Cataract surgery in very old patients: A case-control study

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

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Article number4658
JournalJournal of Clinical Medicine
Issue number20
StatePublished - 1 Oct 2021


FundersFunder number
Finnish Ophthalmological Society
Nissi Foundation
Suomen Lääketieteen Säätiö
Paulon Säätiö
Waldemar von Frenckells Stiftelse


    • Cataract surgery
    • Very old patients
    • Visual acuity gain


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