Phacoemulsification

Cataract Surgery

The patient arrives at the place where the surgery will be performed 1-2 hours before the surgery. Depending on their general health status, necessary tests are performed or requested to be done beforehand. Preliminary preparation for the eye is made with some drops, and the patient is taken to the operating room. In today’s cataract surgery, except for special cases, there is no longer general or local anesthesia. The patient is prepared for surgery only by putting drops that numb the eye. After these drops are applied 4-5 times, the surgeon can start the surgery.

Step 1: Surgery

First, a drop that numbs the surface of the eye is put in the patient’s eye 4-5 times. There is no need for another anesthesia method. Numbing done with drops in this way is called “topical anesthesia”, that is, drop anesthesia. The area where the cornea, the transparent part of the eye, and the sclera, which forms the white part, meet is where the first incision is made in cataract surgery. The inside of the eye is reached with a special incision of approximately 3 mm.

Step 2

A special jelly-like substance that has the feature of protecting the eye tissues is filled into the eye through this incision site. This substance allows the surgeon to work comfortably and safely inside the eye.

Step 3

Behind the iris, the colored part of the eye, is the lens of the eye (the tissue we call cataract when it becomes opaque). The cataract is located within a membrane. With the help of an instrument we call a cystotome, a round window is opened on the front surface of the cataract’s membrane.

Step 4

This membrane, with a window opened in the middle, is separated from the core (nucleus) and shell (cortex) of the cataract using fluid. Fluid injected to the back from the side surfaces of the membrane with a special syringe peels and separates the membrane from the other parts. With this procedure, the cataract becomes free within its own membrane.

Step 5

Now it is time to clean the cataract. At this stage, an instrument called a phacoemulsifier (phaco for short) is used. This instrument uses ultrasonic power, that is, sound wave power. This instrument, with a diameter of 2.7 mm, fragments the cataract, suctions these fragments into itself, and fills the emptied area with a fluid close to natural.

Step 6

In hard cataracts, the process of breaking the nucleus is performed with the help of a second instrument. By breaking the hard cataract into smaller pieces, it is ensured that it is cleaned more easily.

Step 7

After the nucleus, which is the large part of the cataract, is cleaned, the cortex is cleaned. This tissue is a kind of inner shell attached to the inner surface of the membrane. It ensures that the natural membrane of the cataract becomes an empty, clean bag.

Step 8

The inside of the eye is now cleared of the cataract. For comfortable and safe working, it is refilled with the jelly substance. Now, this substance can fill the inside of the membrane emptied by the cataract.

Step 9

It is time to place the artificial intraocular lens in place of the removed natural lens (cataract). This artificial lens, made of a special material, can be folded because it is soft. Again, by being folded with special systems, it is inserted into the eye through the incision prepared as 3 mm, and then placed into the membrane of the natural lens. This lens is made of a special material known for more than 50 years not to cause a reaction in the eye.

Step 10

The surgery is now complete. Without the need to place any stitches, the patient can get up from the operating table. After about 1 hour, they can open their eye and return home.