up the cataract.  With laser cataract surgery, a skilled surgeon first takes a 3-D image of the eye using non-invasive light waves – this is called OCT (optical coherence tomography); and then creates a precise surgical plan for the incisions.  The OCT imaging allows your cataract surgeon to create incisions with a specific location, depth and length in all planes of the cornea – low degrees of astigmatism can be corrected this way.

OCT Imaging

A capsulotomy is then performed to gain access to the cataract.  In laser cataract surgery this is performed with a femtosecond laser versus using a needle and/or forceps to tear the capsule in a circular fashion as with traditional cataract surgery.  Using the femtosecond laser leads to greater precision, and enables better centering of the intraocular lens implant which may increase the chance of a better visual outcome.

After the capsulotomy, the cataract will be removed.  With laser cataract surgery, the reduced energy used during the phacoemulsification process to remove the cataract means there will be less chances of burning and distorting the incision, and less chances for complications swelling of the cornea.

Benefits of Phacoemulsification surgery include:

  1. Smaller incisions which lessen the possibility of induced astigmatism
  2. Less complications related to incision size
  3. No hospitalization needed
  4. Quick recovery, meaning patients are able to return to work or normal activities typically the next morning
  5. No bandages
  6. Minor ocular inflammation
  7. Early restoration of vision
  8. Incisions typically seal themselves without stitches

Topical or local anesthesia is typically used during most cataract surgery.  However, general anesthesia may be needed for people who are allergic to certain local anesthetics, or who suffer from extreme anxiety; and sometimes with children.

Phacoemulsification with laser cataract surgery is well suited for patients with a less-advanced cataract; and is one of the most successful and effective surgical procedures performed in the United States today.