Phaco Surgery for Cataract

8. What is routine Cataract Surgery with Phacoemulsification?

Cataract Surgery as it was practiced around 20 years ago, was a procedure known as ECCE. In ECCE, a large incision was made in the eye, and the cataractous lens expressed out. This was followed by intraocular lens implantation.

ECCE Step 1
Conventional Cataract Surgery involves making a large incision in the eye.
Lens Expression during ECCE
In Conventional Cataract Extraction (ECCE) after making a large incision in the eye, the lens is expressed out of the eye

ECCE was a great improvement over earlier procedures, but it suffered from several issues. The large incision meant that there would be several sutures necessary, and a long healing and recovery period.

Over the last 20 years, phaco surgery has replaced ECCE as the procedure of choice for Cataract Surgery. Instead of making a large incision in the eye to express out the lens, a small self sealing incision is made in the eye.  The outer skin of the lens is carefully removed to create a small, round opening in the eye. (The procedure is known as Capsulorhexis). A hollow needle (known as a phaco needle) is then inserted into the incision, and this needle is moved back at forth at a high frequency. This back and forth movement of the needle breaks up the lens, and the small lens pieces are sucked out of the eye through the hollow needle.

Incisions for phacoemulsification Surgery
In phaco surgery, a small self sealing incision is first made in the eye

The technique to break up the lens can have several variations, including trenching, divide and conquer and chopping. Whichever technique is used, the objective is to remove the lens through a small incision. As machines and techniques have improved, the incision size has become smaller and smaller, down from 3.2 mm to 1.8 mm. At 1.8 mm, it is like doing surgery through a ball point sized incision in the eye.

Grooves made during phacoemulsification
Grooving during Phaco Surgery











Divide and Conquer Phaco Surgery
During phacoemulsification, the lens is made into pieces and the small pieces are then removed from the eye through a hollow needle.







Recently, another advance has led to the development of bladeless laser cataract surgery,which which greatly simplifies and standardizes the cataract surgery procedure.


9. What are the possible complications of Phaco Surgery?

While modern phaco surgery with an experienced surgeon is very safe, nevertheless, some complications can occur.

The possible complications of Phacoemulsification are the following:

a) Anesthetic Complications: At our centre, the majority of patients undergo surgery with only anesthetic drops, which greatly reduces the chances of any anesthetic complications. Nevertheless, in some patients, especially who have existing cardiac conditions, or who, in the judgement of the surgeon, cannot co-operate during surgery, will need to have sedation or anesthetic.  At this time, and very rarely with anesthetic drops, various complications of anesthesia can occur. Please refer to complications of anesthesia here

b) Other Surgical Complications can include a posterior capsular rupture, which may involve some pieces of the lens falling into the eye, or may prevent an intraocular lens from being implanted in the eye. It may necessitate an intervention where a specialist surgeon removes these pieces from the eye.

A posterior capsular rupture is more likely when operating certain types of cataracts, or when the capsulorhexis has not been properly performed.

c) Excessive Inflammation of the Eye; Excessive Inflammation of the eye can result in a delay in visual recovery. There may be the necessity of increasing the medication in the eye. It may also necessitate a small surgical intervention.

Excessive inflammation is more likely due to issues with the patients, as with some systemic problems with diabetes or autoimmume disease, or also due to fluids used during surgery or excessive energy being input into the eye.

d) Infection: Infection can be a very serious problem, including with loss of the eye. We take a lot of precautions against infection, but it also requires the patient’s co-operation in regular use of medication and in avoiding touching of the eye, and avoiding contact with other infected patients.

In addition to these, there are a variety of other rare complications. Please discuss these with your surgeon before deciding for surgery.


For answers to more questions regarding cataract surgery, please visit the Cataract Surgery Page.