Phacoemulsification with intraocular lens (IOL) is a procedure done for patients having cataract.
Phacoemulsification with intraocular lens (IOL) is a procedure done for patients having cataract.

Phacoemulsification with an intraocular lens (IOL) is a procedure done for patients having cataract. The cataract-affected lens inside the eye is removed, and an artificial lens is inserted in its place.

The procedure takes anywhere between 15 minutes and 1 hour. It is done under local anesthesia. If you are very anxious, you may be given medicines to put you to sleep.

The procedure is done with the help of a microscope. A 2-3 mm cut is made at the 12 o'clock position at the limbus. Limbus is the margin between the transparent cornea covering the iris (colored part of the eye) and white sclera.

A rod-like instrument called a probe is inserted into the eye through the cut. This probe uses ultrasonic energy to break the lens of the eye into small pieces. These pieces are then suctioned out of the eye through the same probe.

In its place, an IOL or a folded artificial lens is inserted into the eye through the probe. This lens moves inside the eye chamber and opens. A solution is injected inside the eye to help the lens unfold. This new lens is held in place by the structures inside the eye.

Phacoemulsification is also called the suture-less cataract surgery because the tiny cuts made heal on their own. Today, phacoemulsification is the most popular surgery done all over the world for cataracts.

What are the risks associated with phacoemulsification surgery?

Phacoemulsification is a very safe surgery. Among all other cataract operations, phacoemulsification is associated with better vision at six weeks after surgery.

However, like every procedure, it has a few risks. These are as follows:

  • Postprocedural pain and redness: Pain and redness post the procedure are mostly minor and bearable.
  • Swelling of the cornea: The cornea becomes swollen when the cut is made near its surface. This generally settles on its own.
  • Endophthalmitis: This is a serious complication of cataract surgery. The entire eye becomes red and swollen. This may result in a permanent loss of vision.
  • Retinal detachment: The probe may heat up during the procedure causing damage to the surrounding structures. The vibrations during the procedure may cause the separation of the retina (layer of the eye responsible for transmitting signals to the brain) from its surrounding structures.
  • Cystoid macular edema (CME): The appearance of cystoid (cyst-like) swellings on the macula (the central part of the retina) is called CME. This may also cause vision loss.
  • Glaucoma: Damage to the drainage system of the eye during the surgery can cause glaucoma. In this, the pressure inside the eye increases. It adversely affects the optic nerve (the nerve responsible for sight).

The ideal candidates for phacoemulsification are patients with cataracts with no other medical conditions. The outcomes of patients with diabetes who undergo phacoemulsification are not that good.

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What happens after the surgery?

After the surgery, the cut will be covered with an antiseptic ointment and a sterile dressing. You will be shifted to a ward for observation. You must lie down and avoid sudden head movements. You may have mild-to-moderate eye pain after the surgery. If throbbing in the eye is severe, you must notify your doctor.

The day after the procedure, the doctor will remove the bandage and check for eye redness and eye discharge. He will check the pupil reaction to light and for the position of the inserted lens in the eye. He will give you antibiotics and anti-inflammatory eye drops to reduce redness and promote healing.

  • You must not carry weights or do strenuous exercise until advised by the doctor.
  • You must avoid straining, coughing, or any other activity that may increase pressure in the eye and delay wound healing.
  • You must avoid dusty areas in the house or outside.
  • You must avoid driving because this may put extra strain on the eyes. Moreover, your vision may not fully recover until around six weeks after surgery.
  • You must discontinue swimming until your doctor okays it.
  • You may wash your head and face after the operation but be careful not to let the soap or shampoo get into the eye.
  • You must not rub your eyes. You must wear an eye patch or eye shield if possible.

You will be called for a follow-up visit at one month and three months after the surgery.

At both these visits, your visual screening will be done. The eye will be examined for discharge, pain, and redness. The eye pressure will be measured. The pupil will be dilated with eye drops to check for the lens position. The retina will be examined for swelling or detachment.

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Medically Reviewed on 9/30/2020
References
Parson’s diseases of eye, 22nd Edition

https://emedicine.medscape.com/article/1844198-medication

https://pubmed.ncbi.nlm.nih.gov/15878068/

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