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Phacoemulsification

Phacoemulsification. By Ian Andersen. History - Kelman. Charles D. Kelman (May 23, 1930 – June 1, 2004). Born in Brooklyn, NY Boston’s Tufts University University of Geneva, Switz. – M.D. Residency in Ophthalmology at Wills Eye Hospital Inspired by dentist’s ultrasonic tools

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Phacoemulsification

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  1. Phacoemulsification By Ian Andersen

  2. History - Kelman Charles D. Kelman (May 23, 1930 – June 1, 2004) • Born in Brooklyn, NY • Boston’s Tufts University • University of Geneva, Switz. – M.D. • Residency in Ophthalmology at Wills Eye Hospital • Inspired by dentist’s ultrasonic tools • President of The American Society of Cataract and Refractive Surgeons

  3. Ophthalmology Deals with the anatomy, physiology and diseases of the eye. Greek roots: ophthalmosand logos “the science of the eyes” FYI: Indian surgeon Sushruta (800 BC) described 76 ocular diseases (of these 51 surgical) as well as several ophthalmological surgical instruments and techniques. Pre-Hippocrates, Greek physician Galen, Medieval Islam, 17th and 18th centuries. The first ophthalmic surgeon in G.B. was John Freke, who was so good, that his skill legitimized the field.

  4. Ophthalmologists • Ophthalmologists are physicians (M.D. or D.O.) • Completed a college degree, medical school, and residency in ophthalmology. Note: Ophthalmology was the first branch of medicine to offer board certifications, which is now a standard. • Most ophthalmologists train in medical residency programs accredited by the: ACGME (Accreditation Council for Graduate Medical Education) ADA (American Osteopathic Association) and are board-certified by the: ABO (American Board of Ophthalmology) AOBOO (American Osteopathic Board of Ophthalmology and Otolaryngology)

  5. Cataract Surgery In 1962, Kelman devised the cryo-probe, a freezing instrument for the extraction of cataracts.

  6. Cataract Surgery Removal of the lens of the eye (also called crystalline) that has developed opacification, called a cataract. The lens is made of mostly water and protein. As we age, some of the protein may clump together and start to cloud areas of the eye. Opaque – Not transparent or translucent, impenetrable to light

  7. Cataract Surgery It’s not known for sure why the eye’s lens changes, but there are identified factors. • Ultraviolet radiation from the sun • Diabetes • Hypertension • Obesity • Smoking • Prolonged use of corticosteroids • Statin medicines used to reduce cholesterol • Eye injury or inflammation • Hormone replacement therapy • Alcoholism • Genetics • High nearsightedness

  8. Cataract Surgery Two main types: Phacoemulsification (Phaco) Extra-capsular cataract extraction (ECCE) In both types, an intraocular lens is inserted.

  9. Phacoemulsification • Phaco – Lens/Lens-shaped • Emulsion - A colloidal suspension of a liquid in another liquid. • Colloidal – a substance made up of a system of particles with linear dimensions dispersed in a continuous gaseous, liquid, or solid medium.

  10. Phacoemulsification Preferred method in most cases. It involves the use of a machine with an ultrasonic hand-piece with a titanium or steel tip. The tip vibrates at ultrasonic frequency (40,000 Hz) and the lens material is emulsified. A second fine instrument (called a cracker or chopper) may be used from a side port to break the nucleus into smaller pieces.

  11. Phacoemulsification After the cataract is emulsified, a dual irrigation-aspiration (I-A) probe or bimanual I-A system is used to aspirate our the remaining peripheral cortical material. Aspiration – drawing something in, out, up, or through as if by suction

  12. Preparation • Most often done in an ASC. • Use of antibiotic drops 1 – 3 days prior to surgery. • May be accompanied by lid scrubs to further clear potential contaminants. • May also be required to start preoperative anti-inflammatory drops, and/or dilating drops in the eye days leading up to surgery. • For the morning of the surgery, no food/beverages, and someone to pick you up after you are done.

  13. Phacoemulsification The Actual Thing! Most Descriptive

  14. FIN

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