Geriatric Cataract Surgery: A Comparative Study Of Middle-Old (75–84) And Old-Old (85+) Age Groups

The aim of our study is evaluation of clinical outcomes and factors affecting visual results in middle-old (75–84 years) and oldest-old (≥85 years) geriatric patient groups undergoing cataract surgery.

This retrospective study analyzed the medical records of 198 elderly patients who underwent cataract surgery between January 2019 and January 2025 at Sakarya University Training and Research Hospital, Turkey.

Patients were classified into two groups:

• Group 1: 99 patients (49 males, 50 females), aged 75–84 years
• Group 2: 99 patients (51 males, 48 females), aged ≥85 years 

The study examined various preoperative factors, including gender, systemic and ocular comorbidities, cataract type, presence of pseudoexfoliation and zonular weakness; pupillary dilation (PD) status; visual acuity (VA); and specular microscopy findings. Additionally, surgical challenges—including complications, the use of trypan blue dye (TBD), cumulative dissipated energy (CDE), and anesthesia type—were assessed. The impact of these factors on postoperative visual outcomes was also analyzed.

In Group 1 (78.5 ± 2.8 years) and Group 2 (88.3 ± 3.3 years) with similar gender distribution (p = 0.88), hypertension was the most common systemic disease. Neurological diseases were more frequent in Group 2 (p < 0.005). Age-related macular degeneration (p = 0.208) and nuclear cataracts were common in both groups, but white and brunescent cataracts were more frequent in Group 2. Group 2 had significantly lower endothelial cell counts (1651.03 ± 1239.7, p < 0.001 ), worse preoperative (0.107 ± 0.120, p < 0.001) and postoperative VA (0.557 ± 0.312, p < 0.001), also higher CDE levels (20.00 ± 17.09, p < 0.001). TBD was required more frequently in Group 2 (17 vs. 33, p = 0.009). Intraoperative complications were similar (p = 0.57).

Oldest-old patients (≥85 years) undergoing cataract surgery experienced greater surgical challenges and poorer visual outcomes compared to middle-old patients (75–84 years). They had lower endothelial cell counts, worse preoperative and postoperative visual acuity, increased use of TBD, and higher CDE, indicating denser cataracts and greater surgical difficulty in this age group. Postoperative visual outcomes were significantly lower, largely due to the presence of ocular diseases such as age-related macular degeneration and neurological disorders. These findings underscore the importance of meticulous surgical planning and management to optimize visual outcomes in very elderly cataract patients.