Intraoperative complications during cataract surgery in the very old

To determine if there is a difference in intraoperative complications during cataract surgery in very old patients (> or = 88 years) compared with younger patients (< 88 years).

The records of 802 consecutive cataract operations were reviewed. Identical techniques of small-incision phacoemulsification were used in all cases. A total of 102 eyes were in patients aged 88 to 98, designated as the "very old." The remaining 700 eyes were in patients under 88, designated as "younger." The incidence of intraoperative complications in the 2 groups was compared.

Posterior capsule tears, vitreous loss, and loss of the nucleus were found as complications. Overall, these events occurred in 10% of the very old and in only 3% of those under age 88. Vitreous loss occurred in 7% of the very old and in only 1.6% of those under 88. There was 1 dropped nucleus in the very old. In the younger patients, 90.5% of eyes with complicated surgery achieved 20/40 visual acuity or better, but only 40% of complicated cases in the very old achieved this. Furthermore, 50% of complicated cases in the very old had visual acuity of 20/200 or worse, all directly attributed to surgical difficulties. Fifteen percent of patients in both groups had trabeculectomies with no influence on complications. We noted that 8% of the very old required pupil stretching compared with 2% of those under 88.

This study strongly suggests that very old patients (i.e., those 88 years and older) have a higher incidence of intraoperative complications during cataract surgery than younger patients. Furthermore, such complications may result in severe visual loss. These findings may have significance as the population ages.