Aspirated fluids are replaced with irrigation of balanced salt solution to maintain the volume of the anterior chamber during the procedure.

It is best suited to relatively soft cataracts, where the ultrasonic energy required is moderate, and insertion of foldable intraocular prosthetic lenses, which take advantage of the small incision possible.

The three purposes of irrigation are to maintain intraocular pressure, carry lens particles out of the eye in the aspiration system,and to cool the phaco handpiece.

[3] Sleeves for the phaco tip are standard accessories to insulate the wound surface from heat generated by the ultrasonic energy, and provide a route for irrigation.

General anesthesia is recommended for children, traumatic eye injuries with cataract, for very apprehensive or uncooperative patients and animals.

[citation needed] Either topical, sub-tenon, peribulbar, or retrobulbar local anaesthesia is used, usually causing the patient little or no discomfort.

The shape, position, and size of the incision affect the capacity for self sealing, the tendency to induce astigmatism, and the surgeon's ability to manoeuvre instruments through the opening.

[8] Ophthalmic viscosurgical devices (OVDs), also known as viscoelastics, are injected into the anterior chamber to support, stabilize, and protect the eyeball to help maintain eye shape and volume during the procedure, and to distend the lens capsule during IOL implantation.

[9] OVDs are used to protect the corneal endothelium from mechanical trauma and to maintain volume and form of the intraocular space during an open incision.

When done correctly, a CCC does not have any edge notches, and forces applied to the capsule during surgery are better distributed and less likely to result in a tear.

In some methods a second steel instrument called a "chopper" is used from a side port (auxiliary incision) to help with breaking the nucleus into smaller pieces.

[14] Other methods include bimanual twin instruments approaches for counter chopping, such as use of a cross-action cracking forceps, two modified cystotomes for middle prechop, the Fukasaku hydrochopping cannula, the Escaf ultrasonic ultrachopper, and the femtosecond laser.

These prechop techniques allow surgeons to bypass the sculpting and chopping steps to fracture the nucleus, but require additional special instruments.

The mechanical action of the blade is augmented by the vibrations to cut hard and fibrous nuclear material easily.

[12] When hydrodissection is used, the cataract's outer (cortical) layer is then separated from the capsule by a gentle, continuous flow or pulsed dose of liquid from a cannula, which is injected under the anterior capsular flap along the edge of the capsulorhexis opening.

Because a smaller incision is sufficient, no stitches should be needed, and recovery time is usually shorter when using a foldable IOL.

At the end of the procedure, OVDs that were injected to stabilize the anterior chamber, protect the cornea from damage, and distend the cataract's capsule during IOL implantation are removed from the eye to prevent post-operative viscoelastic glaucoma, a severe intra-ocular pressure increase.

[6] Other complications include failure to aspirate all lens fragments, leaving some in the anterior chamber;[23] and incisional burns caused by overheating of the phacoemulsification tip.

[28] Toxic anterior segment syndrome (TASS), a non-infectious inflammatory condition, may occur following cataract surgery.

[32] Swelling of the macula, the central part of the retina, results in macular oedema and can occur a few days or weeks after surgery.

[33] Uveitis–glaucoma–hyphema syndrome is a complication caused by the mechanical irritation of a mis-positioned IOL over the iris, ciliary body or iridocorneal angle.

[34] Other possible complications include Elevated intraocular pressure;[35] swelling or oedema of the cornea; displacement or dislocation of the IOL implant (rare); unplanned high refractive error—either myopic or hypermetropic—due to error in the ultrasonic biometry (measurement of the eye length and calculation of the required intraocular lens power); cyanopsia, in which the patient's vision tinted blue and often occurs for a few days, weeks or months after removal of a cataract; and floaters, which commonly appear after surgery.

[38] Patients should avoid driving for at least 24 hours after the surgery, largely due to possible swelling affecting focus, and pupil dilation causing excessive glare.

Restrictions against lifting and bending were intended to reduce the risk of the wound opening, because straining increases intraocular pressure.

[41] After full recovery, visual acuity depends on the underlying condition of the eye, the choice of IOL, and any long-term complications associated with the surgery.

Borderline or poor visual outcomes are usually due to pre-surgery conditions such as glaucoma, macular disease, and diabetic retinopathy.

[44] In a 2009 study in Sweden, factors that affected predicted refraction error included sex, preoperative visual acuity, and glaucoma, and other eye diseases.

Prediction error decreased with time, which is likely due to the use of improved equipment and techniques, including more-accurate biometry.

[52] A Cochrane Review of 42 trials seeking to compare the effectiveness of laser-assisted cataract surgery with standard ultrasound phacoemulsification found uncertain evidence suggesting benefits of one procedure over the other.

[53] A meta-analysis of more than 14500 eyes and 37 studies found no significant differences between the two techniques in terms of visual or refractive outcomes or overall complications.