Cataract Surgery by a Retina Surgeon

Choosing a retina surgeon for your cataract surgery offers a considerable advantage in terms of safety and quality of care. Dr Julien Gozlan, an ophthalmologist surgeon in Paris 16, combines expertise in cataract surgery and vitreoretinal surgery. This dual competence allows him to manage all intraoperative situations, including the most complex ones, and to offer combined procedures when the retina requires simultaneous treatment. This article explains why entrusting your cataract to a retina surgeon provides additional peace of mind, from complication management to the treatment of associated retinal conditions.

Why choose a retina surgeon for your cataract?

Cataract surgery is the most commonly performed procedure in France, with a success rate exceeding 99%. However, certain anatomical situations or associated conditions increase the complexity of the procedure. A retina surgeon masters not only phacoemulsification (the standard technique for lens extraction), but also the full range of vitrectomy and posterior segment surgery techniques. This dual expertise ensures an immediate capacity to adapt in the event of intraoperative difficulty, without requiring a delayed re-operation or transfer to another practitioner.

Optimal management of intraoperative complications

Posterior capsular rupture and vitreous prolapse

Posterior capsular rupture is the most feared intraoperative complication during cataract surgery. It occurs in approximately 1 to 2% of procedures and may be accompanied by vitreous prolapse into the anterior chamber. Faced with this situation, a retina surgeon has a perfect command of anterior vitrectomy: they can meticulously remove the prolapsed vitreous, avoid any traction on the peripheral retina, and implant the artificial lens under the best possible conditions, often in the ciliary sulcus. This expertise considerably reduces the risk of secondary complications such as retinal detachment, cystoid macular oedema, or endophthalmitis.

Dislocation of lens fragments into the vitreous

In rare cases, lens fragments may fall into the vitreous cavity during phacoemulsification. This situation typically requires a second procedure performed by a retinal surgeon. When your cataract surgeon is also a retina surgeon, they can perform a posterior vitrectomy during the same operative session, retrieve the dislocated fragments, and complete the lens implantation. The patient thus avoids a second anaesthetic, an anxiety-inducing waiting period, and prolonged inflammation.

Combined cataract and retina surgery: a major advantage

Many patients present simultaneously with a cataract and a retinal condition requiring surgical treatment. A retina surgeon can offer combined surgery (phaco-vitrectomy) in a single operative session, which represents a considerable benefit in terms of comfort and visual recovery.

Retinal conditions that can be treated at the same time

• Macular epiretinal membrane: membrane peeling can be performed immediately after cataract extraction, offering overall visual recovery within a single convalescence period.
• Macular hole: combined surgery avoids the secondary cataract that occurs almost systematically after vitrectomy in patients over 50.
• Retinal detachment: in certain indications, phacoemulsification combined with vitrectomy and tamponade allows complete management.
• Intravitreal haemorrhage: particularly in diabetic patients, combined surgery improves intraoperative visibility and accelerates visual rehabilitation.

By performing both procedures in a single session, the retina surgeon reduces the number of anaesthetics, the number of postoperative consultations, and the total duration of convalescence.

Superior preoperative retinal assessment

Before any cataract surgery, a comprehensive retinal examination is essential. A retina surgeon personally interprets the OCT (optical coherence tomography), OCT angiography, and, where necessary, fluorescein angiography. This expert interpretation enables the detection of retinal abnormalities that may sometimes be masked by the cataract itself: age-related macular degeneration (AMD), diabetic retinopathy, subclinical macular oedema, or peripheral retinal tears. The choice of intraocular lens, biometric calculation, and surgical strategy are thereby tailored with optimal precision, taking into account the patient's actual retinal status.

Management of complex cataracts

Certain cataracts carry an increased surgical risk: very dense cataracts (white or brunescent), zonular weakness (pseudoexfoliation syndrome, history of trauma), vitrectomised eyes, highly myopic patients, or patients with only one functional eye. In all these situations, the dual expertise of a retina surgeon provides an additional safety net. Mastery of vitrectomy instruments, capsular tension rings, secondary implantation techniques, and intraoperative retinal laser allows the procedure to be completed successfully even in the most challenging cases.

For patients with myopic tractional maculopathy or other associated vitreoretinal conditions, planning by a retina surgeon ensures a tailored strategy that avoids unexpected complications.

Enhanced postoperative follow-up

After cataract surgery, careful monitoring of the retina is essential, particularly in at-risk patients. A retina surgeon provides comprehensive postoperative monitoring including dilated fundus examination, macular OCT, and, where needed, the performance of intravitreal injections (IVT) in cases of postoperative macular oedema (Irvine-Gass syndrome) or recurrence of exudative AMD. This integrated follow-up, carried out by the same practitioner, ensures optimal continuity of care and an immediate response to any retinal complication.

FAQ: cataract surgery by a retina surgeon

Why choose a retina surgeon for a straightforward cataract?

Even though cataract surgery is a routine procedure, unpredictable complications can arise. A retina surgeon has the skills and equipment to immediately manage any intraoperative difficulty, including capsular rupture, vitreous prolapse, or dislocation of lens fragments. This expertise offers maximum safety, regardless of the complexity of your cataract.

What is combined cataract-vitrectomy surgery?

This is a single procedure during which the surgeon removes the cataract and then performs a vitrectomy to treat a retinal condition (epiretinal membrane, macular hole, intravitreal haemorrhage). This combined approach avoids two separate anaesthetics, reduces overall convalescence time, and optimises visual recovery by treating both problems simultaneously.

Is cataract surgery more painful when performed by a retinal surgeon?

No, the procedure follows exactly the same anaesthetic protocols, generally under topical anaesthesia (drops) or locoregional anaesthesia. The procedure is painless. The fact that your surgeon is also a retina does not affect operative comfort, but adds an additional layer of safety.

How long does visual recovery take after combined surgery?

Recovery depends on the retinal condition being treated. For combined cataract and epiretinal membrane surgery, visual improvement is gradual over 2 to 3 months. When gas or silicone oil tamponade is used, vision may be temporarily blurred until the tamponade is absorbed. Dr Julien Gozlan will give you precise information about the expected recovery timeline during the preoperative consultation.

Is cataract surgery reimbursed?

Cataract surgery is covered by the French national health insurance (Assurance Maladie) at the standard rate. Dr Julien Gozlan is a Sector 2 physician (may charge above standard rates), with any additional fees typically reimbursed by supplementary health insurance. A detailed quote is provided before the procedure so you can determine your potential out-of-pocket costs based on your supplementary insurance plan.

When can I resume driving and sport after the procedure?

Following straightforward cataract surgery, driving can generally be resumed within 48 to 72 hours of the procedure, once vision is sufficiently clear. Light sport is permitted after one week, and aquatic activities and intense physical effort after 3 to 4 weeks. In the case of combined surgery, these timeframes may be extended depending on the type of tamponade used.

Can a retina surgeon treat a secondary cataract?

Yes, secondary cataract (posterior capsule opacification) is treated by YAG laser capsulotomy, a quick and painless procedure performed during a consultation appointment. A retina surgeon systematically checks the retinal status before and after this laser treatment, which is particularly important in patients at retinal risk.

When should you consult Dr Julien Gozlan?

It is recommended to consult Dr Julien Gozlan, a retina surgeon in Paris 16, if you experience progressive vision loss or glare suggestive of a cataract, particularly if you are already being monitored for a retinal condition (AMD, diabetic retinopathy, epiretinal membrane, history of retinal detachment). Equally, if a colleague has identified a complex cataract or a particular surgical risk, the dual expertise in cataract surgery and vitreoretinal surgery guarantees comprehensive, safe, and personalised care within a single practice.

Further reading

• Vitrectomy: procedure and indications: everything you need to know about vitreoretinal surgery performed by Dr Julien Gozlan.
• Cataract surgery: technique, anaesthesia, postoperative course, and visual recovery after phacoemulsification.
• Macular epiretinal membrane: symptoms, OCT diagnosis, and surgical treatment by peeling.
• Ocular biometry: how intraocular lens calculation is optimised to achieve the best refractive outcome after cataract surgery.