Mr Velota Sung FRCS(Ed), FRCOphth, MSc(Warwick)

Phacoemulsification with lens implant

Phacoemulsification is the most typical technique used for cataract operation in the UK.

The technique has evolved over the last two decades, and with better machines and techniques, the operation is much safer and has a much shorter recovery time.

The operation is commonly performed under local anaesthetic and as a day case.

On the day of the operation

If your operation is going to be undertaken under local anaesthetic, then you can eat normally, but it would be a good idea to eat lightly as you will be lying down for surgery.

You should wear loose clothes; most hospitals will allow you to wear your clothes to the operating theatre, so make sure your clothes are clean. Bringing a pair of slippers to the hospital would be a good idea.

Phacoemulsification is the most typical technique for cataract surgery in the UK. This technique involves making a small incision at the corner of the eye. A jelly-like substance is injected inside the anterior chamber to prevent it from collapsing.

The anterior capsule that wraps around the crystalline lens is peeled off with a can-opening manoeuvre. An ultrasound probe is inserted inside the eye, producing high-frequency ultrasound to break the lens substance into fragments. The lens fragments are then broken into pieces by using the ultrasound probe and sucked away.

The remnants of lens fibres are then cleaned from the capsular bag in preparation for a lens implant. The anterior chamber is then filled with a jelly-like substance to facilitate the lens implantation.

The artificial lens implant (IOL) is then loaded in an injection cartridge and ready to be injected inside the eye. The IOL is unfolded inside the eye and resting inside the capsular bag, essential to keep the IOL in a central position. The jelly-like substances are then aspirated away, and the wound is sealed by injecting water into the wound to create a self-sealing closure. Antibiotics and steroids are then injected inside the eye.

A cotton wool eye pad and a plastic shield cover the eye. The patient can go home with antibiotics and steroid eye drops. The next day, the eye pad can be removed, and the post-operative eye drops can be used.

How successful is Phacoemulsification cataract surgery?

Phacoemulsification cataract surgery is a very successful operation. The risk of complication is very low in highly experienced surgeons' hands. Like any operation, however, there is a small risk of complication.

Generally speaking, the risk of complication is a 1 in 100 chance for minor complications requiring prolonged medication treatment or further surgery. There is a 1 in 1000 chance of severe complications that can risk losing the sight of an eye.

Minor complications include rupture of the capsule during surgery that requires an alternative lens implant, post-operative excessive inflammation, raised eye pressure, and swelling of the retina (Cystoid macular oedema). More serious complications include bleeding inside the eye during the operation, dropping part of the lens fragment into the posterior segment, and post-operative infection (endophthalmitis), which can cause permanent loss of vision.