Cataract surgery at the Clinique Sainte-Geneviève (Paris 14)

The procedure is performed under local anesthesia: anesthetic drops instilled repeatedly into the eye, supplemented by light sedation for your comfort. No general anesthesia in the vast majority of cases. You remain conscious but relaxed, and feel neither pain nor contact: only the light from the microscope is perceived.

Building your surgical file

Between the decision-making consultation and the day of surgery, my assistant builds your surgical file. You receive three categories of documents to read, sign and keep:

• The quote: a detailed financial document specifying the cost of the procedure, the anesthesia, the clinic, as well as any out-of-pocket cost if you have chosen a premium implant. Full transparency before the decision. The reference figures are centralized on the Cataract fees page.
• The SFO information sheet: the information sheet from the Société Française d’Ophtalmologie, which constitutes the standard informed-consent document in France for cataract surgery. It describes the procedure, its expected benefits, its risks and its alternatives. Careful reading and signing are mandatory before the procedure.
• The prescriptions: a pre-operative prescription (dilating drops to be instilled on the morning of the procedure, according to the precise protocol provided with it) and a post-operative prescription (an antibiotic to prevent infection, an anti-inflammatory to control the local inflammatory response, and artificial tears in case of a feeling of dryness related to the procedure or to the prior asepsis).

Any question about these documents can be put directly to my assistant or raised in consultation. It is better to clarify a point beforehand than to leave with uncertainty.

The anesthesia consultation prior to surgery at the clinic

In accordance with French law (decree no. 94-1050), an anesthesia consultation is mandatory before any scheduled surgical procedure. For cataract surgery, it takes place at the Clinique Sainte-Geneviève, with an anesthetist from the team, ahead of the procedure (generally in the weeks beforehand).

During this consultation, the anesthetist:

• Collects your medical history, allergies, and current treatments (in particular anticoagulants, antiplatelet agents, beta-blocker eye drops).
• Assesses any comorbidities (cardiovascular, respiratory, diabetes) and the posture compatible with the procedure.
• Chooses the optimal anesthesia protocol: local anesthesia (drops) supplemented by light sedation for your comfort.
• Validates your fitness for anesthesia ahead of the procedure.

Practical point: the trip to the clinic for this anesthesia consultation is made by your own means: the transport voucher issued by the practice does not cover this journey, which precedes the procedure (see the Sick leave and transport voucher section).

Before the procedure: preparation

A few days before surgery, you receive the precise instructions:

• Instilling the dilating drops on the morning itself, according to the pre-operative prescription provided by the assistant. Generally three instillations 10 minutes apart before leaving for the clinic.
• Taking your usual medications, including anticoagulants if your cardiologist has approved it (anticoagulants are not stopped for a cataract under local anesthesia in the general case). Verification is done during the anesthesia consultation.
• Respecting the pre-operative fasting according to the anesthetist’s instructions: as light sedation is combined with the local anesthesia for your comfort, the fasting details are specified to you during the anesthesia consultation and must be followed scrupulously.
• Coming accompanied for the return home. Vision will be blurry for a few hours after surgery, and driving the same day is to be avoided.
• Usual hygiene: a normal shower, no eye makeup in the morning, no contact lenses if you wear them.
• Documents to bring: Carte Vitale, proof of supplementary insurance, signed quote, signed SFO sheet, prescriptions, ID.

The details of the work-up examinations carried out beforehand (biometry, topography, macular OCT) are recalled on the Cataract pre-operative work-up page.

The day itself: hour-by-hour timeline

• Arrival at the clinic: 1 to 2 hours before the procedure, for administrative check-in and settling into a room or outpatient bay.
• Preparation: verification of identity, the operated side, and signed documents. The dilating drops are supplemented if needed by the care team.
• Settling in the operating room: you lie on the operating table. Disinfection of the surgical field with diluted povidone-iodine (Betadine). Placement of a sterile drape and a small retractor on the eyelids so that you do not have to “force” the eye open.
• Local anesthesia: repeated anesthetic drops, supplemented by light sedation for your comfort. The eye becomes completely insensitive within a few minutes.
• The procedure itself: micro-incision, capsulorhexis (circular opening of the anterior capsule), phacoemulsification, aspiration, implantation. Duration 15 to 30 minutes.
• Immediate aftermath: a protective shield is placed over the operated eye. Return to the room, a snack, pressure check.
• Discharge: about 2 to 3 hours after check-in begins, with your companion.

How long does the procedure take?

The operating-room time itself (between the first incision and the final placement of the protective shield) is about 15 to 30 minutes per eye. This time varies according to the density of the lens (a very advanced cataract may require a little more phacoemulsification), the type of implant placed (toric implants require precise orientation in the capsule), and any anatomical particularities.

The total time spent at the clinic (from your arrival to your discharge) is, however, 2 to 4 hours, including check-in, preparation, the procedure, the immediate post-operative monitoring and the discharge file.

The first 24 hours

From the moment you leave the clinic, you will wear a protective shield over the operated eye, to be kept on the first night. Vision is blurry, sometimes with a milky veil, and there is some sensitivity to light. Sensations of grittiness or watering are normal and related to the passage of the instruments through the conjunctiva.

You begin the drops prescribed on the post-operative prescription: an antibiotic (infection prevention), a steroidal or non-steroidal anti-inflammatory (control of edema and the inflammatory reaction), and artificial tears if you feel a sensation of dryness (related to the procedure itself or to the Betadine asepsis used during the preparation of the surgical field).

Simple analgesics (paracetamol) are generally enough. Pain is almost absent in the vast majority of cases: this is one of the appreciated features of this surgery.

Recovery: the D+2 protocol at the practice

Two days after the procedure, you are seen again at the Cachan practice (or in Paris 13 depending on your scheduling) for the D+2 follow-up consultation: checking the intraocular pressure, examining that the implant is well positioned, confirming the absence of abnormal inflammation. The protective shield can then be removed.

The drops are to be continued according to the schedule provided (tapering over about 4 weeks). Other check-ups are scheduled at D+7, M+1 and M+3 if needed. The practical details of what to do and avoid, returning to work, sport and driving are developed on the Cataract post-operative recovery page.

Sick leave and transport voucher

As cataract surgery is a medically necessary procedure, it entitles you to administrative documents:

• Sick leave: I can issue you a sick-leave note suited to your occupation. The typical duration is 3 to 7 days for sedentary work (office, screen), and may be extended for a job exposed to dust, vibration, chemicals or sustained physical effort. The duration is discussed in consultation and adapted on a case-by-case basis. Unlike refractive surgery (LASIK, PRK, ICL, SMILE), which is elective surgery and does not entitle you to sick leave within the meaning of article L.323-1 of the French Social Security Code, cataract surgery is indeed a reimbursed and compensable procedure.
• Transport voucher: issued for the surgery day only, it covers the round trip between your home and the Clinique Sainte-Geneviève on the day of the procedure. It does not cover the post-operative consultations (D+2 at the practice, D+7, M+1) nor the anesthesia consultation held at the clinic beforehand: you travel to those by your own means (a relative’s car, public transport, taxi at your own expense).

Risks and complications: informed consent

Like any surgical procedure, phacoemulsification carries risks that it is essential to know about before committing. The vast majority are rare or transient, but I present them systematically in consultation out of a duty of honest disclosure.

• Endophthalmitis: a severe intraocular infection, the most feared complication. Its current incidence in phacoemulsification is estimated at fewer than 1 case per 1,000 procedures thanks to intracameral antibiotic prophylaxis and asepsis protocols. It occurs within the first few days and manifests as pain, a sudden drop in vision and a red eye: an absolute emergency.
• Cystoid macular edema (Irvine-Gass): a macular inflammatory reaction that can cause a drop in vision a few weeks after the procedure. Incidence on the order of 1 to 2%. It most often regresses with local and systemic anti-inflammatories.
• Post-operative retinal detachment: a rare complication (less than 1%), more frequent in highly myopic patients. It requires urgent surgical management.
• Intra-operative capsular rupture: a technical complication managed in the operating room, which may change the choice of implant or its placement.
• Secondary cataract (opacification of the posterior capsule): affects about 20% of patients within the 3 years following the procedure. Simple and generally painless treatment with the YAG laser. See Secondary cataract: YAG laser.
• Residual refractive error: a small optical correction may remain necessary after the procedure, particularly for reading if you have chosen a monofocal implant (a normal and expected situation).

Fees and reimbursement

The procedure and the standard monofocal implant are fully covered by the French Assurance Maladie and responsible supplementary insurers: the procedure, the anesthesia, the clinic, the follow-up consultations. Any fee supplements depend on your contractual sector and your supplementary insurance policy.

An out-of-pocket cost exists only if you opt for a premium implant (toric, EDOF or multifocal): the added cost of the implant is not covered by Social Security, and some supplementary insurers cover it partially. All the precise figures: Social Security base rates, any fee supplements, the specific cost of each type of EDOF implant, multifocal or toric implant, special cases such as diabetic cataract: are centralized on the Cataract fees page.

Frequently asked questions about the procedure

Sources

• Pershing S, Lum F, Hsu S, et al. Endophthalmitis after cataract surgery in the United States: a report from the Intelligent Research in Sight Registry, 2013-2017. Ophthalmology. 2020;127(2):151-158. PMID 31611015.
• Chu CJ, Johnston RL, Buscombe C, Sallam AB, Mohamed Q, Yang YC. Risk factors and incidence of macular edema after cataract surgery: a database study of 81 984 eyes. Ophthalmology. 2016;123(2):316-323. PMID 26681390. Incidence and risk factors of post-phaco cystoid macular edema.
• Lundström M, Dickman M, Henry Y, et al. Risk factors for refractive error after cataract surgery: Analysis of 282 811 cataract extractions reported to the European Registry of Quality Outcomes for Cataract and Refractive Surgery. J Cataract Refract Surg. 2018;44(4):447-452. PMID 29778108.
• Haute Autorité de Santé. Chirurgie de la cataracte chez l’adulte : recommandations de bonne pratique. HAS, 2018 (2024 update).

This content describes the standard pathway practiced at the Clinique Sainte-Geneviève. Each procedure is individualized according to your work-up and discussed during the pre-operative consultation.