Abstract
Purpose To determine the course and outcomes of cataract surgery in one-eyed patients. Methods This retrospective cohort study was conducted at the University Hospital of Nice, France. All one-eyed patients who underwent cataract surgery in their functional eye between January 2014 and December 2018 were included. A one-eyed patient was defined as having a visual acuity (VA) ≤20/200 in the other eye. Data were collected from the medical records and included the sociodemographic factors, the past medical history, data from the preoperative and postoperative clinical examinations, the surgical course, and the visual outcomes. Results One hundred one-eyed patients with a mean age of 74.01 years were included (48 men/52 women). The mean preoperative VA was 20/100 (+0.74 logMAR). The VA ranged between 20/200 and 20/40 in 75 (75%) patients, was >20/40 in 8 (8%), and was <20/200 in 17 (17%) patients. Fifty-eight (58%) patients were operated on an outpatient basis. General or locoregional anesthesia was used in 29 (29%) and 9 (9%) patients, respectively. All cataract surgery procedures were performed by phacoemulsification. Five (5%) patients experienced intraoperative complications. Seventy-three (73%) one-eyed patients achieved a final VA ≥20/40. The mean final VA was 20/50 (+0.37 logMAR) (p < 0.001). Conclusion A low rate of intraoperative complications was observed in one-eyed patients during cataract surgery. In most cases, a good visual recovery was achieved after cataract surgery, even in patients who experienced a surgical complication.
Highlights
IntroductionCataract surgery is one of the most common surgical procedures performed in France with almost 800,000 procedures yearly (according to the PMSI (programme de medicalisation des systemes d’information) database)
Cataract is one of the leading causes of blindness worldwide [1]
When oneeyed patients have a cataract in their seeing eye, ophthalmologists face several challenges [2]: would it be better to perform surgery earlier to facilitate the surgical procedure, there is a risk of operative complications for a slight benefit? Or on the contrary, would it be better to wait for a poorer preoperative VA to achieve a greater postoperative benefit, knowing that patients would be exposed to an increased risk of surgical complications? Should we use general anesthesia in these cases to limit the risk of patient movements, or to avoid complications related to retrobulbar/peribulbar anesthesia? What additional Journal of Ophthalmology precautions should be taken to prevent surgical complications?
Summary
Cataract surgery is one of the most common surgical procedures performed in France with almost 800,000 procedures yearly (according to the PMSI (programme de medicalisation des systemes d’information) database). It is generally a safe procedure but it can lead to surgical complications, occurring during surgery (intraoperative complications) or in the days or months following surgery (early and late postoperative complications). When oneeyed patients have a cataract in their seeing eye, ophthalmologists face several challenges [2]: would it be better to perform surgery earlier to facilitate the surgical procedure, there is a risk of operative complications for a slight benefit (benefit-risk ratio)? When oneeyed patients have a cataract in their seeing eye, ophthalmologists face several challenges [2]: would it be better to perform surgery earlier to facilitate the surgical procedure, there is a risk of operative complications for a slight benefit (benefit-risk ratio)? Or on the contrary, would it be better to wait for a poorer preoperative VA to achieve a greater postoperative benefit, knowing that patients would be exposed to an increased risk of surgical complications? Should we use general anesthesia in these cases to limit the risk of patient movements, or to avoid complications related to retrobulbar/peribulbar anesthesia? What additional
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