Cataract Surgery Outcomes In Nonagenarians

Advances in surgical techniques and increased life expectancy have made cataract surgery in the over 90s age group more common. Reports of surgical outcomes in the over 90s is limited. Our aim is to determine if cataract surgery in nonagenarians is beneficial.

Ophthalmology Department in Maidstone and Tunbridge Wells NHS Trust. 

Single centre, retrospective review of consecutive cases performed from April 2015 to January 2023. Primary outcome was proportion achieving best visual acuity (BVA) ≥6/12 (0.5 decimalised Snellen). Secondary outcomes were intra- and post-operative complications and adverse events. Demographic data included age, gender, ocular and systemic co-morbidities, surgeon rank, anaesthetic type.

919 cases were reviewed, mean age was 92 (SD 3.63) years. M:F= 1:1.5. Mean pre-operative BVA 0.29 (SD±0.18)(n=658), mean post-operative BVA 0.49 (SD±0.25)(n=493). Overall 74% had improvement in BVA, 52% BVA≥0.5, 5.01% BVA declined by ≥2 lines of Snellen. Consultants performed most (79%) cases. Most common ocular and systemic co-morbidities were glaucoma and ARMD, arterial hypertension, diabetes mellitus, malignant neoplasms. 1.1% of cases had intraoperative complications, all of which were PCRs, and postoperative complications occurred in 0.4% of cases. One case was performed under GA and the remaining were under LA (n=531).

Cataract surgery is generally safe and successful in nonagenarians and improves BVA in most cases. Common ocular co-morbidities, e.g. age-related macular degeneration and glaucoma limited the improvement in BVA in these patients.