Rodman & Engelstein | Cataract Surgery

Phacoemulsification
Small Incision Cataract Surgery

A cataract is a cloudy or opaque lens. Inside the eye there is a lens which helps to focus the image on the retina so that vision is clear. If that lens gets cloudy or opaque, the image is no longer clear, vision is blurred, and glasses or contact lenses can not make the image clearer. In order to improve vision, the cloudy lens (the cataract) needs to be removed and replaced with a plastic lens (an intraocular lens implant or IOL) which restores clear vision.

Dr. Engelstein edited a medical textbook on cataract surgery which has been very popular in the United States, Japan and Latin America. This book was published in 1984 and describes the most modern cataract surgical techniques at that time. As surgical techniques have improved, Dr. Rodman and Dr. Engelstein have remained in the forefront, always using the most modern and safe procedures.

The best surgical technique for the removal of cataracts has undergone a gradual evolution. The goal has always been to get the hazy cataractous lens out of the visual pathway in as safe a way as possible. Doctors have sought for many years to keep the incision, the opening into they eye, as small as possible. Combining the notions of safety and small incisions, Dr. Rodman and Dr. Engelstein believe that the present state-of-the-art procedure is phacoemulsification.

Centuries ago, surgeons would simply push the cataractous lens into the back of the eye. This would clear the visual pathway, but the cataract would float around inside the eye and a thick magnifying spectacle was needed to restore the focusing ability of the eye.

More recently, the cataract surgeon would remove the entire cataract, including its envelope (capsular bag). The procedure worked quite well, however, an intraocular lens implant (IOL) could not be placed into the space formerly occupied by the natural lens.

The development of improved lens implants coincided with the evolution of extracapsular cataract surgery, which left most of the capsular “bag” of the natural lens in its normal position. Conventional ECCE involves making a semicircular incision into the eye. The hard central portion of the cataract (the nucleus) could then be expressed from the eye. The remaining cortical material could be aspirated from the eye leaving a clear capsular bag.

To increase safety and promote rapid healing, surgeons were attracted to another type of ECCE, involving a much smaller incision, called phacoemulsification. This technique involves the creation of only a 3 mm opening. An ultrasound probe is placed through this small incision, emulsifying the nucleus and aspirating it. During phaco, the eye volume is controlled by the infusion of fluid. This maintains the shape of the eye.

Another advantage of phaco is its small incision. Foldable implants can be inserted through the small phaco incision. Healing is faster than with a larger incision.

Small incision cataract rsurgery with intaocular lens implants is state-of-the-art care for the modern cataract patient.