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What is phacoemulsification in cataract surgery?

ophthalmologist performing phacoemulsification during cataract surgery

If you're planning to have cataract surgery, you may have learned that your surgeon plans to use phacoemulsification to remove the lens of your eye during surgery. 

Phacoemulsification, sometimes referred to as phaco, is a technique used in most cataract surgery today. Read on to learn more about what phaco is, how it's done and the advantages of phacoemulsification over non-phaco cataract surgery.

Phacoemulsification steps

In order to understand phacoemulsification, it's important to know what a cataract is and how cataract surgery works.

A cataract is the clouding of the eye's natural lens, the clear structure that is shaped like an oval and sits behind the pupil. During cataract surgery, the surgeon removes the cloudy lens in your eye and replaces it with an artificial intraocular lens (IOL).

Phacoemulsification is a procedure used to remove the natural lens of the eye during cataract surgery. These are the steps of phacoemulsification:

  1. The cataract surgeon makes a tiny incision in the cornea

  2. The surgeon uses a probe that emits ultrasound waves to break up the lens. 

  3. The eye surgeon then uses suction to remove the remnants of the lens. 

Phaco is also called "small incision cataract surgery" because of the technique involved.

Phacoemulsification vs. non-phaco cataract surgery

In extracapsular cataract extraction (ECCE), the surgeon makes a larger incision in the cornea in order to remove the cloudy part of the lens in one piece. The surgeon then uses suction to extract the remaining part of the lens. 

This procedure is also referred to as extracapsular cataract surgery and non-phaco cataract surgery. It may be used if the patient cannot have phaco because their cataracts are too advanced or they have another issue preventing use of the phaco technique.

Even though ECCE is usually a less expensive option, phaco tends to be more popular among patients and surgeons because it has a: 

  • Higher rate of success.

  • Lower risk of complications.

  • Faster recovery time.

Am I a candidate for phacoemulsification?

Most cataract surgery patients today are candidates for phaco, but you'll need to consult with your cataract surgeon in order to know for sure.

Here are two reasons a patient might not be a candidate for phacoemulsification:

  • Hard cataracts – In the past, cataract surgeons would perform non-phaco surgery on patients with hard (extremely advanced) cataracts. But phacoemulsification technology has evolved, and many patients with hard cataracts are now candidates for phaco.

  • Weak zonules – In a patient with "loose" or "weak zonules," the lens does not have enough support in the eye. This weakness can be caused by eye disease or trauma and can make cataract surgery more challenging overall. Patients who have loose zonules may not be candidates for phaco and may need to have extracapsular cataract extraction instead. 

Is phacoemulsification safe?

Phacoemulsification is a very safe procedure that generally has few risks. With phaco, the incision is small and stitches typically are not required.

One of the rare complications of phaco is called a dropped lens, dropped nucleus or dropped lens nucleus. A dropped lens happens when fragments of the lens fall into the vitreous humor, the gel-like liquid that fills the back of the eye.

If your surgeon encounters a dropped lens while operating, it may be possible for them to adjust the procedure to remove the nucleus then. But if they can’t remove the lens fragments safely, you may need to consult with a vitreoretinal surgeon, someone who specializes in performing surgery on the retina, a membrane on the back of the eyeball that plays a key role in vision. 

A dropped lens happens in just up to 1.5% of cataract surgeries and can threaten your eyesight. However, it can usually be fixed if caught and treated early.

If you've been diagnosed with cataracts, consult your eye doctor for a referral to a cataract surgeon, who can explain your individual situation and answer your questions about surgery. They will help make sure you understand the benefits and risks of any procedure they plan to perform.

Types of cataract surgery. Wills Eye Hospital. Accessed April 2021.

Phaco and ECCE. EyeNet Magazine. April 2009.

Phacoemulsification versus capsular extraction: Governmental costs. Clinics (Sao Paulo). April 2010. 

Comparing two different techniques of removing cataracts. Cochrane Database of Systematic Reviews. January 2014.

Phaco with weak zonules: Part 1. EyeWorld. May 2012.

The dropping and dropped nucleus. EyeWorld. August 2018.

Surgical management of a dropped lens as a complication of cataract surgery. Retinal Physician. May 2018. 

The basics of phacoemulsification. Cataract & Refractive Surgery Today. May 2011. 

Fundamentals of phacoemulsification power. American Academy of Ophthalmology. Accessed April 2021. 

Current and effective advantages of femto phacoemulsification. Current Opinion in Ophthalmology. January 2017. 

Keys to managing weak zonules. Review of Ophthalmology. March 2013. 

Pseudoexfoliation syndrome. EyeWiki. December 2020.

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