Age and cataract surgery complications

We read with interest Robbie et al's article.¹ We agree with the authors that identification of risk factors for cataract surgery is important, as it has implications for patient care, surgical training, auditing and revalidation. The authors concluded that older age was not associated with an increased risk of intraoperative complications. Complication rates in patients ⩾88 years old were not significantly different to patients <88 years (4.5% vs 6.3%, p = 0.54). Complication rates in patients ⩾96 years was higher than in patients <96 years but this was not statistically significant (11.1% vs 6.3%, p = 0.45). However, the study included only 54 patients older than 90 years (number of patients older than 88 years not stated) and 9 patients older than 96 years.

In a similar study, we identified all phacoemulsification cataract procedures carried out between 2001 and 2005 at the Southampton Eye Unit. Intraoperative complications, as classified in the National Cataract Surgery Survey,² were recorded on a computer database for each cataract procedure. We analysed the same data as the above study,¹ including age of patient, grade of surgeon and intraoperative complications (defined as abnormality in wound closure, posterior capsule tear, zonule dehiscence, anterior chamber haemorrhage, iris trauma or persistent iris prolapse).

Logistic regression analysis was carried out to examine whether patients aged ⩾88 and aged ⩾96 years were associated with an increased risk of complications. SPSS version 14 was used for statistical analysis; p<0.05 was considered statistically significant.

We identified 9367 consecutive phacoemulsification procedures. The mean patient age was 76.9 (SD 9.8) years. The overall complication rate was 3.1%. No significant difference was found between grades of surgeon and complication rates (trainee vs consultant: 3.2% vs 3.1%, p = 0.90).

Interestingly, the complication rate in patients ⩾88 years (837 eyes) was 4.3% compared to 3.0% in patients <88 years (OR 1.4, 95% CI 1.005 to 2.049, p<0.05). In patients ⩾96 years (36 eyes), the complication rate was 8.3% compared to 3.1% in patients <96 years (OR 2.8, 95% CI 0.858 to 9.228, p = 0.09).

Therefore, in contrast to the above study,¹ our results suggest that older age may be a risk factor for intraoperative complications during phacoemulsification surgery. We suggest that the rate of complications in cataract surgery in different age groups requires further study and that, in view of our results, experienced surgeons should preferentially operate on patients older than age 88 years.