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

Abstract

Purpose To analyse surgical outcomes following cataract surgery in patients aged 90 years and older. Methods 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. Results 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). Conclusions 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.

Clinical Outcomes of Cataract Surgery in Very Elderly Adults

“…The result was comparable with the results of several studies investigating the visual outcome of individuals aged 90 and older in recent years (Appendix S1). Three studies showed that approximately 70% of very elderly adults achieved improvement in visual acuity . One study demonstrated that visual acuity improved in 94% of individuals aged 90 and older .…”

“…The clinical outcomes of cataract surgeries in individuals younger than 90 have been reported in the literature, but data regarding clinical outcomes in very elderly adults are limited (Appendix S1). Three previous studies reported that approximately 70% of very elderly adults could achieve improvement in visual acuity after cataract surgery . Small sample size or short duration of follow‐up constrained these studies.…”

Impact of ocular comorbidities on visual function and quality of life in cataract and pseudophakic patients

“…U literature nailazimo das u te vrednosti u jednoj studiji 22% a u drugoj 63% [7,8]. Upoređujući rezultat rada sa podacima iz literature zaključuje se da postoji visok stepen poklapanja.…”

“…U jednoj studiji zastupljenost senilne degeneracije makule je 47,4% a primarnog galukoma otvorenog ugla 24,5%, a u drugoj zastupljenost senilne degeneracije makule iznosi 15,5%, glaucoma 35%, neproliferativne dijabetičke retinopatije 6% i miopije 24%. [8,9] Pacijenti koji su operisali kataraktu udruženu sa drugim oftalmološkim oboljenjem (senilna degeneracija makule, miopija, glaukom, neproliferativna dijabetička retinopatija i sl.) imali su značajno poboljšanje prosečne vidne oštrine u odnosu na prosečne preoperativne vrednosti.…”

“…Zaključak je da je operacija katarakte opravdana kod pacijenata sa lakom formom senilne degeneracije makule i da odlaganje može negativno uticati na ukupan kvalitet života pacijenata [6]. U drugoj sprovedenoj studiji pacijenti sa senilnom degeneracijom makule su posle operacije katarakte imali niži stepen poboljšanja vidne oštrine ili istu vidnu oštrinu u odnosu na pacijente sa primarnim glaukomom otvorenog ugla, ali ipak je evidentno da je 62,5% pacijenata sa senilnom degeneracijom makule imalo poboljšanje vidne oštrine [8]. Međutim, druga istraživanja govore da je udružen nalaz uticao da vidnu oštrinu 0,5 i veću ima manji procenat operisanih očiju sa udruženim nalazom u odnosu na operisane oči bez udruženog nalaza [10].…”