Phacoemulsification (Phaco = lens, emulsification) or phaco as it is popularly called, is a technique where the lens is broken into small pieces, emulsified and then aspirated.The ultrasound energy is used to emulsify the cataract. A handpiece with quartz crystals is used to produce the ultrasonic energy which moves the tip of 0.9 to 1.4 mm size back and forth to hit and emulsify the cataract.
The whole procedure is performed through an incision size of 3.2 mm in the form of a self sealing tunnel which does not require any stitches for its closure. The "phaco probe" has both irrigation and aspiration through the 3.2 mm and a continuous flow of a balanced fluid goes into the eye and is aspirated out along with emulsified pieces of cataract. The lens has a nucleus in the center, surrounded by epinucleus and then cortex with "capsule" around it and a continuous round hole of approximately 5-6mm (the CCC or Continuous curvilinear CAPSULORRHEXIS) is made so that the phaco tip can directly come into contact with the nucleus to emulsify it.
Phacoemulsification has gained in popularity in recent years, and is now the preferred form of cataract removal. Although this procedure has been available to us for a long time, recent advances and refinements in machine and microsurgical instruments have made it safer and more effective than previously.
The technique of phacoemulsification utilizes a small incision. The tip of the instrument is introduced into the eye through this small incision. Localized high frequency waves are generated through this tip to break the cataract into very minute fragments and pieces, which are then sucked out through the same tip in a controlled manner. A thin 'capsule' or shell is left behind after cleaning up of the entire opaque cataract.
The incision size for phacoemulsification is approximately 3.0 millimeters in width. If a lens implant that can be folded is used following removal of the cataract, this incision may not have to be enlarged. If a lens is used which cannot be folded, the incision must be enlarged to 5.0 or 5.5 mm.
Implantable Contact Lens (ICL)
The incision (wound) required for phacoemulsification is small (3 mm) and the wound construction is such that it is self-sealing. Therefore a surgery in which a foldable lens has been implanted through the small 3 mm wound, generally does not require any stitch, as it is watertight. The surgeries in which the wound has been enlarged (5 or 5.5 mm) to put a lens that can not be folded, is likely to require one stitch, because the wound is larger.
In addition, some surgeons simply prefer the safety of having the incision sutured, even if the incision is already watertight. The best procedure for a patient is usually the one with which his or her ophthalmologist feels the most comfortable, since these variations of cataract surgery are all quite effective.
Eye-Drop Anaesthesia For Phaco
Anaesthetic eye drops are used prior to the procedure to numb the eye. Sometimes a diluted 1% lidocaine is irrigated into the anterior part of the eye to numb the sensitive iris in case the phaco tip touches it. Since phaco is a short time painless procedure and there is very little handling of the eye, this no-injection eye drop anaesthesia is enough for a total comfort of the patient.One should also remember that eye drop anaesthesia is safer than injection which can cause complications like drug reaction and perforation of the eye.
The No-Stitch Phaco
Phacoemulsification is done with a thin probe which can enter the eye through a 3.2 mm incision. This incision is made in such a manner that a small tunnel is formed with a length of approximately 2.5 mm. The configuration of the tunnel is such that it closes when the eye pressure is increased and so does not need any stitch to keep it closed.
Best Time For Phaco Cataract Surgery
Today the lifestyle of every person is such that eyes are used extensively for reading/writing/driving during day and night/ watching television etc. and cataract surgery has become very patient friendly. The recovery is quick and discomfort is minimal. Also as the cataract "matures", it becomes harder and difficult to emulsify with phacoemulsification. It is therefore, advisable to get the phaco-cataract surgery done as early as possible. Definitely when the person is able to read the top letter indicating cataract is sufficiently ready for operation.
Precautions Before & After Phaco Cataract Surgery
It is advisable to maintain proper hygiene and cleanliness. No cosmetics should be used on the eye or face. There are no dietary restrictions required before or after cataract operation. Dietary restrictions for other systemic diseases should be observed. Splashing water in the eye to wash it is not to be done. Face can be washed and head bath can be taken with the eyes closed.
Phaco Cataract Surgery In Diabetics
Control of blood sugar is essential. A post prandial blood sugar level of up to 180 mg % should be maintained before and after cataract operation.
Phaco Cataract Surgery In High Blood Pressure
Blood pressure control should be maintained with appropriate medications before/ during and after surgery.
Phaco Cataract Surgery In Other Diseases
Other diseases like Bronchial Asthma, Rheumatoid Arthritis, Dependance on steroids should be discussed and appropriate measures should be taken.
The Cold Phaco
New phacoemulsification probe produce less heat during ultrasonic vibration thus preventing heat induced damage to the incision and cornea. This can even be used without infusion sleeve through a smaller incision of 1 – 1.4 mm.
Micro- Incision Cataract Surgery (MICS)
Phacoemulsification through a smaller incision of around 1 mm with a sleeveless phaco tip and irrigation through a separate side port provides an advantage of speedy recovery, faster healing and lesser surgery induced astigmatism. The surgery involves insertion of a rollable lens of 5.5mm dia which can be inserted through 1.2 mm incision (The microincision).
Glaucoma (kala motia) is a chronic progressive irreversible optic neuropathy characterized by raised intra ocular pressure (IOP), optic nerve damage & corresponding visual field damage . The disease can be managed with regular annual preventive eye screening of intra-ocular pressure , Automated Visual Field and Ocular Coherence Tomography assisted monitoring of glaucoma defects Glaucoma is the most common cause of asymptomatic ,irreversible blindness in adult population and incidence and prevalence increases with aging Advanced stage progression is checked by regular treatment and a careful life long follow-up.
Glaucoma (kala motia) is the most common cause of irreversible blindness, asymptomatic until advanced stages. Issues in the management of Glaucoma are diagnosing the case at the earliest, even before any substantial structural damage has occurred. As IOP is the only recognizable and controllable cause hence assessing target IOP and controlling it to prevent any subsequent structural/ functional damage is the main stay of therapy. Newer imaging techniques help us provide information that is reproducible and free of inter-observer variability.
At Neeraj Eye Hospital, a comprehensive eye check up helps catch the disease in unsuspecting cases even before the person is aware of symptoms like frequent change of glasses, poor dark adaptation, headache mistaken to be migraine etc.
Laser Treatment For Glaucoma
We treated 54 eyes of 51 patients with refractory glaucoma by using contact transscleral Neodymium: YAG laser cyclophotocoagulation; 32 burns (7 watts during 0.7 second) were applied to each eye by positioning the anterior edge of the probe at 0.5 to 1 mm from the limbus. The mean preoperative intraocular pressure (IOP) was 33.7 mmHg and the mean postoperative IOP was 25.6 mmHg with a follow-up of five months. There was a decrease of IOP in 72.3% of the cases. The postoperative IOP was controlled (IOP < 21 mmHg) in 41.3% of the treated eyes.
Pain decreased in 6.7% of the cases that had no control of IOP and they could stop their medical treatment. During the follow-up period we observed neither early postoperative hypertonia nor phthisis bulbi. Three eyes had scleral perforations. Laser treatment can be repeated if necessary in no controlled IOP cases. We had less complications with the laser treatment than with cyclocryo application. We described the advantages of the contact probe used.
Automated Visual Field Test
Your visual field is everything that you see. An Automated Visual Field test evaluates your vision straight ahead (central) as well as your vision to the side (peripheral). This test is important in the diagnosis of many eye disorders, especially glaucoma.</p?
During this test, the technician will use computerized instruments to map out your visual field. Your pupils will not be dilated for this test. This test takes approximately 10-20 minutes per eye. An Automated Visual Field Test is also referred to as "Perimetry."
Diabetic retinopathy is an eye disease that's associated with long-standing diabetes .The longer a person has diabetes and poorly controlled the higher their chances of developing diabetic retinopathy .Prolonged periods of high blood sugar levels cause damage to the small blood vessels in the retina at the back of the eye. The retina is the film at the back of the eye, which receives light images and sends them to your brain. A healthy retina is essential for good vision.
We also use surgical procedures to repair retinal detachments. These procedures may be done in conjunction with LASER photocoagulation or cryopexy and pars plana vitrectomy. The type, size and location of the retinal detachment will determine which surgical approach eye surgeon recommends. In general, these surgeries can successfully treat most cases of retinal detachment although a second procedure is sometimes necessary.
• Well equipped air condition eye outdoor with day-care surgery facilities
• Electronic patient monitoring system
• Cashless hospitalization and treatment for all major health insurance companies and TPAs
• Free/Discounted eye health screening camps for schools, corporates & N.G.O.s ,Surgeries, medicines and glasses to less privileged class.
• We provide under one roof - Micro Incision Cataract Surgery, Glaucoma Surgery, Retinal Reattachment Surgery, Squint Treatment, Laser Treatment for Retinal Disease & Glaucoma
If there is a misalignment between the two eyes of a person, such that they appear to be looking in different directions, this condition is called squint. The misalignment could be greater in one direction of the gaze due to nerve palsy, or it may be in all directions. It’s important in all cases of squint, especially those among children, to have a thorough Eye check-up to eliminate any other cause of loss of vision.
Parents often notice the deviation of the eyes amongst children. It must be noted though newborns rarely have perfectly aligned eyes, and eyes take about 8-12 weeks to stabilize. A squint in children above the age of three month or wandering eyes needs attention and must be evaluated by an ophthalmologist because development of binocular vision could suffer the adults could be misaligned eyes or double vision.
Treatment Important objectives :
1.Preserve or restore vision
2. Straighten the eyes
3. Restore binocular vision
Not all patients need surgery most can be controlled with the help of glasses after careful refraction & exercises.
Squint surgery can be done in either one or both the eyes. It involves weakening or strengthening of the relevant muscles to restore the balance and coordination. In some cases with double vision, prisms may be added in the glasses to ease the symptoms.
Treatment for Squint
Listed below are the objectives, in order of importance, in any treatment of squint:
1. Preserve or restore vision
2. Straighten the eyes
3. Restore binocular vision
The primary focus is to treat any refractive error if it is leading to squint. Often, a correction of this refractive error may be all that is required to treat this condition, termed "accommodative squint". Next, the eyes are checked for the presence of amblyopia, which must be treated before any surgery for squint. The importance has to be communicated to parents as their cooperation is essential in such cases. Finally, squint surgery can be done of either one or both the eyes. It involves weakening or strengthening of the relevant muscles to restore the balance and coordination. In some cases with double vision, prisms may be added in the glasses to ease the symptoms.
Contact lens clinic offers specialised fittings required in cases of keratoconus with rose-k ,scleral and r.g.p. lenses.Contact lenses are miraculous pieces of plastic that allow you to see without glasses. In most cases, contact lenses are used as a substitute for glasses, allowing you to dispense with them. Contact lenses may also be used to treat certain eye diseases or may be used for cosmetic purposes to change the apparent color of your eyes.
It is very painful to see small children suffering from various eye ailments and equally satisfying to treat these children and to make them able to lead a normal visual life. For this we offer Ophthalmology surgery, ophthalmology treatment and pediatric ophthalmology surgery. In ophthalmology treatment and pediatric ophthalmology surgery we offer therapies for small child and that are relevant to pediatric patients.
Screening for eye problems should start at birth.we offer premature babies screening for retinopathy of prematuarity in nurseries as well in our hospital.we believe a preschool screening at about 3 -4 years of age will ensure early detection and treatment of refractive errors ,squint & other potentially blinding diseases treatment of squint should start at early age and carefull followup with glasses and at times surgery can improve eye coordination in a majority of children as well as adults.
There are certain diseases, congenital, hereditary or acquired ones that may lead to permanent partial or total loss of vision.
The aim is to provide optical aids to patients whose vision is poor and cannot be improved with spectacles, in order to maximize the use of their remaining vision. No electronic devices are used.
LASIK (Laser In Situ Keratomileusis) is the most advanced of all the refractive surgical procedures and is used to treat most refractive errors. First performed for vision correction in 1991, it combines the excimer laser with the first part of another procedure called Automated Lamellar Keratectomy, commonly referred to as ALK. Because of the excimer laser, this procedure has a high degree of predictability. In the first part of the procedure, a thin flap of corneal tissue is created and moved over as though on a hinge. Next, the computer driven excimer laser is used to reshape the underlying tissue. Finally, the surface layer is repositioned.
C3R is a disease of the eye where the front surface of the eye, called Cornea, becomes weak, leading to progressive thinning and stretching which gradually progresses. Gradually, the Cornea bulges forwards, leading to an irregular cone shape. This causes distortion and blurring of the image formed by the cornea. Usually this disease is bilateral, though the severity may vary between the two eyes.
Everyone’s vision can change with age. Some vision changes make it difficult for elderly to perform everyday activities. Many vision changes can be corrected. Some of these common vision changes can be corrected with glasses, contact lenses, Improved lighting and magnifying the content. To diagnose the vision problems, a checkup with qualified eye specialist is required for detailed examination and appropriate treatment.
A checkup is required by a qualified eye specialist for a detailed examination, intra-ocular pressure to detech glaucoma, diabetics, and annual examination.
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