Medical Health Encyclopedia

All cataract procedures involve removal of the cataract-affected lens and replacing it with an artificial lens.

Phacoemulsification. Phacoemulsification (phaco means lens, emulsification means to liquefy) is now the most common cataract procedure in the United States and account for 85% of cases. Benefits are greater than with standard extracapsular surgery, and it may be particularly beneficial for people with diabetes.

The procedure generally is as follows:

• The surgeon makes an incision, which is much smaller than with standard cataract extraction.
• Ultrasound is then used to break up the clouded lens into small fragments.
• The tiny pieces are sucked out with a vacuum-like device.
• A replacement lens is then usually inserted into the capsular bag where the natural lens used to be. In most cases, this is an intraocular lens (IOL), which is foldable and slips in through the tiny incision.
• Because the incision is so small, it is often watertight and does not require a suture afterward, particularly if a foldable lens has been used. One may be required if a tear or break occurs during the procedure or if an unfoldable lens is inserted that requires a wider incision.

Click the icon to see an illustrated series detailing cataract surgery.

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Most procedures now take about 15 minutes, and the patient is usually out of the operating room in about an hour. There is little discomfort afterward and visual rehabilitation takes about 1 to 3 weeks.

Surgeons in the U.S. and Europe are currently investigating Microphaco, a new approach to cataract surgery that uses two smaller (micro) incisions. The smaller incisions measure about 1.6 mm compared to the traditional 3 mm. Experts say this procedure is expected to revolutionize refractive and cataract surgery.

Extracapsular or Intracapsular Cataract Extraction. The standard procedure has been extracapsular cataract extraction, but is generally used now only in patients who have an extremely hard lens. It typically involves the following steps:

• The ophthalmologist works under an operating microscope to make a small incision in the cornea of the eye.
• The surgeon then extracts the clouded lens through this incision.
• The capsule is left in place, which adds structural strength to the eye and enhances the healing process. (Less commonly, in intracapsular cataract extraction, the surgeon removes the lens and the entire capsule. There are greater risks with this procedure for swelling and retinal detachment.)
• A replacement lens is then usually inserted.
• A small suture is needed to stitch the incision together.