- 17 Sep, 2024
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Phacoemulsification Training Course
Phacoemulsification Training Course
The “Phacoemulsification Training Course” is an introductory course designed
to provide a comprehensive understanding of the fundamentals of phacoemulsification surgery.
Phacoemulsification is a type of cataract surgery that uses ultrasound waves
to break up the cloudy lens of the eye, which is then removed by suction.
Phacoemulsification training courses typically include lectures, discussions,
and hands-on practice in a simulated laboratory setting.
The hands-on practice may involve using simulators that mimic the feel of real surgery or practicing on animal eyes.
There are different phacoemulsification training courses designed for various levels of experience:
– Beginners Phaco Surgery Course: This is a one-month course designed for surgeons
with no prior experience in cataract surgery.
The course typically starts with Extracapsular Cataract Extraction (ECCE) and Small Incision
Cataract Surgery (SICS) before proceeding to phacoemulsification.
– Basic Phaco Course: This is a two-week course designed for surgeons who already
have experience with ECCE/SICS. The course focuses on the fundamentals of phacoemulsification surgery.
– Advanced Phaco Course: This is designed for surgeons who are already confident in basic
phacoemulsification techniques.
The course focuses on teaching advanced techniques, such as those used for complex cataracts.
Purpose of the Phacoemulsification Training Course
The training course aims to provide a comprehensive understanding of the fundamentals
of phacoemulsification surgery.
By the end of the course, participants will know the key steps of the procedure,
the rationale for each step, the basic skills involved, and the possible complications of the surgery.
The phacoemulsification training course will also provide the learners with an overview
of the latest developments in modern cataract surgery.
Preparing for the Phacoemulsification Training Course
The first step in the phacoemulsification training course begins with Preparing for the Course
by Understanding the Surgical Environment.
First and foremost, essential equipment, such as the phaco machine, microscopes,
and monitors are introduced.
It is important to know how and what the machine is capable of and to familiarize how they integrate.
The rest of the lesson is usually a lecture on how to set up the machine,
the principles of phacoemulsification, the types of probes,
and the machine settings and parameters, which are important to know before setting
hands on the machine and the patient’s eye.
Phacoemulsification Training Course Curriculum
In the first section of the course, Trainers discuss one of the most important aspects
of phacoemulsification surgery, which is knowing and understanding the anatomy of the eye,
the different layers of the eye, which are the cornea, the sclera, the choroid, the retina, and the optic nerve.
Trainers explain how improper incisions made during cataract surgery can cut the major structures
of the eye, leading to severe complications such as retinal detachment.
During the training session is discussed the vitreous humor, its significance,
and how its removal with vitrectomy can provide much better visualization
of the posterior segment during vitreous surgery.
Topics covered in the Phacoemulsification Training Course include:
1- Anatomy of the Eye
The lens is located behind the iris and is composed of layers of anucleate, transparent cells called lens fibers.
The lens is unique in that it continues to grow throughout a person’s lifetime.
However, it becomes less pliable with age, so it is harder for the ciliary muscle
to change the shape of the lens to focus on close objects.
2- Instrumentation and Equipment
Phacoemulsification is usually performed in an operating room or an outpatient surgical facility.
The main requirements for instruments and materials include: the operating microscope
helps the surgeon to get a clear view of the structures of the front section of the eye.
The machine uses high-frequency ultrasound which vibrates the tip of the instrument inserted into the eye.
The tip of the phacoemulsification instrument is connected to tubing that removes fluid from the eye.
The fluid that is removed from the eye is replaced by a sterile salt solution that keeps
the front section of the eye inflated during surgery.
Because the incision is very small and self-sealing, stitches are not usually required.
At the end of the surgery, the salt solution is allowed to drain from the eye and the incision is left to heal naturally.
The phaco machine is quite sophisticated. It allows the surgeon to control the amount
of ultrasound energy that is used to break up the cataract.
This has made the surgery even safer than in the past, with less risk of complications,
the surgeon can address the individual needs for the particular cataract being removed.
3- Surgical Techniques
the first step of the surgical techniques is similar.
These procedures will involve creating an access into the anterior chamber to allow the surgical
instruments to pass through.
Subsequently, a circular opening in the anterior capsule is created and this allows
the cataractous lens material to be removed by the phacoemulsification technique.
Following the capsulorhexis step, the phacoemulsification machine can be used.
This machine uses an ultrasonic transducer that vibrates at high frequency and this vibration
will transmit to the phacoemulsification needle.
This causes a “jackhammer-like” motion, and this leads to the mechanical break-up of the nucleus
which requires less power and reduces the energy delivered into the eye.
During this stage, the fluid that irrigates the cornea will flow out and this flow
is being monitored by the machine as well.
After the removal of the cataract, an intraocular lens is implanted by the surgeon.
This lens is made of flexible material, most commonly silicone or acrylic.
Once the lens is in the eye, it will slowly unfold itself and rest within the capsule.
As the wound caused by the incision is self-sealing, stitches are not always necessary.
· Incision creation
The incision for cataract surgery is made at the junction between the cornea and the sclera,
and it is very important to understand the anatomy of the cornea and sclera.
The anterior chamber, created by the cornea and the sclera, is where the surgery takes place
Then a cystotome is introduced into the anterior chamber, and a puncture is made
on the anterior capsule of the lens, followed by a circular tear to create a continuous circular capsulorhexis.
The second step involves the creation of a central circular zone and a peripheral zone of the circular
capsulorhexis, and this circular zone is where the subsequent steps of the surgery will take place.
After that, the phacoemulsification proceeds with the emulsification of the nucleus
and aspiration of the cortical lens, and the last step is the insertion of the intraocular lens.
· Capsulorhexis
another surgical technique called capsulorhexis.
The anterior chamber, the front portion of the eye, is filled with a fluid called aqueous humor,
which is a clear, watery fluid that flows in and out of the eye, providing nourishment to the surrounding tissues.
To perform a successful phacoemulsification surgery, it is important to maintain
a stable anterior chamber for a better surgical view.
That is why a tiny incision is made at the edge of the cornea and then a viscoelastic
material is injected into the anterior chamber.
The viscoelastic material serves several purposes.
First of all, it helps to maintain the depth of the anterior chamber.
Also, it acts as a protective cushion for the corneal endothelium,
which is the innermost layer of the cornea, to prevent the cornea from swelling up during the surgery.
Last but not least, the viscoelastic material can disperse the pigment and the debris
created during the phacoemulsification process and hence maintain a clear view of the operation.
The round, thin, and elastic anterior lens capsule is very important in holding the lens implant in place.
Instead of removing the cataract by phacoemulsification first,
which is the older technique called extracapsular cataract extraction, in phacoemulsification,
the cataract is emulsified and aspirated after capsulorhexis is done at the beginning of the operation.
Capsulorhexis is said to be the most difficult part of mastering the technique of phacoemulsification.
It requires very good control of the forceps and the injection of the viscoelastic material
because any uncontrolled movement may lead to an irregular, off-centered,
or large anterior capsular opening.
· Phacoemulsification and aspiration:
An aspiration tool is used to suck the emulsified lens using a minimal amount of ultrasound energy.
Phacoemulsification is performed using a microscope and a machine that is composed of a console,
a foot pedal, and an applicator.
After the phacoemulsification, the cortical cleanup is performed.
The aspiration tool is used to remove the cortex present in the posterior wall of the lens.
· Intraocular lens implantation:
Most IOLs are made of a flexible, foldable material, not only the far but near distant visions
can also be corrected when a mono-focal.
Practical phacoemulsification training course
The practical training is the core of the Phacoemulsification Training Course.
It is designed to cover a wide range of knowledge, skills, and confidence in various aspects of phacoemulsification.
Before the practical training day, participants will be given a brief overview of the phaco room,
the phaco machines, the theatre layout, setting up the machine, and associated theatre equipment.
The practical training day will start from the very basic, such as setting up the microscope,
up to the more advanced practice, like quick chopping through the dense cataracts.
Each participant will have the chance to try different phaco techniques on the latest
soft cataract and the rock-hard cataracts practiced on the synthetic eyes, to experience the real-world situation.
After the synthetic eyes practice, there will be a further wet lab practical session,
where the participants will have the chance to practice on the animal eyes.
Troubleshooting and Complication Management
During the Phacoemulsification Training Course, we will discuss several strategies to prevent
this complication from occurring with various demonstrations on ways to engage
the occurrence of this complication as well as the management.
In this part of the course, participants will be taught some of the most common complications
that occur during cataract surgery and how to manage them effectively.
For instance, you might experience a sudden, severe drop in blood pressure,
possibly accompanied by a slowed heart rate.
This could be due to an acute intraoperative thrombosis or a vasovagal episode.
Advanced Phacoemulsification Techniques
Chapter three of the Phacoemulsification Training Course provides in-depth tutelage
on different but still advanced phacoemulsification techniques,
all aiming at guiding the prospective surgeons in choosing the best technique
that suits each particular case or patient.