Abstract
Purpose To evaluate intraoperative complications and utilization of adjunctive devices between microscope and intracameral illuminations during cataract surgery in the elderly over 75 years. Design A retrospective, consecutive, interventional case series Participants. Two hundred eighty-six eyes of 184 patients older than 75 years who underwent cataract surgery using microscope and intracameral illuminations. Methods A chart review was performed on an advanced cataract surgery group of 141 consecutive cases in which the intracameral illumination was used and on a standard cataract surgery group of 145 consecutive cases in which the intracameral illumination was not used. Main Outcome Measures Intraoperative complications (posterior capsule rupture, radial tear of the anterior capsule, dropped nucleus, or sulcus-implanted/sclera-fixated IOL) and utilization of adjunctive devices (pupil expansion device or anterior capsule staining). Results The frequency of use of the pupil expansion device was lower in the advanced cataract surgery group than that in the standard cataract surgery group (0.7% vs 6.9%; p=0.007). Furthermore, the rates of a posterior capsule rupture and at least one intraoperative complication were lower in the advanced cataract surgery group than those in the standard cataract surgery group (0.7% vs 4.8%; p=0.067) (0.7% vs 7.6%; p=0.004). Conclusions In the current cohort of patients over 75 years, the rate of intraoperative complications was lower when using the intracameral illumination than that when using the conventional method. Cataract surgery using intracameral illumination would be good option for elderly people.
Highlights
Modern cataract extraction generally provides excellent visual outcomes
A chart review was performed on an advanced cataract surgery group of 141 consecutive cases in which the intracameral illumination was used and on a standard cataract surgery group of 145 consecutive cases in which the intracameral illumination was not used. e advanced cataract surgery using intracameral illumination described in our previous studies [11,12,13,14,15] was used in the treatment group
Demographic characteristics were similar across all cases with no clinically significant differences between the advanced and standard cataract surgery groups. e mean age of the patients was 79.41 years (SD 4.03; range 75–96) in the advanced cataract surgery group and 79.72 years (SD 4.40; range 75–95) in the standard cataract surgery group (p 0.541)
Summary
Modern cataract extraction generally provides excellent visual outcomes. Good visualization of the lens structures is essential for safe and effective performance of phacoemulsification cataract surgery. Older age may contribute to posterior capsule rupture due to weakening of the zonules with advancing age, increased lens density, and other agerelated ocular or systemic comorbidities that elevate the complexity of the cataract surgery performed [2,3,4]. Utilization of adjunctive tools such as pupil expansion or capsule staining in the setting of challenging cataract cases can significantly limit adverse intraoperative outcomes and result in reproducible surgical success. Their increased cost, increased time requirement, iris trauma, or inadvertent posterior capsule staining may limit their widespread use [7,8,9,10]
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