-Chiqui-

SMCQC
NCM 1o4
• form of cataract removal
• is a cataract surgery in which an
ultrasonic device is used to break up
and then remove a cloudy lens, or
cataract, from the eye to improve
vision.
• Involves removing the eye's natural
lens while leaving in place the back
of the capsule, which holds the lens
in place.
 The
eye
first lens is the cornea, a works
clear membrane that covers like
the front of the eye. a
camera
with
two
lenses.

second lens is the eye's

natural crystalline lens,
which is held in place by a
capsule located behind the
pupil
 • When the natural lens becomes cloudy,
usually because of the aging process, it
keeps light rays from passing through or
diffuses the light in such a way that vision
becomes fuzzy or hazy.

• Cataracts also can occur anytime because of

injury, exposure to toxins, or diseases such as
diabetes. Congenital cataracts are caused by
genetic defects or developmental problems, or
exposure to some contagious diseases during
pregnancy.
• Phacoemulsification, or phaco, as
surgeons refer to it, is used to restore
vision in patients whose vision has
become cloudy from cataracts. In the first
stages of a cataract, people may notice
only a slight cloudiness as it affects only a
small part of the lens, the part of the eye
that focuses light on the retina. As the
cataract grows, it blocks more light and
vision becomes cloudier. As vision
worsens, the surgeon will recommend
cataract surgery, usually phaco, to restore
clear vision. With advancements in
cataract surgery such as the IOL
(intraocular lens) patients can sometimes
• The technique of phacoemulsification utilizes
a small incision. The tip of the instrument is
introduced into the eye through this small
incision. Localized high frequency waves are
generated through this tip to break the
cataract into very minute fragments and
pieces, which are then sucked out through
the same tip in a controlled manner. A thin
'capsule' or shell is left behind after cleaning
up of the entire opaque cataract.

• The incision size for phacoemulsification is

approximately 3.0 millimeters in width. If a
lens implant that can be folded is used
following removal of the cataract, this
incision may not have to be enlarged. If a
 Disposable keratome.
This instrument is designed for clear
corneal phacoemulsification. The width of
the wound created will allow the entry of the
phaco tip without it being too narrow or too
wide.

Cystotome needle.
This needle is designed with for easy manipulation in the
anterior chamber. The sharp bent tip is used to tear the
anterior capsule and initiate the capsulorrhexis.

Utrata forceps.
This forceps has bent sharp tips. It can be used
instead of cystotome needle for capsulorrhexis.
Alternatively, it can be used to pick up the anterior
capsular flap created by the cystotome needle to
complete the capsulorrhexis.
 Phacoemulsification probe.
The phaco needle is used to emulsify the
nucleus. The sleeve is placed over the
needle during phacoemulsification. The
sleeve is incompressible and serves as an
insulator. Water which flows
between the sleeve and the needle acts as
a coolant and avoids burnt to the cornea.

Nucleus rotator.
used to divide the nucleus. with the help of
the phaco tip

Simcoe irrigation-aspiration cannula.

This instrument is used to remove any cortical material left after
phacoemulsification. It has two ports: one for irrigation to maintain
the anterior chamber and the other for aspiration. It can also be
used to remove viscoelastic material at the end of the surgery.
 Folding forceps.
This instrument is designed to fold
the lens at right angle and implant it
into the capsular bag.

Sinskey hooks. Straight and bent.

The hook is used to dial the haptic into the
capsular bag.

Intraocular lens (IOL) Phaco probe

• In phacoemulsification cataract surgery, the surgeon makes a very
small incision -- about 1/8th of an inch -- in the white of the eye
near the outer edge of the cornea. A small ultrasonic probe is
inserted through this opening and, oscillating at 40,000 cycles per
minute, is used to break up (emulsify) the cataract into tiny pieces.
The emulsified material is simultaneously suctioned from the eye
by the open tip of the same instrument. The hard central core of
the cataract (the nucleus) is removed first, followed by extraction
of the softer, peripheral cortical fibers that make up the remainder
of the lens. The front (anterior) section of the lens capsule is
removed along with the fragments of the natural lens. The back
(posterior) portion of the capsule is left in place to hold and
maintain the correct position for the implanted intraocular lenses.
• After removal of the cataract, a prescription intraocular lens, or
IOL, is permanently implanted in the lens capsule to replace the
natural crystalline lens of the eye that was removed during the
surgery. This lens is rolled inside a tiny hollow tube and inserted
through the same incision that was used to remove the cataract.
The folded lens is pushed out of the tube by a tiny plunger and, as
it unfolds, is positioned by the surgeon in the center of the lens
1. The process begins with the creation of a
micro incision with a diamond knife.
2. A round opening is then made in the skin
of the natural lens, which is like a grape, with
a skin and a softer interior.
3. Next, using a special probe with suction, the interior of
the natural lens is removed, leaving only the skin. This
technique is called phacoemulsification and uses
ultrasound to remove the cataract. Lasers are not used
to remove the cataract but may be used after the
surgery.
4. The lens capsule is carefully cleaned and polished, providing a
natural location for the new lens (the intraocular lens) that will be
inserted into the eye to correct vision. The lens is flexible and actually
fits through the tiny initial incision, opening inside the eye into the "skin"
of the natural lens. Over time, the capsule contracts, "shrink-wrapping"
the lens in place and making it a permanent part of the eye.
5. The new lens becomes so well
integrated into the eye that even severe
trauma will not dislodge it.
• Complications are unlikely, but can occur. Patients may
experience spontaneous bleeding from the wound and recurrent
inflammation after surgery. Flashing, floaters, and double vision
may also occur a few weeks after surgery. The surgeon should be
notified immediately of these symptoms. Some can easily be
treated, while others such as floaters may be a sign of a retinal
detachment.

• Retinal detachment is one possible serious complication. The

retina can become detached by the surgery if there is any
weakness in the retina at the time of surgery. This complication
may not occur for weeks or months.

• Infections are another potential complication, the most serious

being endophthalmitis, which is an infection in the eyeball. This
complication, once widely reported, is much more uncommon
today because of newer surgery techniques and antibiotics.

• Patients may also be concerned that their IOL might become

displaced, but newer designs of IOLs also have limited reports of
intraocular lens dislocation.
• Immediately following surgery, the patient is monitored in an
outpatient recovery area. The patient is advised to rest for at
least 24 hours, until he or she returns to the surgeon's office
for follow-up. Only light meals are recommended on the day of
surgery. The patient may still feel drowsy and may experience
some eye pain or discomfort. Usually, over-the-counter
medications are advised for pain relief, but patients should
check with their doctors to see what is recommended. Other
side effects such as severe pain, nausea, or vomiting should be
reported to the surgeon immediately.

• There will be some changes in the eye during recovery.

Patients may see dark spots, which should disappear a few
weeks after surgery. There also might be some discharge and
itching of the eye. Patients may use a warm, moist cloth for 15
minutes at a time for relief and to loosen the matter. All matter
should be gently cleared away with a tissue, not a fingertip.
Pain and sensitivity to light are also experienced after surgery.
Some patients may also have slight drooping or bruising of the
eye which will improve as the eye heals.
• Patients have their first postoperative visit the day after
surgery. The surgeon will remove the eye shield and prescribe
eye drops to prevent infections and control intraocular
pressure. These eye drops are used for about a month after
surgery.

• Patients are advised to wear an eye shield while sleeping, and

refrain from rubbing the eye for at least two weeks. During that
time, the doctor will give the patient special tinted sunglasses
or request that he or she wear current prescription eyeglasses
to prevent possible eye trauma from accidental rubbing or
bumping. Unlike other types of cataract extraction, patients
can resume normal activity almost immediately after phaco.

• Subsequent exams are usually at one week, three weeks, and

six to eight weeks following surgery. This can change, however,
depending on any complications or any unusual postoperative
symptoms.

• After the healing process, the patient will probably need new
corrective lenses, at least for close vision. While IOLs can
remove the need for myopic correction, patients will probably
need new lenses for close work.