Phaco Cataract Surgery: How It Works, Step by Step

Medically reviewed by Dr. Fouad El Sayyad, Consultant Ophthalmologist — Cornea, Cataract & Refractive Surgery · Last reviewed: October 2026

Quick answer: Phaco (phacoemulsification) is the modern way of removing a cataract. Through a small incision of about 2.2 mm, an ultrasound probe breaks the cloudy lens into tiny pieces and gently removes them, and a foldable lens implant is placed inside the eye. I perform phaco on the Alcon Centurion; the operation usually takes about 10–15 minutes and the incision seals on its own.

Key Takeaways

• Phaco uses high-frequency ultrasound, not a laser, to remove the cataract.
• The incisions are small and usually seal without stitches.
• The operation usually takes about 10–15 minutes, and you go home the same day.
• A foldable lens implant is placed inside the natural lens capsule, where it stays permanently.
• Some eyes are more complex, such as very dense cataracts or small pupils; careful planning makes these safer.

What Is Phaco Cataract Surgery?

Phacoemulsification, usually called phaco, is the standard technique for cataract surgery worldwide. “Phaco” refers to the lens, and “emulsification” to breaking it into tiny pieces. A fine probe vibrates at ultrasound frequency, breaks the cloudy lens inside its capsule and suctions it out at the same time. Because the lens is removed in small pieces, the incision can stay very small.

Is Phaco the Same as Laser Cataract Surgery?

No, although many patients think so. Phaco uses ultrasound energy, not a laser. Femtosecond laser-assisted cataract surgery uses a laser for a few early steps, but it does not remove the cataract: you still need an incision and phaco to take out the lens and place the implant. I do not use the laser routinely, because it adds time to the surgery and, for most patients, does not add a real benefit. A large randomised trial in The Lancet (FEMCAT, 2020) found it was not superior to standard phaco surgery.

What Happens During Phaco Surgery, Step by Step?

1. Preparation: drops widen the pupil, and the anaesthetic is given: a local block around the eye, or numbing drops with extra anaesthetic inside the eye, with mild sedation if you are anxious.
2. Sterile preparation: the skin around the eye is cleaned and covered with a sterile drape, and a small clip keeps the eyelids open.
3. Small incisions: I make a main incision of about 2.2 mm at the edge of the cornea and a smaller side incision.
4. Opening the capsule: a protective gel fills the front of the eye, and I make a round, smooth opening in the front of the lens capsule (capsulorhexis).
5. Removing the cataract: the phaco probe breaks the cloudy lens into small pieces and removes them, leaving the thin capsule in place.
6. Cleaning: the remaining soft lens material is gently aspirated, so the capsule is clear.
7. Placing the lens implant: the foldable lens is injected through the small incision and unfolds inside the capsule. A toric lens is rotated to the planned position.
8. Finishing: the gel is removed, I check that the incisions are sealed, and a protective shield is placed over the eye.

The whole operation usually takes about 10–15 minutes. You may see lights and movement and feel light pressure, but you will not see the instruments.

What Are the Advantages of Phaco?

• Small incisions (about 2.2 mm) that usually seal without stitches
• Quick visual recovery, often within days
• Less induced astigmatism than older large-incision techniques
• Precise placement of modern lens implants, including toric, EDOF and trifocal lenses
• Day surgery, with most patients home within one to two hours

When Is Phaco Surgery More Complex?

Most cataract operations are routine, but some eyes need extra planning. I identify these at the examination before surgery:

• Very dense (hard) cataracts, which need more ultrasound energy; another reason not to wait too long
• Small pupils that do not widen well, including in patients taking tamsulosin for the prostate, now or in the past
• Weak lens support (zonules), for example in pseudoexfoliation or after eye injury
• Corneal disease or a weak corneal endothelium, where I protect the cornea carefully during surgery
• Previous LASIK, PRK or SMILE, which makes the lens calculation more demanding

“Phaco is a few minutes of surgery built on careful preparation. Knowing before the operation that a pupil will not dilate well or that a cataract is very dense lets me plan for it, and that is what keeps surgery calm and safe.” — Dr. Fouad El Sayyad

What Is Recovery Like After Phaco?

Most patients see more clearly within the first few days. You use an antibiotic drop for one week, a steroid drop for about four weeks with a taper, and lubricating drops for one to three months. Prayer and sujood are allowed from the second day. Keep water and soap out of the eye for one week, and avoid eye makeup and swimming for two weeks. Read the full instructions after cataract surgery and the recovery timeline.

What Are the Risks of Phaco?

Phaco is one of the safest and most successful operations in medicine, but no surgery is risk-free. Possible problems include inflammation, a rise in eye pressure, swelling of the cornea or the centre of the retina, infection and, rarely, a tear in the lens capsule or retinal detachment. Months or years later, the capsule behind the implant can become cloudy, which is treated with a quick YAG laser. Read about cataract surgery complications.

Where Is Phaco Surgery Performed?

I perform cataract surgery at the main Sayyad Eye Center branch in Mohandeseen, with the Alcon Centurion phaco system under ZEISS surgical microscopes. Consultations and follow-up are available at both branches. For the full picture, read the complete guide to cataract surgery and lens implantation.

How Much Does Phaco Cost?

See the cataract surgery cost guide.

What Patients Say (Google Reviews)

Honestly, words cannot describe the professionalism of Dr. Fouad El Sayyad and his team, starting with the quick anaesthesia before the operation and the follow-up before and after surgery. My vision became 6/6 after I could barely see.

Google review · Sayyad Eye Center, Mohandeseen · 2025 · translated from Arabic

Where Does Dr. Fouad El Sayyad See Patients?

• Sayyad Eye Center, Mohandeseen (main branch, where cataract surgery is performed): 3A Gameat El Dowal El Arabeya St., Sphinx Square.
• Sayyad Eye Center, New Cairo: Medical Park 2, opposite New Cairo Court.

To book an appointment with Dr. Fouad El Sayyad, call or WhatsApp 01000088168.

Frequently Asked Questions

What are the complications of phaco cataract surgery?

Most patients have no serious problems. Possible complications include inflammation, raised eye pressure, swelling of the cornea or retina, infection and, rarely, retinal detachment. Later clouding of the capsule is common and treated with a quick YAG laser.

What is the difference between phaco and laser cataract surgery?

Phaco uses ultrasound to remove the cataract. Laser-assisted surgery uses a laser for a few early steps, but phaco is still needed to remove the lens. Studies show the laser does not give better results than standard phaco.

How long does phaco surgery take?

The operation usually takes about 10–15 minutes. Including preparation and a short rest, plan to spend about one to two hours at the centre.

Are stitches needed after phaco?

Usually not. The incisions are small and designed to seal on their own. A stitch is occasionally used if an incision needs extra support.

Is phaco surgery painful?

No. The eye is numbed with a local block or drops, and mild sedation can be given if you are anxious. You may feel light pressure during surgery and mild grittiness for a day or two afterwards.

Can phaco be done for a very mature cataract?

Yes, but a very dense cataract needs more ultrasound energy and more careful technique. This is one reason I advise surgery once a cataract affects your daily life, rather than waiting for it to “ripen”.

Why should I tell the doctor about prostate medicines?

Medicines such as tamsulosin, even if taken in the past, can make the pupil and iris behave differently during surgery. Knowing in advance lets me plan for it and keep the operation safe.

When can I see clearly after phaco?

Most patients notice clearer, brighter vision within the first few days. Vision continues to settle over the following weeks, and glasses, if needed, are usually prescribed after about a month.

This article is for general education and does not replace an eye examination. Treatment decisions depend on your own eye assessment.

References

• Miller KM, Oetting TA, Tweeten JP, et al. Cataract in the Adult Eye Preferred Practice Pattern. Ophthalmology. 2022;129(1):P1–P126.
• Schweitzer C, Brezin A, Cochener B, et al. Femtosecond laser-assisted versus phacoemulsification cataract surgery (FEMCAT): a multicentre randomised trial. Lancet. 2020;395(10219):212–224.