To compare the visual outcome after cataract surgery in patients 85 years of age or older with those in other age groups.
This retrospective study included 313 eyes of 204 patients who underwent cataract surgery from April 2014 to March 2015 at Kangwon National University Hospital and were followed up or 3 months or longer. The patients were divided into groups A (86 eyes of 53 patients between 55 and 69 years of age), B (85 eyes of 53 patients between 70 and 84 years of age), and C (143 eyes of 98 patients 85 years of age or older), and the medical records of the patients were reviewed and analyzed.
The postoperative best-corrected visual acuity (BCVA) improved in 95% of group A patients, 87% of group B, and 81% of group C. When compared with the log MAR BCVA before and after surgery, the visual acuity after cataract surgery was improved effectively from 0.40 to 0.06 in group A, from 0.50 to 0.16 in group B, and from 0.75 to 0.31 in group C (
The ratio of visual acuity improvement was decreased among the patients over 85 years of age. Pre and postoperative visual acuities in group C were observed worse than in other groups. Additionally, the postoperative visual acuity was low. However, average visual acuity improved in 81% of patients. Therefore, cataract surgery should be strongly recommended for very old patients.
Baseline characteristics of patients
Characteristics | Group A | Group B | Group C |
---|---|---|---|
Number (patients [eyes]) | 53 (86) | 53 (85) | 98 (143) |
Age (years, range) | 62.3 ± 4.4 (55-69) | 75.1 ± 4.1 (70-84) | 87.1 ± 2.6 (85-98) |
Sex (male:female) | 33:20 | 18:35 | 44:54 |
Diabetes mellitus (%) | 12 (23) | 18 (34) | 21 (21) |
Hypertension (%) | 22 (42) | 34 (64) | 54 (55) |
Preoperative ECC (cells/mm2) | 2,710 ± 307 | 2,670 ± 296 | 2,637 ± 355 |
Surgical methods (PE/ECCE) | 85/1 | 84/1 | 142/1 |
Values are presented as mean ± SD unless otherwise indicated.
ECC = endothelial cell count; PE = phacoemulsification; ECCE = extracapsular catract extraction.
Ocular comorbidities
Eyes | Group A | Group B | Group C | |
---|---|---|---|---|
Diabetic retinopathy | 16 | 10 | 3 | |
Glaucoma | 4 | 6 | 9 | |
ARMD | 2 | 6 | 12 | |
Posterior synechiae | 2 | 0 | 2 | |
Corneal opacity | 1 | 1 | 0 | |
Granular corneal dystrophy | 0 | 2 | 0 | |
Bullous keratopathy | 0 | 0 | 1 | |
BRVO | 1 | 0 | 2 | |
CRVO | 0 | 0 | 1 | |
BRAO | 0 | 0 | 1 | |
CRAO | 0 | 0 | 1 | |
Retinal tear | 1 | 0 | 2 | |
Asteroid hyalosis | 0 | 2 | 2 | |
Optic atrophy | 0 | 0 | 5 | |
ERM | 0 | 0 | 1 | |
Macular hole Total | 027 | 0 27 | 1 43 | 0.958 |
ARMD = age-related macular degeneration; BRVO = branch retinal vein occlusion; CRVO = central retinal vein occlusion; BRAO = branch retinal artery occlusion; CRAO = central retinal artery occlusion; ERM = epiretinal membrane.
Post hoc analysis of ocular comorbidities
Group I | Group J | Mean difference (Group I and J) | Standard error | |
---|---|---|---|---|
A | B | −0.00369 | 0.07100 | 0.999 |
A | C | 0.01325 | 0.06334 | 0.978 |
B | C | 0.01695 | 0.06358 | 0.965 |
Preoperative and postoperative best corrected visual acuity (log MAR)
Group A | Group B | Group C | |||||
---|---|---|---|---|---|---|---|
Preoperative BCVA | 0.40 ± 0.47 | 0.50 ± 0.51 | 0.75 ± 0.62 | <0.001 |
|||
(−0.08~3.00) | (0.00~3.00) | (0.05~3.00) | |||||
Postoperative BCVA | 0.06 ± 0.19 | 0.16 ± 0.24 | 0.31 ± 0.29 | <0.001 |
|||
(−0.18~0.82) | (−0.18~1.22) | (−0.08~1.52) | |||||
<0.001 |
<0.001 |
<0.001 |
|||||
log MAR improvement | 0.34 ± 0.42 | 0.34 ± 0.45 | 0.44 ± 0.57 | ||||
(0.00~3.00) | (0.00~2.70) | (−0.82~2.78) | |||||
VA improvement (eyes, %) | 82/86 (95%) | 0.792 |
74/85 (87%) | 0.710 |
116/143 (81%) | 0.698 |
0.009 |
Postoperative BCVA ≥ 20/40, (eyes, %) | 77/86 (91%) | 0.384 |
72/85 (85%) | 0.295 |
96/143 (67%) | 0.522 |
<0.001 |
Values are presented as mean ± SD unless otherwise indicated. In each group, pre- and postoperative BCVA were compared. Comparisons of pre- and postoperative BCVA, respectively, were also done among the 3 groups.
BCVA = best corrected visual acuity; VA = visual acuity.
Post hoc analysis of BCVA before and after cataract surgery
Mean difference (Group I and J) | Standard error | ||
---|---|---|---|
Preoperative log MAR | |||
A |
−0.10573 | 0.08404 | 0.454 |
A |
−0.35519 | 0.07498 | <0.001 |
B |
−0.24947 | 0.07525 | 0.005 |
Postoperative log MAR | |||
A |
−0.10103 | 0.03855 | 0.034 |
A |
−0.25342 | 0.03440 | <0.001 |
B |
−0.15239 | 0.03452 | <0.001 |
BCVA improvement (eyes, %) | |||
A |
0.08290 | 0.05152 | 0.276 |
A |
0.14230 | 0.04597 | 0.009 |
B |
−0.05940 | 0.04614 | 0.438 |
Postoperative BCVA ≥ 20/40 | |||
A |
0.04829 | 0.06171 | 0.736 |
A |
0.22402 | 0.05505 | <0.001 |
B |
0.17573 | 0.05526 | 0.007 |
BCVA = best corrected visual acuity.
Group I;
Group J.
Intraoperative complications
Eyes | Group A | Group B | Group C |
---|---|---|---|
PCR | 0 | 0 | 1 |
ZD | 3 | 0 | 3 |
Iris prolapse | 0 | 2 | 0 |
Total | 3 | 2 | 4 |
PCR = posterior capsular rupture; ZD = Zonular dialysis.
Postoperative complication
Eyes | Group A | Group B | Group C | |
---|---|---|---|---|
Corneal edema | 1 | 5 | 27 | <0.001 |
Increased IOP | 3 | 5 | 3 | |
Total | 4 | 10 | 30 | 0.002 |
IOP = intraocular pressure.
Factors influencing the visual acuity after cataract surgery
Factor | Group A | Group B | Group C | |||
---|---|---|---|---|---|---|
R |
R |
R |
||||
Age | 0.732 | −0.038 | 0.338 | 0.105 | 0.135 | −0.126 |
Sex | 0.974 |
0.725 |
0.412 |
|||
Diabetes mellitus | 0.687 |
0.381 |
0.303 |
|||
Hypertension | 0.902 |
0.799 |
0.829 |
|||
ECC | 0.230 | −0.139 | 0.118 | −0.180 | 0.472 | 0.072 |
Comorbidity | 0.062 |
0.071 |
0.261 |
|||
Intraoperative Cx | 0.035 |
0.550 |
0.814 |
ECC = endothelial cell count; Cx = complication.
Pearson's correlation coefficient;
Student
Factors influencing not to improve BCVA after cataract surgery
Eyes | Group A | Group B | Group C |
---|---|---|---|
Intraoperative complications | |||
Iris prolapse | 0 | 1 | 0 |
Postoperative complications | |||
Corneal edema | 0 | 0 | 8 |
Ocular comorbidities | |||
Glaucoma | 1 | 1 | 2 |
ARMD | 0 | 2 | 2 |
Granular corneal dystrophy | 0 | 1 | 0 |
Diabetic retinopathy | 0 | 1 | 0 |
BRVO | 0 | 0 | 1 |
CRAO | 0 | 0 | 1 |
Posterior synechiae | 0 | 0 | 1 |
Glaucoma + ARMD | 0 | 0 | 1 |
Total | 1 | 6 | 16 |
BCVA = best corrected visual acuity; ARMD = age-related macular degeneration; BRVO = branch retinal vein occlusion; CRAO = central retinal artery occlusion.