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Cataract surgery (modern phacoemulsification)

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Cataract surgery (modern phacoemulsification)
Photo by Delhieye centre / Unsplash

Surgical removal of an opacified crystalline lens via small-incision phacoemulsification and implantation of an intraocular lens (IOL) into the capsular bag.

Cataracts
Cataracts are the opacification of the lens, a natural component that helps focus light in your eyes. While normally transparent, there are many ways for a lens to become opaque, affecting vision and quality of life. The Lens: Structure and Function The lens is a transparent, biconvex, avascular structure in
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Key Steps

  1. Incisions & viscoelastic
  2. 2) Continuous curvilinear capsulorhexis (CCC) ~5–5.5 mm (optimum 360° optic overlap)
  3. Hydrodissection ± hydrodelineation
  4. Nucleus management (divide-and-conquer, stop-and-chop, phaco-chop)
  5. Epinucleus & cortical cleanup (I/A)
  6. IOL implantation (in-the-bag preferred)
  7. OVD removal & wound hydration
  8. Intracameral antibiotic per surgeon preference.

Viscoelastics – Cohesive vs Dispersive

  • Cohesive (e.g., Healon): Maintain space, easy removal; great for CCC.
  • Dispersive (e.g., Viscoat): Coat endothelium; better retention; remove last to protect cornea.

Zonular Issues & CTR

Capsular tension ring (CTR) helps stabilize capsular bag in zonulopathy (PXF, trauma, ectopia lentis). Consider hooks or segments for focal dialysis.

Complications

  • Posterior capsular rupture (PCR) → anterior vitrectomy
  • dropped lens → PPV referral
  • zonular dialysis
  • iris trauma
  • CME
  • TASS
  • endophthalmitis
  • negative dysphotopsia
  • refractive surprise.

Toric & Refractive Pearls

  • Toric misalignment: Each 1° off-axis ≈ ~3.3% loss of astigmatic effect.
  • Targeting: monofocal distance vs mini-monovision per
    patient.
  • Wound construction affects astigmatism
Types of IOLs
After removing a lens during cataract surgery, an artificial lens called an intraocular lens (IOL) is placed to help patients maintain their vision. Since an artificial lens isn’t an exact replica of the natural lens, certain tradeoffs must be considered when choosing the best option for each patient. Monofocal IOLs
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