• Phacoemulsification cataract surgery describes the breakdown and removal of a cataract by high frequency ultrasound.
• The ultrasonic waves are generated within a handpiece connected to a phacoemulsification unit. The handpiece is inserted into the cataractous lens via a small corneal incision and a circular incision within the anterior lens capsule.
• During the phacoemulsification procedure, fluid irrigation and aspiration is used to maintain the shape of the globe, to keep the tip of the handpiece cool and to remove the lens fragments.

Uses

• For removal of cataracts Cataract Cataract: acquired Lens: congenital primary cataract Lens: hereditary primary cataract.
• For removal of a subluxated lens Lens: luxation.
• For treatment of acute traumatic lens capsule rupture leading to phacoclastic uveitis Uveitis.

Advantages

• Phacoemulsification is a state-of-the-art technique which, in experienced hands, offers the best success rate for cataract surgery in dogs and cats.
• Following removal of the cataract, the lens capsule remains in place and an artificial intra-ocular lens (IOL) can be placed within the capsule to optimize visual acuity.
• Bilateral cataract surgery can be performed under the same anesthetic.
• When used for treatment of lens subluxation it gives a superior postoperative outcome to lendectomy (ICLE) Lendectomy.
• Lens capsule rupture often leads to severe and intractable complications such as uveitis and secondary glaucoma Glaucoma. Early phacoemulsification surgery is often successful in preventing these complications and saving vision.

Disadvantages

• Phacoemulsification is a specialist surgical technique. It is essential that the surgeon has extensive microsurgical experience and has undergone detailed training in phacoemulsification techniques.
• The use of an operating microscope and the correct microsurgical instrumentation and consumables are essential.
  Referral to a specialist ophthalmologist who is experienced in this technique is required.
• Owner and patient compliance are vital. Intensive post-operative topical and systemic medications are essential for the success of this procedure, and regular post-operative re-examinations are required.
• Postoperative complications may include wound breakdown, corneal ulceration Cornea: spontaneous chronic corneal epithelial defects (SCCEDs) , anterior uveitis, secondary glaucoma, retinal detachment Retina: detachment.

Alternative techniques

• Extracapsular cataract extraction (ECCE). This technique has been superseded by phacoemulsification.

Procedure

• 30-40 minutes per eye for an experienced surgeon.

Decision taking

Risk assessment

• Phacoemulsification can be performed on all stages of cataract, but there is a higher risk of complications in advanced (hypermature) cataracts, and some cataracts may become inoperable due to complications such as retinal detachment, severe uveitis or secondary glaucoma.
• Following a diagnosis of cataract, early referral to a veterinary ophthalmologist is advised, so that the surgical suitability can be assessed. This is especially important in the case of diabetic cataracts, which can progress rapidly to become inoperable.
• Owner and patient compliance are vital. Intensive post-operative topical and systemic medications are essential for the success of this procedure, and regular post-operative re-examinations are required.