Cataract Surgery in Very Old Patients: A Case-Control Study.

Area of Science:

• Ophthalmology
• Geriatric Medicine
• Surgical Outcomes

Background:

• Cataract surgery is increasingly performed in very elderly patients due to longer life expectancy and surgical advancements.
• Surgical outcomes in patients over 90 years old may be compromised, particularly when ocular comorbidities are present.

Purpose of the Study:

• To compare cataract surgery outcomes between very old patients (over 90 years) and a matched control group.
• To identify factors influencing visual acuity gain in very elderly individuals undergoing cataract surgery.

Main Methods:

• A retrospective case-control study involving 53 eyes of 53 very old patients (mean age 92.6) and 140 matched control patients (mean age 75.2).
• Matching was based on gender, and systemic and ocular comorbidities.
• Comparison of phacoemulsification energy (CDE), intraoperative floppy iris syndrome (IFIS) rates, and visual acuity gains (UCVA, BCVA) at postoperative day 30.

Main Results:

• Very old patients exhibited higher cumulative dissipated energy (CDE) and a greater incidence of intraoperative floppy iris syndrome (IFIS) compared to controls (p=0.01 and p=0.02, respectively).
• Postoperative visual acuity gains (uncorrected and best-corrected) were significantly poorer in the very old group at 30 days (p<0.001 and p=0.006, respectively).
• Age independently predicted poorer visual gain at 30 days, even after accounting for CDE and IFIS.

Conclusions:

• Cataract surgery in very old patients presents unique challenges, including higher nuclear density and increased IFIS rates, potentially requiring more experienced surgeons.
• Outcomes in this age group necessitate adjusted expectations for visual acuity recovery, emphasizing the independent impact of advanced age.