OPERATION PERFORMED: PHACO EMULSIFICTION with INTRAOCULAR LENS,

LEFT
PATIENT NAME: O.C.J
DATE OF OPERATION: September 12, 2017
NAME OF STUDENT: ADLAWAN, Vianca Marie Yzabel A.
ROLE: Student Scrub Nurse

PHACOEMULSIFICATION
Phacoemulsification is a 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 to maintain the anterior chamber.
INTRAOCULAR LENS
Intraocular lenses (IOLs) are medical devices that are implanted inside the eye to replace
the eye's natural lens when it is removed during cataract surgery. IOLs also are used for a type of
vision correction surgery called refractive lens exchange.
INSTRUMENTS:
1.) PHACO HANDPIECES AND TIPS
Typical phaco instrumentation consists of a phaco handpiece (which varies by
manufacturer and technology) and a phaco tip (which also varies). The phaco tip serves to both
deliver ultrasound energy and aspirate (ie, vacuum in material) from its open end. Surrounding
the phaco tip is the sleeve, which is often of a rubbery consistency. The sleeve allows for
irrigation around the tip, lowering the resulting temperature to avoid wound burns. Irrigation
typically exits the sleeve from side ports. The sleeve can be adjusted to expose the amount of
phaco tip the surgeon desires. The sleeve can act as a barrier to tip penetration into lens material.
2.) FOOT PEDAL
This instrument has a paddle-like tip to facilitate surface area contact within a groove.
Other instruments include choppers, such as the Seibel chopper which we often use. The Seibel
has a rounded tip, which avoids bringing any sharp edges potentially near the capsular bag. The
Seibel can also serve as a divide and conquer second instrument. The list of choppers is
immense, and your instructor can guide you to those available in your operating room.
Foot position 1: Irrigation only. Upon entering the eye, it is vital to maintain irrigation
when there is no viscoelastic in the anterior chamber. Failure to do so will allow fluid egress
through the open wound and collapse the chamber. This ensures chamber maintenance and less
fluctuation in intraocular pressure.
 Foot position 2: Irrigation and aspiration. In addition to irrigation, aspiration is applied at
the phaco tip. This vacuum force allows for lens material to be brought to the tip, and held there
upon occlusion of the tip with material.
Foot position 3: Irrigation, aspiration, and phacoemulsification. As above, the phaco
settings will determine in which manner the energy is delivered at the phaco tip. Regardless, foot
position 3 should be reserved for the emulsification of lens material, and thus should not be
entered unless there is lens material at the tip. Engaging position 3 without lens material can
deliver phaco energy to nearby structures, including capsule or iris, resulting in untoward
damage.
PROCEDURE:
During phacoemulsification surgery:
Two small incisions are made in the eye where the clear front covering (cornea) meets
the white of the eye (sclera). A circular opening is created on the lens surface (capsule). A small
surgical instrument (phaco probe) is inserted into the eye. Sound waves (ultrasound) are used to
break the cataract into small pieces. Sometimes a laser is used too. The cataract and lens pieces
are removed from the eye using suction. An intraocular lens implant (IOL) may then be placed
inside the lens capsule. Usually, the incisions seal themselves without stitches.
During standard ECCE:
An 8 mm to 10 mm incision is made in the eye where the clear front covering of the eye
(cornea) meets the white of the eye (sclera). Another small incision is made into the front portion
of the lens capsule. The lens is removed, along with any remaining lens material. An IOL may
then be placed inside the lens capsule. And the incision is closed.

OBSERVATION AND EXPERIENCE:

On our 2nd day (09-12917), we got to receive our first major case which involved the
procedure of Phacoemulsification together with the inserting of intraocular lens at the patient’s
(O.F.J) left eye. I was the assigned scrub nurse. Ienne and Calister were my circulating nurses. It
was a fun experience because I got to prepare the different instruments needed for the eye
surgery. The draping of the mayo table had another plastic cover since the operation was
associated with the use of water. During the procedure, Ienne and Calister were being given
trivia by the anesthesiologist. My only task during the procedure was to make sure that the eye
was irrigated with the prepared solution. He was also asking them questions related to the
anatomy and physiology of the eye, like its structure and the like. The procedure only took 15
minutes and the cleaning of the materials did not also take a lot of time.