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

Nussinovitch, Hanan; Tsumi, Erez; Tuuminen, Raimo; Malyugin, Boris; Lior, Yotam; Naidorf Rosenblatt, Hadar; Boyko, Matthew; Achiron, Asaf; Knyazer, Boris

doi:10.3390/jcm10204658

Open AccessArticle

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

by

Hanan Nussinovitch

^1,†,

Erez Tsumi

^2,†,

Raimo Tuuminen

^3,4

,

Boris Malyugin

^5,6

,

Yotam Lior

⁷

,

Hadar Naidorf Rosenblatt

⁸

,

Matthew Boyko

⁷

,

Asaf Achiron

^9,*,‡

and

Boris Knyazer

^2,*,‡

¹

Department of Ophthalmology, Shaarei Zedek Medical Center, Jerusalem 9103102, Israel

²

Department of Ophthalmology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba 8410501, Israel

³

Helsinki Retina Research Group, Faculty of Medicine, University of Helsinki, 00100 Helsinki, Finland

⁴

Department of Ophthalmology, Kymenlaakso Central Hospital, 48210 Kotka, Finland

⁵

S. Fyodorov Eye Microsurgery Federal State Institution, 127486 Moscow, Russia

⁶

Department of Eye Diseases, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, 127473 Moscow, Russia

⁷

Division of Anesthesiology and Critical Care, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba 8410501, Israel

⁸

Ophthalmology Department, Kaplan Medical Center, Rehovot 7610001, Israel

⁹

Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv 6997801, Israel

^*

Authors to whom correspondence should be addressed.

^†

Equally contributed as first author.

^‡

Equally contributed as last author.

J. Clin. Med. 2021, 10(20), 4658; https://doi.org/10.3390/jcm10204658

Submission received: 14 August 2021 / Revised: 15 September 2021 / Accepted: 8 October 2021 / Published: 11 October 2021

(This article belongs to the Special Issue Cataract Surgery and Postoperative Care)

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Abstract

Advancements in surgical techniques and increased life expectancy have made cataract surgery more common among very old patients. However, surgical outcomes seem impaired in patients older than 90 years, especially with ocular comorbidities. A retrospective case-control study of 53 eyes of 53 very old patients (mean 92.6 ± 3.0) and 140 eyes of 140 matched patients (mean 75.2 ± 7.6) was undertaken. Groups were matched in terms of gender and systemic and ocular comorbidities. In very old patients, higher phacoemulsification energy (cumulative dissipated energy [CDE], 25.0 ± 22.4 vs. 16.1 ± 10.7, p = 0.01) and rate of intraoperative floppy iris syndrome (IFIS, 9.4% vs. 1.4%, p = 0.02) were observed compared to controls. Uncorrected (UCVA) and best-corrected distance visual acuity (BCVA) gains were significantly poorer among the very old patients than among the control at postoperative day 30 (0.20 ± 0.70 vs. 0.56 ± 0.61 logMAR, p < 0.001 and 0.27 ± 0.64 vs. 0.55 ± 0.62 logMAR, p = 0.006, respectively). Even after including CDE and IFIS as covariates, age remained an independent factor for poor visual gain at 30 days (p < 0.001). Cataract surgery in very old patients may demand more experienced surgeons due to higher nuclear density and the rates of IFIS. Expectations in visual acuity gains should be aligned with the patient’s age.

Keywords: cataract surgery; very old patients; visual acuity gain

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MDPI and ACS Style

Nussinovitch, H.; Tsumi, E.; Tuuminen, R.; Malyugin, B.; Lior, Y.; Naidorf Rosenblatt, H.; Boyko, M.; Achiron, A.; Knyazer, B. Cataract Surgery in Very Old Patients: A Case-Control Study. J. Clin. Med. 2021, 10, 4658. https://doi.org/10.3390/jcm10204658

AMA Style

Nussinovitch H, Tsumi E, Tuuminen R, Malyugin B, Lior Y, Naidorf Rosenblatt H, Boyko M, Achiron A, Knyazer B. Cataract Surgery in Very Old Patients: A Case-Control Study. Journal of Clinical Medicine. 2021; 10(20):4658. https://doi.org/10.3390/jcm10204658

Chicago/Turabian Style

Nussinovitch, Hanan, Erez Tsumi, Raimo Tuuminen, Boris Malyugin, Yotam Lior, Hadar Naidorf Rosenblatt, Matthew Boyko, Asaf Achiron, and Boris Knyazer. 2021. "Cataract Surgery in Very Old Patients: A Case-Control Study" Journal of Clinical Medicine 10, no. 20: 4658. https://doi.org/10.3390/jcm10204658

APA Style

Nussinovitch, H., Tsumi, E., Tuuminen, R., Malyugin, B., Lior, Y., Naidorf Rosenblatt, H., Boyko, M., Achiron, A., & Knyazer, B. (2021). Cataract Surgery in Very Old Patients: A Case-Control Study. Journal of Clinical Medicine, 10(20), 4658. https://doi.org/10.3390/jcm10204658

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