by
Mamisoa Andriantafika
Cataract surgery is the most commonly performed surgical procedure worldwide. It restores clear vision by replacing the cloudy lens with a customized artificial intraocular lens.
Cataract is a clouding of the natural lens causing loss of contrast vision, especially at night, and glare with bright lights. Cataract surgery involves removing the cloudy lens and replacing it with an artificial lens. This eliminates the vision loss caused by the lens opacity.
The most commonly used technique is phacoemulsification: the lens is fragmented by ultrasound and then aspirated through a micro-incision of less than 3mm. This minimally invasive technique allows for rapid recovery and excellent visual results.
Phacoemulsification eliminates vision loss caused by lens opacity.
Choosing the right lens is a crucial step in cataract surgery. It determines post-operative visual quality and dependence on glasses. Several types of lenses are available, each with its own advantages.
The monofocal lens is the most commonly used. It corrects vision at a single distance, usually distance vision. The patient will need glasses for reading and near activities. It is a reliable solution with excellent visual results.
It is possible to perform monovision: one eye is corrected for distance vision and the other for near vision. This technique requires good brain adaptation and is not suitable for all patients.
Monofocal lenses offer excellent visual quality at a chosen distance.
Multifocal lenses allow you to see far and near without glasses.
Multifocal lenses (bifocal or trifocal) allow vision at multiple distances: far, intermediate, and near. They significantly reduce dependence on glasses for most daily activities. They may cause nighttime halos in some patients.
EDOF lenses (Extended Depth of Focus) provide continuous vision from far to intermediate with fewer halos than multifocals. They are particularly suitable for active patients who use computers frequently. A slight near correction may be needed for prolonged reading.
Toric lenses correct corneal astigmatism in addition to cataract. They are available in monofocal, multifocal, or EDOF versions. Precise positioning is essential for optimal results.
Accurate astigmatism measurement is performed using corneal topography devices such as the Anterion or Pentacam, allowing selection of the most suitable toric lens.
Toric lenses correct astigmatism for clear vision without glasses.
A comprehensive assessment is performed to determine the lens power and detect any contraindications. It includes:
These examinations allow precise calculation of lens power and discussion of available options based on your visual needs and lifestyle.
The operation takes about 15 to 20 minutes under local anesthesia.
The operation is usually performed under local anesthesia as a day procedure: with anesthetic drops and possibly an injection of anesthetic around the eye. It takes about twenty minutes.
The main steps are:
Femtosecond laser assistance can be offered for certain steps (incisions, capsulorhexis, fragmentation), providing increased precision.
The patient is monitored throughout the first postoperative month:
Treatment with anti-inflammatory and antibiotic eye drops is prescribed for approximately 4 weeks. Visual recovery is generally rapid, with noticeable improvement within the first few days.
By choosing the best lens, it is possible to achieve vision without glasses.
As with any surgical procedure, cataract surgery may involve risks. However, it is one of the safest and most commonly performed surgeries in the world.
The most feared early complication (<1 month) is intraocular infection or postoperative endophthalmitis. It is rare, according to scientific publications estimated at approximately 0.05% or less. A prophylactic antibiotic injection into the eye is given at the end of surgery. The postoperative treatment must be followed strictly.
Nevertheless, if it occurs, it must be treated quickly. Other early complications are less threatening and your ophthalmologist will provide useful explanation.
Especially during the first week and up to the first month after surgery, if you experience pain with a red operated eye and significant vision loss, do not hesitate to contact your ophthalmologist urgently.
Intraocular infection is rare, but must be treated quickly.
Secondary cataract is a benign late complication treated by YAG laser.
Late complications are rare and the most common is posterior capsule opacification or secondary cataract. It occurs in approximately 10% of cases, generally around the second postoperative year.
The capsular bag may become cloudy and cause symptoms similar to cataract. The artificial lens remains clear but the bag containing it may become opaque. Treatment is quite simple: it involves opening the capsule at its posterior surface using a "YAG" laser which allows light to pass through again. The procedure is quick and painless.
Cataract surgery is a safe and effective procedure that restores clear vision. The choice of lens is personalized based on your visual needs, lifestyle, and eye condition.
Several types of lenses are available: monofocal for clear vision at one distance, multifocal or EDOF to reduce dependence on glasses, and toric to correct astigmatism.
A comprehensive preoperative assessment determines the best option for you. The most appropriate technique for your case will be chosen by your ophthalmologist surgeon after an in-depth discussion of your expectations.
The choice of lens is personalized according to your visual needs.
These explanations are not exhaustive and do not replace those of your ophthalmologist.
