Which type of cataract surgery: laser or ultrasound?

Conventional, ultrasound cataract surgery

The first part of the surgery is the creation of small, self-sealing incisions in the cornea (called “clear corneal incisions”) with a special knife. Through these the surgeon places the surgical instruments inside the eye and performs the surgery, removing the old lens, and introducing the new IOL. The old lens is held in place by a structure known as the capsular bag. The surgeon creates circular hole in the bag to (1) enable the removal of the old lens, and (2), hold the new IOL in place, inside the bag. The circular hole can be made manually, with the surgeon grabbing the bag, and tearing the circular shape.

For decades now, conventional cataract surgery has involved the use of ultrasound energy, delivered by the tip of one of the small surgical instruments, to break down the old lens (a process called “phacoemulsification”). The fragments of the old lens are then “aspirated” away – literally, sucked out. 

Risks involved

Manual cataract surgery is one of the most commonly performed surgeries in medicine. Still, this is delicate surgery, and is performed entirely manually – meaning that the surgeon requires a very steady hand. The greatest risks surround the creation of the hole in the capsular bag and the fragmentation of the old lens. In rare cases, such complications may even lead to retinal detachment and would require retinal surgery.