Advanced Age Does Not Predispose to Intraoperative Complications Among High-Risk Cataract Surgeries

To examine whether advanced age predisposes to intraoperative complications among cataract surgery cohort preoperatively stratified as high-risk.

A retrospective analysis of 100 consecutive patients, 75 of which aged under 80 vs 25 of which aged 80 or above were analyzed for operation time, complication rates, postoperative best-corrected visual acuity (BCVA), and intraocular pressure. Secondary outcomes analysis focused on multivariable models on age and surgical outcomes adjusted for preoperative complication risk factors such as nuclear sclerosis severity, pseudoexfoliation, and intraoperative floppy iris syndrome (IFIS) and ocular comorbidities such as age-related macular degeneration and glaucoma.

Baseline variables for sex distribution, concomitant ocular and systemic comorbidities, nuclear sclerosis grade, pseudoexfoliation, BCVA, and IOP were comparable between the groups. None of the patients underwent anterior or posterior vitrectomy. No differences were observed in the rate of intraoperative floppy iris (IFIS) syndrome (17% vs 16%, P=1.000) and the use of surgical adjuncts such as iris hooks (1.3% vs 4.0%, P=0.439) between patients aged under 80 years and those 80 years or above. Postoperative BCVA at 1 week (0.33±0.35 LogMAR units vs 0.33±0.29 LogMAR units, P=0.962) did not differ between those aged under 80 years and 80 years or above. For patient age at surgery, correlation analysis revealed no associations with operation time (B: -0.09; 95% CI: -0.44 to 0.27; P=0.628), surgical challenge rate (B: 1.12; 95% CI: 1.00 to 1.27; P=0.073), or postoperative BCVA at 1 week (B: 0.004; 95% CI: -0.012 to 0.005; P=0.379). In multivariable analysis, patient age at surgery remained non-significant for operation time when adjusted for pseudoexfoliation and IFIS (B: -0.07, 95% CI: -0.43, 0.30; P=0.629). After adjustment for wet AMD and glaucoma, advancing age showed a trend towards worse 1-week postoperative BCVA, with each additional year corresponding to a 0.01 decline in LogMAR units (B: -0.01; 95% CI: -0.02, 0.00; P=0.051).

Advanced age should not be treated as an inherent risk factor or contraindication for cataract surgery in high-risk patients.