BY IAN ANDERSEN PHACOEMULSIFICATION

HISTORY - KELMAN 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 Charles D. Kelman (May 23, 1930 – June 1, 2004)

OPHTHALMOLOGY Deals with the anatomy, physiology and diseases of the eye. Greek roots : ophthalmos and 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, 17 th and 18 th centuries. The first ophthalmic surgeon in G.B. was John Freke, who was so good, that his skill legitimized the field.

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

CATARACT SURGERY Removal of the lens of the eye (also called crystalline) that has developed opacification, called a cataract. Opaque – Not transparent or translucent, impenetrable to light 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.

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 SURGERY Two main types: Phacoemulsification (Phaco) Extra-capsular cataract extraction (ECCE) In both types, an intraocular lens is inserted.

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.

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.

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 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.

PHACOEMULSIFICATION The Actual Thing! Most Descriptive

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