Challenges and clinical outcomes of cataract surgery in nonagenarians
First Author: PeterMorgan-Warren UK
Co Author(s): Amit Patel
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With an ageing population, the burden of age-related ocular disease will form an increasing part of the ophthalmic workload. The purpose of this study was to evaluate the clinical challenges and visual outcomes of cataract surgery with intraocular lens (IOL) implantation in elderly patients over 90 years of age.
: Department of Ophthalmology, Solihull Hospital, Heart of England NHS Foundation Trust, Birmingham, United Kingdom.
In this retrospective, interventional, non-comparative study, all patients over 90 years of age undergoing cataract surgery with IOL implant during a 7 month period (December 2012 to July 2013, inclusive) were identified from the operating theatre logbook. Clinical records were reviewed for pre-operative ophthalmic status, surgical details and post-operative clinical outcomes. Statistical analysis was descriptive.
A total of 1570 cataract operations were undertaken during the study period, and 58 eyes of 55 patients over 90 years of age were identified, accounting for 3.7% of the surgical caseload. The mean (±SD) age of patients was 92.1±2 years (range 90-99 years), with 41 (71%) female and 17 (29%) male. Ocular co-morbidity was present in 38 (66%) eyes, most commonly age-related macular degeneration (n=26, 45%) and glaucoma (n=12, 21%). Systemic alpha adrenergic blockers were taken by 5 (9%) patients. Mean pre-operative corrected distance visual acuity (CDVA) was 0.72±0.48 LogMAR (approximately 6/30 Snellen, range 0.3-2.7) and post-operative CDVA 0.32±0.38 LogMAR (approximately 6/12 Snellen, range -0.1-2.3). CVDA improved in 51 (88%), remained the same in 1 (2%), decreased in 2 (3%) and was unknown in 4 (7%) eyes. Post-operative CVDA was 0.3 LogMar or better in 40 (69%), with 14 (24%) seeing poorer than 0.3, of whom 12 had documented ocular co-morbidity. Intraoperative floppy-iris syndrome was noted in 4 (7%) cases, all associated with alpha blockers, and posterior capsule rupture occurred in 2 (3%) eyes. Post-operatively, 8 (14%) eyes developed cystoid macular oedema requiring treatment. 11 (19%) cases required district nurse input to assist with post-operative medication.
Successful visual outcomes are possible in the majority of elderly patients over 90 years old undergoing cataract extraction with IOL implantation. Appropriate pre-operative assessment is important as ocular co-morbidity is common in this age group, and may limit the visual potential, and systemic medications such as alpha blockers may be associated with more technically demanding surgery. Elderly patients may require extra assistance for administration of prescribed post-operative topical medications. FINANCIAL INTEREST: NONE