Except in special cases, we perform the surgery on an outpatient basis, that is to say, without hospitalisation. The patient stays about 3 hours at the clinic. We do not operate on the two eyes on the same day but at 8 to 15 days apart.
One hour before surgery, we dilate the pupil with eye drops. We apply anaesthesia by instilling anaesthetic eye drops. We ablate by fragmentation and then aspirate the lens through an incision that is 2 millimetres at most.
We then replace the lens with the intraocular implant, whose power we have calculated beforehand. We inject it folded and then unfold and settle it inside the eye. Thanks to local anaesthesia, the patient remains conscious during the whole procedure which lasts between 10 and 30 minutes.
The patient leaves the clinic after having a snack. The vision in the operated eye is blurry, but you can move around. However, please depart the clinic accompanied.
The cataract operation
We perform the procedure while the patient is on their back, in a sterile surgical setting and under a microscope. We consider cataract surgery a major surgical procedure because it involves incising the eye and extracting one of its internal elements, the lens.
Recovery of vision
The recovery of visual function after lens surgery with intraocular implantation is almost immediate since patients recover practically all of their final vision about 24 hours after surgery.
However, it is impossible to guarantee excellent vision without glasses, both for far and near. The results vary according to the significance of the initial visual defect and the limits of the surgical techniques we use. If the visual correction is insufficient, we can prescribe an optical correction or, failing that we can consider a further surgical enhancement.
The stability of the result
Whatever the technique used, the vision stabilises entirely between the first and the third month following the intervention. The result, once obtained, is final.
The various implants
Implants of different optical power replace the lens after extraction. The intraocular implant is a lens made of a transparent synthetic inert material, most often flexible, perfectly well tolerated by the eye and has an optical power that corrects aphakia (absence of crystalline lens) and myopia, hypermetropia and possibly associated astigmatism. These implants can also correct presbyopia at the same time.
The monofocal implant
This implant is the most classic type. A monofocal implant only corrects a single focal length. That is to say, a single distance of vision. This lens is the type most surgeons offer patients needing cataract surgery.
In general, we choose to favour vision from a distance and to reserve the wearing of glasses to near vision.
However, in some cases, especially in myopic patients who are accustomed to excellent near vision without correction, we can also correct the near vision by the implant leaving myopia that glasses can correct for distance.
It is also possible to achieve a far-reaching compromise by correcting one eye for far vision and the other for intermediate or near vision.
The multifocal implant for aphakic eye
The multifocal implant corrects presbyopia and other associated vision defects.
Presbyopia is a physiological phenomenon related to age. Presbyopia results in a decreased power of accommodation of the eye due mainly to changes in the lens. Accommodation is the mechanism that allows the eye to increase its refractive power to achieve close-up focus. Presbyopia appears between 40 and 45 years old and is complete by the age of sixty.
Surgery for presbyopia with lens extraction consists in correcting presbyopia, associated with or without another ametropia, by the placement of a multifocal or depth-of-field intraocular implant in place of the lens that we remove, that has a cataract or not.
The multifocal implant directs the light that crosses it over several focal lengths. The implant gives excellent vision over several distances: far, intermediate and close. With multifocal implants, your brain receives several images and neutralises the ones that are not useful.
Device manufacturers have made significant progress in the design of the multifocality of the latest generations of implants, improving performance and reducing secondary visual phenomena such as halos and glare. These phenomena can persist, however, especially in the first months after surgery. Driving at night can be more difficult.
We always make patients aware of this possibility beforehand so they can make their choice accordingly. Also, these implants have an additional cost compared to the monofocal implant.
The depth-of-field implant
The depth-of-field implant is an intermediary between the two previous implants, making it possible to restore distant vision and intermediate vision (for example, vision on the computer, or a television) with a reduced risk of visual phenomena. In contrast, near vision usually requires correction.
The extended field of view implant
This implant is a new optical concept that obtains excellent far and intermediate vision, and good near vision too. However, reading tiny characters requires correction. In contrast, visual phenomena (halos) are less frequent than with a conventional multifocal implant.
The toric implant
The toric implant corrects the astigmatism of the cornea, which is essential if we want to obtain a quality vision from far and near. Its use is particularly important when using a multifocal or depth-of-field implant if there is astigmatism of more than one diopter.