Visual outcome following cataract extraction in patients aged 90 years and older

To analyse surgical outcomes following cataract surgery in patients aged 90 years and older.

A retrospective case series of 78 patients aged 90 years or more (82 eyes) undergoing cataract extraction between 2000 and 2006 was performed. Age, sex, ocular comorbidities, surgical reports, preoperative and postoperative visual acuity (VA), and postoperative complications were recorded. A comparison of visual outcome between different ocular comorbidity groups was performed.

Average age was 91.8 years. The most common comorbidities were dry AMD (47.4%) and open-angle glaucoma (24.4%). No ocular comorbidity was found in only 22 patients (28.2%). Posterior capsular tear (8.5%) was the most prevalent operative complication.Overall VA improvement was 67.8%, whereas unchanged VA and VA worsening rates were 16.1% each. A total mean improvement of 0.63 logMAR was achieved (from preoperative 1.36 logMAR to postoperative 0.73 logMAR), whereas patients with no comorbidity achieved as high as 0.8 logMAR improvement (1.42-0.62 logMAR). Almost 17% of patients achieved uncorrected VA of 20/40 or better at day 7, compared to 7% preoperatively. Final VA of 20/40 or better was achieved in 25% of the patients. AMD patients showed lower final improvement rates and higher rates of unchanged VA, as compared to the no comorbidity and glaucoma group (statistically significant at day 7).

Overall, approximately 70% of very elderly patients can achieve VA improvement, which rises to 82% in those without ocular comorbidity. Although patients with AMD show less improvement and more unchanged VA outcome rates, 62.5% can still enjoy improvement in VA.