What anesthesia?
Most often, local anesthesia is sufficient for cataract surgery, i.e. a few drops of eye drops instilled into the eye just before the operation, which completely numb the eye. Cataract surgery is therefore painless and the patient does not really see what is happening during the operation. The premedication administered removes anxiety and provides a vague drowsiness for the half hour necessary for the surgery. In certain specific cases, general anesthesia is offered.
Does cataract surgery involve hospitalization?
Generally, the patient enters the same day as the cataract surgery operation. He will leave the same day after a few hours in outpatient surgery mode with a shell and a bandage on the operated eye.
This shell will be kept for a few days (or only at night depending on the case) and will only be removed a few times during the day, in particular to put in the essential eye drops post-operatively.
Sometimes a very short hospitalization until the next day is proposed for reasons of personal convenience (single person or relatives worried about returning home on the first day).
Description of cataract surgery
Cataract surgery is performed under a microscope, to allow for great precision in the procedures. The surgeon performs an extracapsular extraction: the opacified contents of the lens are removed through a 3-millimeter opening, without touching the posterior capsule of the lens. Before extracting the lens, the surgeon inserts an ultrasound probe into the capsule, which fragments and then aspirates the pieces of lens. Contrary to popular belief, the most modern cataract surgery is not performed using a laser but using ultrasound. This is called phakoemulsification, the most modern and efficient technique; because it has the advantage of requiring only a small opening, sutured by a single thread, or most often leads without a thread [self-sealing incision] which allows rapid visual recovery.
Phacoemulsification devices have continued to improve in recent years, becoming more and more manageable and more reliable.
More rarely, some cataracts do not allow the use of ultrasound: this requires a larger opening of the eye and several suture threads.
Once the lens is removed, the implant is then introduced into the posterior chamber. The placement of this implant (a type of intraocular lens) which replaces the extracted lens, is essential.
Cataract surgery: multifocal implants
Cataract surgery consists of replacing the crystalline lens with an implant to restore clear vision.
The first implants used were not multifocal but monofocal.
Today, monofocal implants are still sometimes fitted but they require the wearing of glasses to correct near vision.
Some time ago, when operating on the eyes, it was necessary to choose between clear vision from a distance and wearing glasses for near vision, or clear vision from near which necessarily led to a reduction in distance vision.
Implants multifocal implantshave developed in recent years. The multifocal implant (or progressive implant), such as progressive lenses, provides excellent vision both at a distance AND near (without the need for glasses or lenses) with reduced side effects.
What is the implant?
This is a technique that has been used for about thirty years now and is perfectly mastered. The implant, an intraocular artificial lens, is the best optical solution because the implant is in the same place as the removed lens and it exactly compensates for the refractive role of this extracted lens.
There is no rejection or contraindications. In some cases, implantation may be impossible or contraindicated due to conditions discovered or appearing during the operation, and the surgeon may then decide not to perform it.
Currently, flexible acrylic or silicone implants are available that have the advantage of being able to be inserted into the folded eye without having to enlarge the incision. Implants can be suitable for almost all patients.
Today, due to the increase in the number of cataracts operated on earlier, the lifestyle of seniors is more demanding (travel, sports, driving, various jobs), the quality of vision becomes essential. It is therefore important to choose an implant that provides the best visual comfort, without discomfort related to light, and better sensitivity to contrast during the day and at night.
The exact calculation of the power of this implant determined by ultrasound of the eye and biometry will sometimes make it possible to correct myopia or hyperopia existing prior to the cataract.
The problem of choosing an accommodative implant that will also compensate for presbyopia is now increasingly common, which is new because just a few years ago it was necessary to choose between clear vision from afar OR clear vision up close.
