Phacoemulsification — usually shortened to “phaco” — is the modern gold-standard technique for cataract surgery. A fine ultrasound probe is used to gently break up the cloudy natural lens through a tiny self-sealing incision, and a foldable intraocular lens (IOL) is implanted in its place. At Suraj Eye Institute, phaco is the technique of choice for the great majority of cataract operations.

How Phaco Works — Step by Step

1. Anaesthesia

Most cases are done under topical anaesthesia (drops only) or sub-Tenon block. The eye is numbed completely; the patient is awake but feels no pain. General anaesthesia is reserved for paediatric cases or specific adult indications.

2. Incision

A 2.2–2.8 mm clear corneal incision is made at the edge of the cornea. The incision is shaped so that it self-seals when surgery ends — no stitches needed in most cases.

3. Capsulorhexis

A precise circular opening (typically 5.0–5.5 mm) is made in the front capsule of the lens. This window allows access to the lens nucleus and provides stable IOL placement at the end.

4. Hydrodissection

Balanced salt solution is gently injected to separate the nucleus from the capsule, allowing it to rotate freely.

5. Phacoemulsification

The ultrasound probe enters through the incision. The nucleus is divided into segments using “chop” or “stop-and-chop” techniques and emulsified with controlled ultrasound energy. The fragments are aspirated as they are broken down.

6. Cortical clean-up

Soft cortical lens material around the periphery is gently aspirated, leaving a clean, intact capsular bag.

7. IOL implantation

A foldable IOL — selected during your pre-op consultation (see choosing the right IOL) — is loaded into an injector and inserted through the same micro-incision. It unfolds inside the capsular bag and is centred precisely.

8. Closure

Visco-elastic material is removed and the incisions are hydrated to seal. No stitch is needed in standard cases. A protective shield is placed over the eye.

What You Will Experience

• Total time in the operating room: 15–25 minutes
• Total time at the hospital: approximately 2–3 hours
• Sensation during surgery: mild pressure, bright lights, vague colours and movement — no pain
• Eye patch: usually a clear protective shield only; you can open the eye later the same day
• Vision the next day: noticeably clearer for most patients

Recovery

• You return home the same day — cataract surgery is a day-care procedure
• Antibiotic and anti-inflammatory eye drops are prescribed for 4 weeks
• Avoid rubbing the eye, swimming, and dusty environments for 2 weeks
• Most everyday activities — walking, eating, reading, light work — can be resumed within 1–2 days
• Driving usually after the post-op review on day 1 or day 7, as cleared by the surgeon
• Final glasses prescription, if required, is given at 4–6 weeks

Risks and Safety

Modern phaco is one of the safest operations performed anywhere in medicine, with success rates well above 98%. We discuss the small risks honestly during your consultation:

• Posterior capsule rupture (<1%) — managed during surgery; may need IOL placement in the sulcus or scleral fixation
• Endophthalmitis — a rare infection of the eye (around 1 in 2,000 cases) — minimised by NABH-grade sterility, intracameral antibiotics, and our strict OT protocols
• Cystoid macular oedema — usually self-resolving or treated with drops
• Refractive surprise — minimised by accurate Anterion biometry
• Posterior capsule opacification (PCO) — common over months to years, treated easily with YAG laser capsulotomy

When Phaco May Not Be the First Choice

Although phaco is our default approach, in some situations manual small incision cataract surgery (MSICS) is safer or more practical:

• Very hard, brunescent or rock-hard cataracts where phaco energy would be excessive
• Severely compromised corneal endothelium
• Selected complex situations where a larger incision is preferable

This decision is made by the surgeon based on your specific eye — not on cost or convenience.

Frequently Asked Questions