Eyeworld

cated that patients in their 90s are no more likely to suffer complica- tions than their 80-something coun- terparts, according to Paul B. Greenberg, M.D., clinical associate professor of ophthalmology, Alpert Medical School, Brown University, Providence, R.I. EW CATARACT 30 June 2011 by Maxine Lipner Senior EyeWorld Contributing Editor Cataract surgery 90-something style: Saying yes to cataract surgery for nonagenarians W hen it comes to per- forming cataract sur- gery in those who can be counted among the oldest patients, practi- tioners may have added concerns. However, new results published in the March issue of Ophthalmology indi- C ompared to prior surveys, it seems that an increasing number of cataract surgeons are routinely using NSAIDs following uncomplicated surgery. This may reflect the increasing evidence from randomized prospective trials that NSAIDs are effective in preventing angiographic and OCT-detectable CME. However, no study has shown improvement in final visual outcome with routine NSAID use, and some ophthalmologists may believe that the benefit does not justify the greater cost and inconvenience of routinely adding these drugs to a topical steroid. It is interesting that although more surgeons are prescribing generic NSAIDs following the discontinuation of sampling, many others still prefer to use branded drugs. Perhaps these respondents value certain potential advantages of the brands (e.g., comfort, reduced dosing, safety record, familiarity), or it may reflect reluctance to change from an established routine. David F. Chang, M.D. The use of routine post-op NSAIDs after cataract surgery appears high amongst surgeons, regardless of the volume of surgery performed. It is also interesting to note that the loss of samples of NSAIDs did not alter the prescribing behav- ior in nearly 50% of surgeons. Bonnie An Henderson, M.D. Monthly Pulse Keeping a Pulse on Ophthalmology Studying this patient population was a natural for investigators. "I think that we're seeing more and more cataract surgery patients in this age group," Dr. Greenberg said. "We recently published a paper that looked at risk factors for ocular com- plications following cataract surgery in veterans." The oldest patients in this preceding study were age 80 and above. "We wanted to find out whether being 90 or older increased the risk of having complications rel- ative to being 80 and older." Included in the national, retro- spective study were 554 nonagenar- ian and 11,407 octogenarians who had undergone cataract surgery at the Veterans Health Administration between October 2005 and Septem- ber 2007. Comorbidities and complications When investigators looked at sys- temic comorbidities, however, they did find an interesting difference. Patients who were age 90 and above tended to have lower systemic co- morbidities. "The 80-89 reference group had a slightly higher rate of COPD, malignant neoplasms, and diabetes, as well as diabetes with complications," Dr. Greenberg said. "Those 90 and above had a slightly higher rate of dementia, which we can understand since it is related to age." Investigators found that the older patients ran the gamut of ex- pected complications. "The intra- operative complications were stan- dard ones, from posterior capsular tear/vitreous loss to retained lens fragments," Dr. Greenberg said. "Post-operatively, complications in- cluded posterior capsular opacifica- tion and cystoid macular edema. By and large the complication rates were similar (for both groups)." Nonagenarians, showed no heightened surgical risk. "We found that there was no increase in risk of complications in nonagenarians compared with octogenarians," Dr. Greenberg said. "Octogenarians were the reference group and they had similar risks for complications." In- vestigators found that the risk was almost identical with octogenarians at 13.5% and nonagenarians at 13.4%. Healthier nonagenarians One possibility he theorized is that nonagenarians who are selected for cataract surgery may be the health- ier ones. "If you're 90 or above and you're healthy enough to have cataract surgery, perhaps you're in better shape systemically," Dr. Greenberg said. "So perhaps we're getting the healthier folks." Dr. Greenberg stressed that the study does not tell practitioners how to select someone who is 90 and

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