EVOLUTION OF

PHACOEMULSIFICATION
BY DR.V.SAVITHA ., 1 ST YEAR OPHTHALMOLOGY
“CAT IN THE BAG METHOD”

• Charles D. KeLman

Butterfly net method:

• Enzyme- loosen zonules
• Manual vibrator on head- lens into AC
• Acetylcholine – constrict the pupil
• Latex Butterfly Net collapsable – mashed with needle- pull the lens
DRILLING OF CATARACT

1. Rotating device- with needle-eddy currents- disinsertion of iris

with hemorrhage.
2. E toothbrush – oscillating
3. Butcher shop meat grinder
4. Engraving tool- longitudinal motion
Disadvantages: endothelium damage due to movement of lens
 PUNCHING BAG AND KNIFE
• Punching bag:1.slow- move with knife.2.fast- enter bag but not move
• High acceleration – US
• Irrigation only and non longitudinal motion- high energy radiated and flaking
• Longitudinal motion at tip- dec. Radiation , disinsertion of iris,reduce flaking.
• Tip from ss steel to titanium
• tip- made of soft silicone sleeve- prevent overheating.
• US stroke Was small and dampen when cataract was pulled out
• Hand piece was heavy and held by 3 dimensional parallelogram.
1ST PHACO
• 1967- human,1st phaco- blind and painful eye who was
planned for enucleation.
• 1st nucleus in ac n then phaco,now phaco in pc with
nucleus removal in iris plane.
• Single handed encapsular phaco – Bimanual endocapsular
phaco.
• Vibration frequency -28,000 to 60,000 cycles per second.
• Less trauma and faster recovery time.
 OTHERS THAN US
1. Erbium yag Laser- 2.9um wavelength,dec thermal injury,no cooling sleeves needed.
2. Nd YAG laser-1064 nm,1.25 mm incision,Plasma formation,shock wave –
photolysis of lens.
3. Sonic phaco-no cavitational effect,no intermolecular friction,
4. Neosonix phaco-Along with US, low frequency,
5. White star technology –micropulse mode US ,less than the thermal relaxation time
of corneal tissue,no sleeve needed, irrigation through a second instrument with side
port.
6. CataRhex- Thro1 mm capsulorhexis with diathermy,rotatory impeller @ 60
kHz,intact capsule,capsular bag expansion.
7. Aqualase-pulses of BSS @ 50 to 100hz- dissolve cataract,prevent secondary pco.
REFERENCES

• Phako,phaconit and laser phaco ,2002- by Sunith ,Athiya ,Amar agarwal.

• Phaco surgery- 2005,by Rasik B Vajpayee
• Thank you