Evaluation of Visual Outcome after Cataract Surgery in Patients Aged 85 Years or Older

Min Jung Ji; Moo Sang Kim; Seung Jun Lee; Sang Beom Han

doi:10.3341/jkos.2016.57.2.214

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Ji, Kim, Lee, and Han: Evaluation of Visual Outcome after Cataract Surgery in Patients Aged 85 Years or Older

Original Article

J Korean Ophthalmol Soc 2016;57(2):214-220.

Published online: 7 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.2.214

Evaluation of Visual Outcome after Cataract Surgery in Patients Aged 85 Years or Older

Min Jung Ji, MD, Moo Sang Kim, MD, Seung Jun Lee, MD, Sang Beom Han, MD

Department of Ophthalmology, Kangwon National University School of Medicine, Chuncheon, Korea

Address reprint requests to Sang Beom Han, MD Department of Ophthalmology, Kangwon National University Hospital, #156 Baengnyeong-ro, Chuncheon 24289, Korea Tel: 82-33-258-9210, Fax: 82-33-258-2296 E-mail: m.sangbeom.han@gmail.com

Received 3 July 2015 Revised 3 September 2015 Accepted 20 November 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To compare the visual outcome after cataract surgery in patients 85 years of age or older with those in other age groups.

Methods

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.

Results

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 (p < 0.001). In group C, preoperative and postoperative BCVAs were significantly worse than in other groups (p < 0.001 and < 0.001, respectively) and the ratio of patients with vision improvement and patients with BCVA of 20/40 or better was significantly lower than in the other groups (p = 0.009 and < 0.001, respectively).

Conclusions

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.

Keywords: Cataract surgery, Elderly patients, Old age, Visual outcome

REFERENCES

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Table 1.

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.

Table 2.

Ocular comorbidities

Eyes	Group A	Group B	Group C	p-value
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.

^* p-values were calculated using one-way analysis of variance (ANOVA). The one-way ANOVA was used to check if there is the difference of visual acuity after cataract surgery in accordance with ocular comorbidities among the three groups. Comparisons of patients with and without ocular comorbidities were done among the 3 groups.

Table 3.

Post hoc analysis of ocular comorbidities

Group I	Group J	Mean difference (Group I and J)	Standard error	p-value
A	B	−0.00369	0.07100	0.999
A	C	0.01325	0.06334	0.978
B	C	0.01695	0.06358	0.965

Table 4.

Preoperative and postoperative best corrected visual acuity (log MAR)

	Group A	p-value	Group B	p-value	Group C	p-value	p-value
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.

^* p-values were calculated using Pearson's chi-square test. The Pearson's chi-square test was used to check if the age have affected to improve visual acuity of each group. In each group, improved and not improved postoperative visual acuity were compared;

^† p-values were calculated using one-way analysis of variance (ANOVA);

^‡ p-values were calculated using Pearson's chi-square test. The Pearson's chi-square test was used to check if the age have affected the postoperative BCVA of each group. In each group, above 20/40 postoperative BCVA was compared a under 20/40 postoperative BCVA.

Table 5.

Post hoc analysis of BCVA before and after cataract surgery

	Mean difference (Group I and J)	Standard error	p-value
Preoperative log MAR
A^* and B^†	−0.10573	0.08404	0.454
A^* and C^†	−0.35519	0.07498	<0.001
B^* and C^†	−0.24947	0.07525	0.005
Postoperative log MAR
A^* and B^†	−0.10103	0.03855	0.034
A^* and C^†	−0.25342	0.03440	<0.001
B^* and C^†	−0.15239	0.03452	<0.001
BCVA improvement (eyes, %)
A^* and B^†	0.08290	0.05152	0.276
A^* and C^{†* †}	0.14230	0.04597	0.009
B^* and C^†	−0.05940	0.04614	0.438
Postoperative BCVA ≥ 20/40
A^* and B^†	0.04829	0.06171	0.736
A^* and C^†	0.22402	0.05505	<0.001
B^* and C^†	0.17573	0.05526	0.007

BCVA = best corrected visual acuity.

^* Group I;

^† Group J.

Table 6.

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.

Table 7.

Postoperative complication

Eyes	Group A	Group B	Group C	p-value
Corneal edema	1	5	27	<0.001^*
Increased IOP	3	5	3
Total	4	10	30	0.002^*

IOP = intraocular pressure.

^* p-values were calculated using one-way analysis of variance (ANOVA). The one-way ANOVA was used to check if there is the difference of visual acuity after cataract surgery in accordance with postopertative complication among the three groups. Comparisons of patient with and without postoperative complication were also done among the 3 groups.

Table 8.

Factors influencing the visual acuity after cataract surgery

Factor	Group A		Group B		Group C
Factor	p-value	R^*	p-value	R^*	p-value	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 t-test. The student t-test was used to check if there is the difference of visual acuity after cataract surgery in accordance with each factor. In each group, mean postoperative visual acuity with and without each factor were compared.

Table 9.

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.

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