From the Guidelines
Phacoemulsification is the preferred method of cataract surgery due to its superior outcomes in terms of uncorrected distance visual acuity and lower rate of surgical complications, as evidenced by recent studies 1. The procedure involves a small incision through which an ultrasonic probe breaks up the cloudy lens before it's suctioned out, allowing for quicker recovery and less astigmatism. Key benefits of phacoemulsification include:
- Quicker recovery time
- Less astigmatism
- Typically doesn't require stitches
- Enables both astigmatism management and the implantation of specialty IOLs After the procedure, an artificial intraocular lens (IOL) is implanted to replace the removed natural lens, with various types available, including monofocal, multifocal, toric, and accommodating lenses. The use of topical nonsteroidal anti-inflammatory drugs (NSAIDs) and intracameral antibiotic administration can help reduce the incidence of early postoperative cystoid macular edema (CME) and postoperative bacterial endophthalmitis, respectively 1. Overall, phacoemulsification with IOL implantation is a safe and effective procedure for treating cataracts, with most patients experiencing improved vision within days, though complete healing may take several weeks.
From the Research
Types of Cataract Surgery
- Phacoemulsification: a surgical technique used to remove a cataractous lens from the eye, which has been shown to have better postoperative visual acuity and fewer complications compared to extracapsular cataract extraction (ECCE) 2, 3, 4
- Extracapsular cataract extraction (ECCE): a traditional surgical technique for removing cataracts, which has been compared to phacoemulsification in several studies, with results suggesting that phacoemulsification may be associated with better outcomes 5, 6, 2, 3
Comparison of Phacoemulsification and ECCE
- A study published in 1997 found no significant difference in cell growth on the posterior capsule between phacoemulsification and ECCE 5
- A review published in 2011 discussed updates in surgical techniques and outcome comparisons between phacoemulsification and ECCE, suggesting that there is little difference in final outcome when each surgery is done well 6
- A study published in 2000 found that phacoemulsification was associated with better postoperative visual acuity and less postoperative inflammation compared to ECCE in patients with diabetes 2
- A systematic review and meta-analysis published in 2014 found that phacoemulsification may result in better visual acuity and a lower complication rate compared to ECCE 3
- A meta-analysis published in 2022 found that phacoemulsification was associated with improved postoperative visual acuity and fewer complications compared to ECCE 4
Complications and Outcomes
- Posterior capsule opacification (PCO) is a common complication of cataract surgery, which can occur with both phacoemulsification and ECCE 5, 3
- Vitreous loss, capsular tear, and cystoid macular edema are potential complications of cataract surgery, which may be less common with phacoemulsification compared to ECCE 4
- The choice of surgical technique may depend on various factors, including the patient's overall health, the severity of the cataract, and the surgeon's expertise 6, 2, 3