Phacoemulsification has gained in popularity in recent years, and is now the preferred form of cataract removal. Although this procedure has been available to us for a long time, recent advances and refinements in machine and microsurgical instruments have made it safer and more effective than previously.
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. The best procedure for a patient is usually the one with which his or her ophthalmologist feels the most comfortable, since these variations of cataract surgery are all quite effective.
In a conventional surgery the incision required is larger (10-12 mm) and requires stitches for closing. This larger incision takes 6-8 weeks to heal. Moreover, the stitches can cause distortion of the normal curvature of the cornea (the clear part of eye) and thus lead to astigmatism and blurred vision because of this.
Essentially 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.