Phacoemulsification of white cataract
Phacoemulsification (Phaco) is the most common technique used by developed countries. It involves the use of a machine with an ultrasonic handpiece equipped 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 (sometimes called a “cracker” or “chopper”) may be used from a side port to facilitate cracking or chopping of the nucleus into smaller pieces. Fragmentation into smaller pieces makes emulsification easier, as well as the aspiration of cortical material (soft part of the lens around the nucleus). After phacoemulsification of the lens nucleus and cortical material is completed, a dual irrigation-aspiration (I-A) probe or a bimanual I-A system is used to aspirate out the remaining peripheral cortical material.
White cataract. These two words strike fear in the hearts of phaco surgeons everywhere. Like any fear, the fear of the white cataract can be overcome through preparation and repeated exposure. There are six dangerous “monsters” to slay to successfully perform phacoemulsification of the white cataract. The task of conquering the white cataract becomes easier once you understand the dangers of each of the six monsters that stand between you and success, and the weapons that will slay each one.
Living and working on Saipan, an island in the South Pacific, about 25% of the people that I operate on have white cataracts. I have found that by addressing six distinct features of the white cataract, phacoemulsification can proceed smoothly and safely, and you can emerge the victor.