Special Hospital SVETI VID has introduced in Serbia the ultrasound cataract operation (phacoemulsification), a method present in the world’s ophthalmology since 1971 and today brought to perfection. Nowadays, the highest level of this surgery is present just here, in SVETI VID, giving to people of Serbia and from abroad the highest quality of surgery with big comfort in performing.
Phacoemulsification allows cataract surgery to be performed in the earliest stage of the disease, at the very onset of the first symptoms, instead of troublesome waiting for cataract to be mature. Waiting for cataract to be mature is actually passing through the dark period of ‘temporary blindness’.
This is unavoidable in the old classical surgical approaches that are still deep-rooted within the Serbian ophthalmology. Furthermore, mature cataract by itself is a risk of inducing possible complications – glaucoma, or inflammatory reactions due to the disintegration of altered human lens materials (uveitis), or it can create difficulties in discovering serious diabetic changes in the posterior segment of the eye, such as bleeding or retinal detachments.
It is not unusual that patients connect their loss of vision only with the cataract, without any idea of other possible causes, from the posterior segment, and that is why an early operation is of great importance.
It has been a very difficult and demanding task to explain to both the patients and the ophthalmologists here the advantages of ultrasound cataract surgery in comparison to an old approach still deeply rooted here, although not present in contemporary ophthalmology for decades.
Phacoemulsification means small incision surgery, today with an incision of less than 2 mm, the use of ultrasound power in emulsifying the lens material and aspiration, applying a foldable lens in the place of the capsular bag through a small incision, and therefore finishing surgery without stitches, except in children where stitches are demanded. The choice of the lens type depends on the case, special patient’s need, wish for correcting a refractive error or a special ophthalmic problem. Patients are particularly happy with the selection of multifocal implants, which provides comfortable far distance and intermediate vision, independent of glasses. A special advantage of multifocals is comfort in looking at the objects from every side with the same quality of a given picture, not as in multifocal spectacles which require an effort to find a picture under a certain angle.
The aim of refractive surgery to beat the presbyiopia has finally been achieved , mainly in presbyopic hyperopic patients.
For the patients with the damaged maculas, an intraocular lens with a blue filter is specially suggested for the protection against harmful blue light.
Quite opposite from the above, the old, classic approach requires a mature cataract, which means a completely blurred lens, with functional “blindness” prior to operation and a large incision, great mechanical trauma for the eye, many sutures at the end. That could lead to accompanying problems in some cataract cases combined with glaucoma, or diabetic changes posteriorly, or big changes in the macula, which mostly made “classic doctors “ to announce such cases as inoperable having fear of making the situation worse with the classical approach to surgery. Since there are an enormous number of combined problems in the eye, a safer surgical approach was required and that is why phacoemupsification was born.
The idea of a great innovator Dr Chareles Kelmman from 1967 of using ultrasound for cataract surgery became reality in 1971.
Developed countries began to realize that it was more expensive to treat the complications of the traditional surgery than to introduce a new method. The ultrasound cataract operation became the GOLD STANDARD in the official ophthalmology.
For beginners, however, even the most basic steps of performing this surgery are very difficult and might turn into a great disaster if done without close supervision by an experienced surgeon, which is a demand. But, unskilled surgeons are prone to take frivolously the high demands of the surgery and completely new technology, and blindly run into complications, without necessary knowledge.
The point is that refining and perfecting the surgical technique requires virtuosity in performing the surgery, and such skilled surgeons dictate the guidelines for modelling the technique. Therefore, owing to one of them, who has won special awards and merits for his contributions to modern ophthalmology, Prof. Dr Pavel Rozsival (who has also introduced the method in Serbia), we now have the opportunity to follow the phenomenal possibilities of the phacoemulsification. This method has already entered a new epoch of its existence, now with a completely new appearance and new instrumentation, with three different energy platforms integrated in one device, INFINITY.
Now we have three different types of probes, to be used in a specific case each. One is a completely new approach without the use of ultrasound – AQUALASE. Aqualase became a new term in refractive lens exchange procedures where ‘gentle lens rinsing’ is achieved by the water-jet phenomenon without a roughly mechanical impact. It is ideal for minimally blurred lenses or clear lens exchange in refractive corrective procedures.
The other two platforms are refined, more balanced ultrasound and neosonix-ultrasound and oscillatory energy in one platform, far more powerful in cases of ‘hard, mature’ cataracts, with an exceptional degree of control and shorter application of ultrasound energy.
This new technology requires a great knowledge of the phacoemulsification technique, experts in this method, and it currently exists only in the few leading world centers, performed by the best surgeons of great experience in phacoemulsification. One of them is Prof. Dr Pavel Rozsival and owing to him and Special Hospital SVETI VID, this top-quality surgery is here in Belgrade.