phacoemulsification

• 水晶体乳化

　

WordNet

1. extracapsular surgery for cataracts in which ultrasonic sound breaks the cortex and nucleus of the lens into small fragments that are then vacuumed away through a small tube

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/06/26 16:05:06」(JST)

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Phacoemulsification
Intervention
Phacoemulsification: Cataract surgery, by a temporal approach, using a phacoemulsification probe (in right hand) and "chopper"(in left hand), being done under operating microscope at a United States Navy medical center
ICD-9-CM	13.41
MeSH	D018918

Phacoemulsification refers to modern cataract surgery in which the eye's internal lens is emulsified with an ultrasonic handpiece and aspirated from the eye. Aspirated fluids are replaced with irrigation of balanced salt solution, thus maintaining the anterior chamber, as well as cooling the handpiece.

Etymology

phaco- (< Gk phako-, comb. form of phakós lentil; see lens ) + emulsification

Preparation and precautions

Being a delicate organ, the eye requires extreme care before, during and after a surgical procedure. An ophthalmologist must diagnose a cataract and conduct or supervise the operation. University programs typically allow patients to specify if they want to be operated upon by the consultant or the resident or fellow.

Proper anesthesia is a must for ocular surgery. Topical anesthesia is most commonly employed, typically by the instillation of a local anesthetic such as tetracaine or lidocaine. Alternatively, lidocaine and/or longer-acting bupivacaine anesthestic may be injected into the area surrounding (peribulbar block) or behind (retrobulbar block) the eye muscle cone to more fully immobilize the extraocular muscles and minimize pain sensation. A facial nerve block using lidocaine and bupivacaine may occasionally be performed to reduce lid squeezing. General anesthesia is recommended for children, traumatic eye injuries with cataract, for very apprehensive or uncooperative patients and animals. Cardiovascular monitoring is preferable in local anesthesia and is mandatory in the setting of general anesthesia. Proper sterile precautions are taken to prepare the area for surgery, including use of antiseptics like povidone-iodine. Sterile drapes, gowns and gloves are employed. A plastic sheet with a receptacle helps collect the fluids during phacoemulsification. An eye speculum is inserted to keep the eyelids open.

Surgical technique

Phacoemulsification and replacement with intraocular lens

Before the phacoemulsification can be performed, one or more incisions are made in the eye to allow the introduction of surgical instruments. The surgeon then removes the anterior face of the capsule that contains the lens inside the eye. Phacoemulsification surgery involves the use of a machine with microprocessor-controlled fluid dynamics. These can be based on peristaltic or a venturi type of pump.

The phaco probe is an ultrasonic handpiece with a titanium or steel needle. The tip of the needle vibrates at ultrasonic frequency to sculpt and emulsify the cataract while the pump aspirates particles through the tip. In some techniques, a second fine steel instrument called a "chopper" is used from a side port to help with chopping the nucleus into smaller pieces. The cataract is usually broken into two or four pieces and each piece is emulsified and aspirated out with suction. The nucleus emulsification makes it easier to aspirate the particles. After removing all hard central lens nucleus with phacoemulsification, the softer outer lens cortex is removed with suction only.

An irrigation-aspiration probe or a bimanual system is used to aspirate out the remaining peripheral cortical matter, while leaving the posterior capsule intact. As with other cataract extraction procedures, an intraocular lens implant (IOL), is placed into the remaining lens capsule. For implanting a PMMA IOL, the incision has to be enlarged. For implanting a foldable IOL, the incision does not have to be enlarged. The foldable IOL, made of silicone or acrylic of appropriate power is folded either using a holder/folder, or a proprietary insertion device provided along with the IOL.

It is then inserted and placed in the posterior chamber in the capsular bag (in-the-bag implantation). Sometimes, a ciliary sulcus implantation may be required because of posterior capsular tears or because of zonular dialysis. Because a smaller incision is required, few or no stitches are needed and the patient's recovery time is usually shorter when using a foldable IOL.

History

Charles Kelman introduced phacoemulsification in 1967 after being inspired by his dentist's ultrasonic probe.

References

See also

• Eye surgery
• Africa Cataract Project

Resources

• A web site that contains a description and animation illustrating the phacoemulsification process
• A web site that contains information on Phacoemulsification training

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

• 1. 成人における白内障 cataract in adults
• 2. 細菌性眼内炎 bacterial endophthalmitis
• 3. 閉塞隅角緑内障 angle closure glaucoma

English Journal

• Fuchs' endothelial corneal dystrophy: a controlled prospective study on visual recovery after endothelial keratoplasty.

• Nielsen E1, Ivarsen A1, Kristensen S2, Hjortdal J1.
• Acta ophthalmologica.Acta Ophthalmol.2016 Dec;94(8):780-787. doi: 10.1111/aos.13126. Epub 2016 Jun 7.
• PURPOSE: To investigate the determining factors of vision and subjective outcome after Descemet's stripping automated endothelial keratoplasty (DSAEK) for Fuchs' endothelial dystrophy (FECD).METHODS: In a prospective study, 41 FECD patients who received DSAEK were compared to 40 cataract patients wi
• PMID 27273977

• Cataract surgery in patients with neovascular age-related macular degeneration.

• Kessel L1,2,3, Koefoed Theil P1, Lykke Sørensen T1,3, Munch IC1,3.
• Acta ophthalmologica.Acta Ophthalmol.2016 Dec;94(8):755-760. doi: 10.1111/aos.13120. Epub 2016 Jun 3.
• PURPOSE: To examine the outcome after cataract surgery in patients with neovascular age-related macular degeneration (AMD) treated with intravitreal anti-vascular endothelial growth factor (VEGF) injections in routine clinical practice.METHODS: We extracted information about patients recorded in ele
• PMID 27255691

• Impact of allergy and atopy on the risk of pseudophakic cystoid macular edema.

• Schaub F1, Adler W2, Koenig MC3, Enders P3, Grajewski RS3, Cursiefen C3, Heindl LM3.
• Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie.Graefes Arch Clin Exp Ophthalmol.2016 Dec;254(12):2417-2423. Epub 2016 Aug 24.
• PURPOSE: To assess the risk of pseudophakic cystoid macular edema (PCME) following cataract surgery in patients with allergies and/or atopic disorders.PATIENTS AND METHODS: Medical records of 3,850 consecutive eyes that underwent cataract surgery were retrospectively reviewed for prevalence of aller
• PMID 27553052

Japanese Journal

• トリパンブルー前囊染色施行,Torsional phaco使用白内障手術による角膜内皮への影響 (特集 第68回日本臨床眼科学会講演集(8))

• 臨床眼科 69(10), 1475-1479, 2015-10
• NAID 40020600496

• 下方で行ったサイヌソトミー併用トラベクロトミーの白内障同時手術の長期成績

• あたらしい眼科 32(4), 583-586, 2015-04
• NAID 40020460798

• Real-time intraocular pressure measurement during phacoemulsification in dogs <i>ex vivo</i>

• Journal of Veterinary Medical Science 77(6), 685-692, 2015
• NAID 130005085857

Related Links

• phacoemulsificationの意味 - goo辞書 英和和英

phacoemulsificationとは。意味や和訳。[名詞] 〔外科〕 水晶体超音波液化吸引(術)：白内障となった水晶体を超音波で破砕液化し吸引除去すること[手術]. (また phakoemulsification)[語源]phaco-〔＜ギリシャ語 phako-(phakós「レンズ ...

• Phacoemulsification - YouTube

phacoemulsification cataract surgery created using 3DsMax, Maya, Photoshop, After Effects, and Premiere Pro by Sara Egner, Josy Conklin, Matt Cirigliano, and Eric Small

Related Pictures

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リンク元	「超音波乳化吸引術」
拡張検索	「phacoemulsification and aspiration」

「超音波乳化吸引術」

　　[★]

英

phacoemulsification& aspiration, PEA

関

白内障

• 白内障手術の一方。現在主流の手技である。
• 水晶体の前嚢を切開し、超音波で破砕しながら吸引する方法である。
• 以前は、水晶体を水晶体嚢ごと摘出し、眼内レンズを挿入していた。

参考

http://homepage2.nifty.com/KatoEyeClinic/cat-ope.htm http://e-eyenet.ne.jp/dictionary/kensa/410/413/04-2/ http://www.cataract-g.com/surgery-kind/page2.html

「phacoemulsification and aspiration」

　　[★] 超音波水晶体乳化吸引術 PEA