The technique of phacoemulsification utilizes a small incision. The tip of the instrument is introduced into the eye through this small incision. Localized high frequency waves are generated through this tip to break the cataract into very minute fragments and pieces, which are then sucked out through the same tip in a controlled manner. A thin 'capsule' or shell is left behind after cleaning up of the entire opaque cataract.
The incision size for phacoemulsification is approximately 3.0 millimeters in width. If a lens implant that can be folded is used following removal of the cataract, this incision may not have to be enlarged. If a lens is used which cannot be folded, the incision must be enlarged to 5.0 or 5.5 mm.
The incision (wound) required for phacoemulsification is small (3 mm) and the wound construction is such that it is self-sealing. Therefore a surgery in which a foldable lens has been implanted through the small 3 mm wound, generally does not require any stitch, as it is watertight. The surgeries in which the wound has been enlarged (5 or 5.5 mm) to put a lens that can not be folded, is likely to require one stitch, because the wound is larger.
In addition, some surgeons simply prefer the safety of having the incision sutured, even if the incision is already watertight.
All the advantages of phacoemulsification are because of small incision, which is self-sealing. The wound is more stable and the chances of wound complications are minimized. The patients can resume their normal activity faster as compared to conventional extracapsular surgery. The wound healing is faster and more predictable, and therefore glasses can be prescribed much earlier as compared to the conventional surgery. The patient requires less follow up visits for checkups. As the incision is small and in many cases stitches are not required, the cornea does not get distorted and therefore the chances of significant astigmatism is minimized.
Manual small incision cataract surgery
Cataracts in children
Some children are born with cataracts. A child may also develop a cataract as a result of an eye injury (traumatic cataract) or due to problems with his or her general health. Cataracts are sometimes passed onto the child through heredity factors from a parent who has had cataracts. In many cases however, the cause is unknown.
It is essential that cataracts be detected and treated when a child is young, before amblyopia develops in the affected eye. The treatment of cataracts varies depending on how cloudy the lens is. Sometimes vision loss is only slight and no treatment is necessary. However usually the cloudy lens must be removed before the vision can improve. An intraocular lens may be placed in place of the cataractous lens depending on the age of the child
Children who have had cataract surgery need to wear glasses or contact lenses to compensate for the loss of the eye's natural lens. Without glasses or contact lenses the child's vision would be poor, and the maximum benefit from the surgery would not be obtained. In children over the age of 2 - 2 1/2 years an intra ocular lens can be inserted.
Some children may develop amblyopia, especially if they have only had a cataract in one eye. The treatment for amblyopia is to patch the "good eye" to encourage the development of better vision in the eye which has had the cataract.
The back capsule of the lens is not removed during surgery and in some cases this can become cloudy and need treatment with a laser procedure. (YAG capsulotomy)
Cataract in special situations