Preoperative management and efficacy of surgery for cataract patients with severe systemic diseases

Abstract

Objective To evaluate the efficacy of cataract surgery and preoperative treatment for cataract patients with severe systemic diseases.Methods Data of 393 eyes of 246 cataract patients with severe systemic disease who underwent cataract surgery in our hospital were retrospectively analyzed.The age was from 46 to 95 years old with average (73.00 ± 9.26) years.The preoperative visual acuity ranged from light perception to 0.6.There were 175 patients with circulatory systemic diseases:1 patient with chronic heart failure,40 patients with arrhythmia,81 patients with angina,47 patients with myocardial infarction,4 patients with valvular disease and 2 patients with myocardiopathy.Other systemic diseases included respiratory systemic diseases in 26 patients,cerebrovascular diseases in 62 patients,chronic renal failure in 17 patients (uraemia in 7),idiopathic thrombocytopenic purpura in 3 patients,and diseases of immune system in 20 patients,cancers in 29 patients.The preoperative managements included:low molecular Heparin instead of anticoagulant used in patients with cardiac bypass surgery or coronary stent implantation 7 days preoperatively,low molecular Heparin 0.4 ml used during renal dialysis in patients with renal insufficiency 1 day before surgery and Protamine used postoperatively to neutralize Heparin.The surgical options included:phacoemulsification in 230 patients (372 eyes) and extracapsular cataract extraction in 16 patients (21 eyes).Posterior chamber intraocular lens were implanted in the bag in all patients.The follow-up time was from 1 to 12 months.Results All the surgeries were performed successfully under electrocardiograph monitoring and continuous low flow oxygen inhalation.The postoperative best corrected visual acuity increased in 385 eyes (97.96％),and remained unchanged in 8 eyes (2.04％).The best corrected visual acuity was 0.25 or below in 20 (5.09％) eyes,between 0.3 and 0.5 in 59 (15.01％) eyes,between 0.6 and 0.8 in 141 (35.88％) eyes,and 1.0 or better in 173 (44.02％) eyes.During operation,blood pressure elevated in 13 patients (5.28％) and was controlled by intravenous injection of medicine immediately.Postoperatively,cornea edema occurred in 52 eyes (13.23 ％),exudation in anterior chamber in 4 eyes (1.02％),hyphema in 1 eye (0.25％),and temporary elevation of intraoeular pressure in 5 eyes (1.27％) respectively.No obvious progression of systemic disease was observed during follow-up period.Conclusion Under proper preoperative management of systemic diseases,patients with severe systemic diseases can undergo cataract surgery successfully and gain better prognosis. Key words: Cataract ; Disease, systemic, severe ; Arrhythmia ; Infarction, myocardial ; Renal failure, chronic