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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

Phacoemulsification

By Ian Andersen

history kelman
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
ophthalmology
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.

ophthalmologists
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)

cataract surgery
Cataract Surgery

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

cataract surgery1
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

cataract surgery2
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
cataract surgery3
Cataract Surgery

Two main types:

Phacoemulsification (Phaco)

Extra-capsular cataract extraction (ECCE)

In both types, an intraocular lens is inserted.

phacoemulsification1
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.
phacoemulsification2
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.

phacoemulsification3
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

preparation
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.
phacoemulsification4
Phacoemulsification

The Actual Thing!

Most Descriptive