Cataracts affect over 20 million people worldwide and are the leading cause of reversible blindness. Phacoemulsification has become the standard procedure for cataract removal. For a successful cataract operation, good equipment is needed including a surgical microscope, phacoemulsification machine, instruments, anesthesia or akinesia, and assisting staff. Key factors for a good microscope include coaxial illumination, focus, magnification, enhanced red reflex, centration, and foot pedals. The parameters of the phacoemulsification machine and foot switches must be understood. Certain patient characteristics are excluded for early cases, such as small or sunken eyes. Proper patient positioning of the head and protection of the eye are also important

1. Abdelmonem Hamed
Professor of Ophthalmology, Benha University

2. Do you know that?
 Cataract represents about
20 million people all over
the world
 Cataract remains the
leading cause of reversible
blindness (51%)
 Phacoemulsification
became the basic surgery
of cataract removal.

3. For successful cataract operation we
need Good
•Surgical microscope
•Phaco machine
•Instruments
•Anesthesia or Akinesia
•Assisting and circulating staff

4. For successful cataract operation we
need Good
•Surgical microscope
•Phaco machine
•Instruments
•Anesthesia or Akinesia
•Assisting and circulating staff

5. For successful cataract operation we
need Good
•Surgical microscope
•Phaco machine
•Instruments
•Anesthesia or Akinesia
•Assisting and circulating staff

6. For successful cataract operation we
need Good
•Surgical microscope
•Phaco machine
•Instruments
•Anesthesia or Akinesia
•Assisting and circulating staff

7. For successful cataract operation we
need Good
•Surgical microscope
•Phaco machine
•Instruments
•Anesthesia or Akinesia
•Assisting and circulating staff

8. The microscope
 Coaxial illumination
 Focus
 magnification
 Enhanced red reflex
 Centration
 Foot-pedal of microscope:

9. The microscope
 Coaxial illumination
 Focus
 magnification
 Enhanced red reflex
 Centration
 Foot-pedal of microscope:

10. The microscope
 Coaxial illumination
 Focus
 magnification
 Enhanced red reflex
 Centration
 Foot-pedal of microscope:

11. The microscope
 Coaxial illumination
 Focus
 magnification
 Enhanced red reflex
 Centration
 Foot-pedal of microscope:

12. The microscope
 Coaxial illumination
 Focus
 magnification
 Enhanced red reflex
 Centration
 Foot-pedal of microscope:

13. The microscope
 Coaxial illumination
 Focus
 magnification
 Enhanced red reflex
 Centration
 Foot-pedal of microscope:

14. Phaco machine
 The parameters of each
machine must be known
by the surgeon
 The surgeon must be
familiar with the foot
switch of each machine

15. Phaco machine
 The parameters of each
machine must be known
by the surgeon
 The surgeon must be
familiar with the foot
switch of each machine

16. Patient exclusion for 1st cases
 Lt. Eye !!
 Small eye
 Sunken eye
 Prominent forehead
 Deaf pt. (local anaesth.)
 Small pupil

17. Patient exclusion for 1st cases
 Soft nucleus grade +
 Nuclear cataract grade ++++
 Intumescent cataract
 Post polar cataract
 Mature cataract
 Pseudoexfoliation
 Topical or local
anaesthesia!!

18. Positioning the pt. head
 Put the Pt. chine up (pt. face
horizontal to the microscope)
 Tilt pt. head to prevent fluid
collection
 Use Superior approach (avoid
temporal one)
 Isolate lashes with eye drape
 Don’t open lids too much with
the speculum

19. Positioning the pt. head
 Put the Pt. chine up (pt. face
horizontal to the microscope)
 Tilt pt. head to prevent fluid
collection
 Use Superior approach (avoid
temporal one)
 Isolate lashes with eye drape
 Don’t open lids too much with
the speculum

20. Positioning the pt. head
 Put the Pt. chine up (pt. face
horizontal to the microscope)
 Tilt pt. head to prevent fluid
collection
 Use Superior approach (avoid
temporal one)
 Isolate lashes with eye drape
 Don’t open lids too much with
the speculum

21. Positioning the pt. head
 Put the Pt. chine up (pt. face
horizontal to the microscope)
 Tilt pt. head to prevent fluid
collection
 Use Superior approach (avoid
temporal one in the first cases)
 Isolate lashes with eye drape
 Don’t open lids too much with
the speculum

22. Positioning the pt. head
 Put the Pt. chine up (pt. face
horizontal to the microscope)
 Tilt pt. head to prevent fluid
collection
 Use Superior approach (avoid
temporal one)
 Isolate lashes with eye drape
 Don’t open lids too much with
the speculum !!

23. Eye sterilization with Betadine 5%

24. Eye lid degermation

25. Isolate eye lashes

26. Support your hand on pt. head during operation

27. Thank you