Phacoemulsification - Ultrasound Surgery and Modern Cataract Surgery

Up to 900,000 cataract surgeries are performed in Germany each year. This makes it one of the most common surgical procedures in the country.

Comparison of a healthy eye and an eye with cataracts @ Alessandro Grandini /AdobeStock

There are two main procedures for removing the clouded lens:

• phacoemulsification and
• the femtosecond laser

Both methods are considered to be similarly safe and effective.

In medicine, a cataract refers to a progressive clouding of the eye’s lens. This process can develop slowly, which is why immediate surgery is not necessary for this condition.

As a rule, patients decide for themselves when it is time for a “lens replacement.” They should not wait until their impaired vision poses a danger to their own health or that of others.

There are frequent reports claiming that certain diets or medications are helpful for cataracts. However, based on current knowledge, there is insufficient evidence to support these claims. The only cure for cataracts at this time is the replacement of the clouded lens.

In addition, waiting too long causes the lens to harden further. This, in turn, can lead to complications during a subsequent surgery that negatively impact the success of the cataract surgery.

Phacoemulsification is the most widely used outpatient surgical method for treating cataracts. It is, so to speak, the standard form of treatment in everyday clinical practice.

The surgery is performed under topical anesthesia. Before the procedure begins, the patient receives anesthetic eye drops that immobilize eye movements.

The phacoemulsification specialist then inserts the phaco needle through the sclera of the eyeball into the interior of the eye. Once inside the lens, the needle is activated and emits ultrasound waves.

Since the lens is harder in cases of cataracts, the ultrasound creates cracks to break up the interior of the lens. A suction device then removes the lens fragments.

The thin capsular bag that held the lens in place is preserved during phacoemulsification. It is used later to hold the artificial lens.

In total, the procedure takes no longer than 20 to 30 minutes. Replacing the removed lens with an artificial lens marks the end of the treatment.

Phacoemulsification breaks up the lens nucleus using an ultrasound-activated cannula; a suction-irrigation device then removes the debris @ RFBSIP /AdobeStock

As is so often the case, medical progress continues to advance in the field of ophthalmology as well. In the future, the so-called femtosecond laser could potentially rival phacoemulsification.

Both procedures proved equally effective in treating cataracts in a 2019 British study.

The only difference lies in the incidence of capsular rupture during the procedure. This complication did not occur in any patient treated with the femtosecond laser, whereas approximately 3% of patients undergoing phacoemulsification experienced it.

Laser cataract surgery using the femtosecond laser @ romaset /AdobeStock

Since phacoemulsification is a well-established standard treatment, the complication rate is only about 2%.

Nevertheless, as with any invasive procedure, risks can of course occur.

Possible risks include:

• Bleeding
• Infections
• Corneal abrasions
• Tear in the posterior lens capsule
• Allergic reaction to the anesthetics used
• Increased sensitivity to glare (especially in younger patients)
• Repeat corrective surgery due to displacement of the artificial lens or
• Secondary cataract (clouding of the remaining posterior lens capsule with impaired vision; occurs in less than 3% of cases within the first 3 years after surgery)

The prognosis for phacoemulsification depends primarily on postoperative care. Patients play a major role in the success of the procedure.

Patients should use eye drops regularly as part of their postoperative care. These drops contain anti-inflammatory, antibiotic, and wound-healing agents.

In addition, you should attend all follow-up appointments with the surgeon and your treating ophthalmologist. While checkups are initially scheduled at shorter intervals, the intervals between visits gradually lengthen. After approximately 6 to 8 weeks, experts will adjust your new corrective lenses.

If there are no complications and the patient is in good overall health, no further treatment is necessary. Therefore, phacoemulsification is an effective way to preserve vision in people with cataracts.

Cataracts fall within the field of ophthalmology. Specialists in phacoemulsification are ophthalmologists with a subspecialty in eye surgery.

Nowadays, cataract surgeries are often performed on an outpatient basis at a hospital or a private specialist practice. Phacoemulsification is the surgical method of choice.

Phacoemulsification is now the standard method for treating cataracts and allows for the gentle removal of the clouded lens. In this modern ultrasound procedure, the clouded lens is broken up through a small incision using ultrasound energy—more specifically, an ultrasound probe—and then aspirated. The surgeon makes a precise incision and removes parts of the lens nucleus using a suction-irrigation device before implanting an artificial intraocular lens into the capsular bag.

The insertion of an intraocular lens serves to replace the natural lens and restore vision. Modern cataract surgery also allows for the use of specialized intraocular lens types, such as toric lenses for astigmatism, to optimally correct refractive errors. Compared to older procedures such as extracapsular cataract extraction (ECCE), this method is significantly gentler and more precise. The implantation preserves the lens capsule, which ensures stability and supports the restoration of vision.

After the lens is removed, follow-up treatment with eye drops is administered to prevent inflammation and achieve optimal results. In some cases, laser treatment such as YAG laser capsulotomy may be necessary later on, for example, if the lens becomes cloudy again due to the proliferation of remaining lens epithelial cells. Overall, such cataract surgeries not only improve visual acuity but also help reduce the need for glasses and restore clear vision.

Despite potential risks and complications, cataract surgery is considered very safe and effective for successfully removing cataracts.

What is phacoemulsification?
Phacoemulsification is a surgical procedure to remove a clouded lens in cases of cataracts. During the procedure, the eye’s lens is broken up using ultrasound and then suctioned out. An intraocular lens is then implanted to restore vision.

How is phacoemulsification performed?
During phacoemulsification, a small incision is made in the cornea. An ultrasound probe is used to break up and remove the lens nucleus. An artificial lens is then inserted into the capsular bag, usually under local anesthesia.

Is phacoemulsification safe?
Phacoemulsification is a very safe method of modern cataract surgery. Risks and complications are rare, as the procedure is performed with precision and is well-established in ophthalmology.

When is phacoemulsification performed?
Phacoemulsification is performed when the eye’s lens becomes cloudy, i.e., in cases of cataracts. The goal is to remove the cloudy lens and improve vision.

What is the postoperative care like?
After the surgery, eye drops are used to prevent inflammation and support healing. Vision often improves quickly, and additional laser treatment is rarely necessary.