Phacoemulsification Cataract Surgery

Phacoemulsification: Modern Cataract Treatment

Phacoemulsification, known as sutureless cataract surgery, is the most reliable and advanced surgical method used in cataract treatment. The phaco method allows the cloudy lens of the eye to be cleared through micro-incisions using ultrasonic energy. It is performed with very small incisions. After phacoemulsification, it is possible to achieve clear vision in a short time.

In this article, you can find answers to all the questions you may have, such as “How long does cataract surgery with the phaco method take?” and “Will I need to keep wearing glasses after phaco surgery?”

Daviva Health Group provides services in cataract surgery with a focus on patient comfort and safety, backed by its technological infrastructure and an experienced team of specialists in the field.

What Is Phacoemulsification?

Phacoemulsification, or phaco for short, is the process of breaking up and removing the eye’s lens, which has lost its transparency due to cataracts, using ultrasonic sound waves. Considered the “gold standard” in modern cataract surgery, this method was introduced to the medical world in 1967 after Charles Kelman saw ultrasound waves cleaning tooth enamel during a visit to a dentist.

Unlike traditional surgeries, this technique is performed without making large incisions in the eye and is based on the principles of microsurgery.

How Is Cataract Surgery Performed with the Phaco Technique?

The phaco method, known as sutureless cataract surgery, is generally performed as follows.

Safe Preparation and Anesthesia: Before the operation, identity and lens verification are performed. Your eye is made completely painless with topical anesthesia (numbing using only drops), and a speculum (a light device that holds the eyelids steady) is placed.
Sutureless Micro-Entry: The surgeon makes micro-incisions of about 2-3 mm in the front part of the eye. These incisions are so small that they do not require stitches at the end of the surgery.
Removal of the Cataract: The cloudy lens is liquefied and removed from the eye by vacuum using the phacoemulsification method (breaking up the lens with ultrasonic sound waves).
Placement of the New Lens: An intraocular lens (an artificial lens placed inside the eye) specially selected for you is inserted into the cleaned area with the help of an injector. This lens gently unfolds inside the eye and settles into its permanent position.
Rapid Recovery and Protection: After the inside of the eye is completely cleaned, an antibiotic injection is given to protect you from infection. The incisions are closed using a tissue-swelling, sealing method, and the procedure is completed in about 15 minutes.

Advantages of the Phaco Technique

The procedure is usually performed without the need for a needle or general anesthesia, using only numbing drops.
Unlike the 10-12 mm large incisions used in traditional methods, phaco cataract surgery is performed with micro-incisions of only 2.2 mm - 3.2 mm.
Because the incision is very small, the wound closes on its own. For this reason, phaco surgery is also known as sutureless cataract surgery. This minimizes post-operative stinging, tearing, and discomfort related to stitches.
The minimal wound area significantly reduces the risk of post-operative infection.
Small incisions do not disturb the eye’s natural corneal structure. This helps prevent unwanted surgically induced astigmatism.
Advanced phaco machines maintain intraocular pressure and fluid balance within milliseconds, allowing the surgeon to work in a safe environment.
The ultrasound energy used during phaco surgery is not continuous; it delivers energy in pulses. This prevents heat build-up in the eye and protects delicate corneal cells.
The micro-bubbles created by sound waves gently liquefy the hardened cataract without damaging surrounding tissues.
The lens to be implanted is calculated with the highest accuracy.
The procedure takes about 10-20 minutes. Patients can leave the hospital walking about 30 minutes after the operation and return to their daily routines on the same day.
Most patients begin to see clearly within the first 1-2 days. The recovery process that used to take weeks with older methods has been reduced to days with phaco.

What Are the Risks and Complications of Phaco Surgery?

Although phacoemulsification (phaco) surgery is a safe method, like any surgical procedure it carries certain risks.

Red spots that form on the white part of the eye, which may look alarming but are harmless.
Mild pain, dryness, stinging, or itching.
Light halos, glare, or increased sensitivity to light.
Tearing of the back wall of the capsule where the new lens will be placed, and the gelatinous fluid inside the eye (vitreous) moving forward. This is one of the most common surgical complications.
Cataract lens fragments falling into the back cavity of the eye (vitreous cavity).
Heat damage caused by the ultrasonic energy emitted from the phaco tip in the corneal tissue or at the wound entry site.
Detachment of the iris, the colored part of the eye, from its root.
Damage to and separation of the innermost layer of the cornea.
Tears due to weakness of the suspensory ligaments that hold the lens in place.
Rare but serious intraocular bleeding that threatens vision, such as choroidal detachment.
Inflammation of the intraocular tissues after surgery. Although rare, it is the most serious complication and carries a risk of permanent vision loss.
Corneal swelling and temporary blurred vision due to the ultrasound energy used.
Increased eye pressure due to incomplete removal of the materials used in surgery or tissue reaction.
Displacement, tilting, or shifting of the implanted artificial lens from the center.
Retinal detachment or macular edema, which can rarely occur after surgery
Clouding of the membrane behind the lens months or years after surgery

Complications usually may develop depending on the hardness of the cataract and the anatomical structure of the eye. Many of these complications are very rare.

High myopia, uncontrolled diabetes, or previous eye surgeries.
Extremely hard cataracts.
The experience level of the team performing the procedure may increase the risk of complications.

Recovery After Phaco Surgery

Phacoemulsification (phaco) significantly speeds up the recovery process thanks to micro-incision technology. Most patients notice a marked improvement in their vision within the first 1-3 days. However, full healing of the eye and clear vision take place between 4 - 8 weeks.

1-3 days:

Vision may initially be hazy or blurry, but it quickly becomes clearer.
Because your pupil has been dilated, lights may seem brighter than normal. This is temporary.
Feeling like there is sand in your eye, itching, or tearing is normal at this stage. These complaints result from the natural closure process of the micro-incision site.
You are usually discharged on the same day as the surgery.

1 Week

Hazy and blurry vision improves. You begin to see more clearly.
Avoiding actions such as bending over or lifting heavy objects helps maintain the artificial lens’s position inside the eye with millimeter precision. Therefore, you should avoid heavy activities. You may take short walks that will not tire you.
You should not skip the eye drops your doctor wants you to use after surgery. Remember that these drops help your eye heal faster while also providing protection against external factors.

4-6 Weeks

The eyeball reshapes itself, and vision reaches its clearest level.
Your brain achieves perfect adaptation to the new lens.
Restrictions such as the sea, swimming pools, heavy sports, and makeup end during this period.

Frequently Asked Questions About Cataract Surgery

Will I feel pain during phaco surgery?

Phaco surgery is usually performed without even a needle, using only highly effective numbing drops. This fully desensitizes the eye surface.
The patient is awake throughout the surgery. However, they do not feel any pain. For very anxious patients, surgeons may also provide a mild sedative support called sedation.
During the surgery, instead of pain, you may only feel touch on the eye, mild pressure, or a sensation of water being flushed over the eye.
After surgery, as the effect of anesthesia begins to wear off, it is normal to feel mild grittiness, stinging, or tearing in the eye. This is part of the natural healing process of the micro-incisions.
Severe pain is not expected after the surgery. If mild soreness occurs, it can be easily controlled with simple painkillers.
Because the pupil is dilated for the surgery and the cataract layer is removed, lights may seem brighter than usual for the first few days.
The surgeon and anesthesia team remain in communication with the patient throughout the procedure. If any discomfort is felt, additional anesthesia support can be provided immediately.

Can cataract surgery be performed on both eyes at the same time?

It is possible to perform cataract surgery on both eyes on the same day. However, because it carries a slight infection risk, it is generally preferred to do them on different days with at least a few days in between.
Even if cataract surgery is performed on both eyes at the same time, each eye undergoes a completely separate surgical process.
To prevent infection from spreading between the two eyes, completely new and sterile surgical instruments, different solutions, and new drapes are used for each eye.
The decision to operate on both eyes at the same time can be planned between the surgeon and the patient according to the patient’s specific condition.

Will I wear glasses after surgery?

Whether you will need glasses after cataract surgery may vary depending on the type of intraocular lens and your personal vision goals.

Standard Monofocal Lenses: These lenses usually correct only distance vision problems. In this case, you will not need glasses while driving or watching TV. However, you will usually need reading glasses for close-up tasks such as reading, sewing, or using a phone.
Premium Multifocal (Bifocal/Multifocal) and EDOF Lenses: These advanced lenses can focus on far, intermediate, and near distances at the same time. Most patients who choose these lenses do not need glasses while using a computer or reading a book.
Toric (Astigmatism-Correcting) Lenses: If you have astigmatism, standard lenses may not fully correct it. Toric lenses can correct astigmatism.
In some cases, the surgeon may plan one eye for distance vision and the other for near vision. This strategy may reduce dependence on glasses.

Does cataract return after cataract surgery?

Cataract is the loss of transparency of the eye’s natural lens. During surgery (phaco), this natural lens is completely removed and replaced with an artificial intraocular lens that will remain in the eye for life.
Therefore, after cataract surgery, it is technically not possible for the cataract itself to recur.
Artificial lenses do not become cloudy or undergo structural changes; therefore, the original cataract does not return.
However, after surgery, a condition may develop that causes complaints similar to cataract symptoms and is commonly known as "secondary cataract".
During surgery, the artificial lens is placed inside a thin, transparent capsule that was holding the natural lens in place. Over time, cells may grow behind this capsule and cause the membrane to lose its transparency and become cloudy.
This is not a recurrence of cataract, but clouding of the capsule. It may be seen in some patients within 2 - 5 years after surgery.
If "secondary cataract" develops, another surgical operation is not needed. Vision is cleared again with a procedure performed in outpatient clinic conditions that takes only a few minutes.