Phacoemulsification is a cataract surgery method in which the internal lens of the eye which has developed a cataract is emulsified with the tip of an ultrasonic handpiece and aspirated from the eye. Aspirated fluids are replaced with irrigation of balanced salt solution to maintain the volume of the anterior chamber during the procedure. This procedure minimises the incision size and reduces the recovery time and risk of surgery induced astigmatism.
It is best suited to relatively soft cataracts, where the ultrasonic energy required is moderate, and insertion of foldable intraocular prosthetic lenses, which take advantage of the small incision possible. It is the most common procedure for cataract removal in the developed world, with an excellent prognosis in uncomplicated cases.
The term originated from phaco- (Greek phako-, comb. form of phakós, lentil; see lens) + emulsification.
The same general contraindications for cataract surgery apply. Specific contraindications for phacoemulsification include hard or dense cataracts where phacoemulsification is likely to cause permanent damage to the cornea.
The phacoemulsification system comprises three sub-systems: Ultrasound, aspiration, and irrigation.
The ultrasound component is used to break the lens down into particles small enough to be aspirated through the suction passages around the tip, which allows a very small incision for access. The incision is small enough that sutures are not needed for closure, and very little astigmatism is caused by healing of the wound in the cornea.
The phacoemulsification handpiece has a tip which vibrates longitudinally at a frequency in the range of 27 to 60 kHz, with a stroke length of 60 to 150 micrometres. Power is adjustable by the operator as a percentage of full power, and indicates a variation in nominal stroke length. Actual stroke length may vary slightly depending on the density of the material it contacts, though some instruments use feedback to maintain nominal stroke by adjusting current, voltage or frequency.
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Cataract surgery, which is also called lens replacement surgery, is the removal of the natural lens (also called the "crystalline lens") of the human eye that has developed a cataract, an opaque or cloudy area. The eye's natural lens is usually replaced with an artificial intraocular lens (IOL). Over time, metabolic changes of the crystalline lens fibres lead to the development of a cataract, causing impairment or loss of vision. Some infants are born with congenital cataracts, and environmental factors may lead to cataract formation.
Eye surgery, also known as ophthalmic surgery or ocular surgery, is surgery performed on the eye or its adnexa. Eye surgery is part of ophthalmology and is performed by an ophthalmologist or eye surgeon. The eye is a fragile organ, and requires due care before, during, and after a surgical procedure to minimize or prevent further damage. An eye surgeon is responsible for selecting the appropriate surgical procedure for the patient, and for taking the necessary safety precautions.
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