Phacoemulsification

PHACOEMULSIFICATION

INTRODUCTION

It was introduced by Charles Kelman in 1967.Small Incision which in turn reduces

• Healing time• No of sutures• Postoperative astigmatism• Hemorrhagic complications

Conservation of posterior chamber, avoiding retinal detachment, maintaining vitreous.

Complete aspiration of cortex.Easy implantation of IOL.

PRINCIPLES OF PHACOEMULSIFICATION

¤Hardness of the nucleus.¤Red reflex of the fundus.¤Corneal transparency.¤Trophism of iris.¤Chamber depth.¤Pathologies.

ANESTHESIA

General Anesthesia Local Anesthesia Topical Anesthesia

FLUID DYNAMICS OF PHACO

► Bottle with irrigation liquid

► An irrigation tube► The eyeball► An aspiration tube► An aspiration

pump

IRRIGATION/ASPIRATION

Irrigation depends on the height of the bottle and thus gravitational force.

Aspiration depends on the type of the pump

Peristaltic.Venturi Diaphragm.

PERISTALTIC PUMP

VENTURI PUMP

MEMBRANE OR DIAPHRAGM PUMP

PARTS OF PHACOEMULSIFIER

Machine bodyConnection systemHandle• Ultrasonic probe• I/A hand piece• Diathermy hand

piece

STEPS FOR PHACOEMULSIFICATION

Incision

Limbal Easy to perform, Need sutures.

Scleral(3.5-7mm) Corneal (2.8-4mm)

(4.5-6.5)

CAPSULOTOMY

It is the process of making the incisions around the anterior capsule of the lens. Can opener. Christmas tree. Postage stamp. Envelope. Capsulorhexis.

CAPSULORHEXIS

HYDRODELINEATION

It is used to separate epinucleus and nucleus.

HYDRODISSECTION

It is used to separate capsulse and cortex ,

Cortex and epi nucleus.

EMULSIFICATION OF CORTEX & NUCLEUS

DIVIDE AND CONQUER

Nucleus is separated into 4 pieces.

Each pieces are emulsified separately.

Easy to do but need lots of ultrasonic power.

STOP AND CHOP

Formation of groove.Nucleus is break into two halves.Easy to do.Less ultrasonic power.Need two hands.

IRRIGATION/ASPIRATION

The amount of irrigation flow depends on:Diameter of the

irrigating tubeDiameter of the

connectionsSize of the orifices in the

tipHeight of the irrigating

bottle

The aspiration depends on:Diameter of the tube and

orificesLevel of vacuum set on the machine

Type of pump used.

INTRAOCULAR LENS

Biocompatible as not to trigger any inflammatory response.

Chemically and physically stable on the long run.

Light weighted.Made of PMMA.