We should all be so lucky to live to 100 years old. It’s quite a rarity and it is something to be respected. But when it comes to delicate ocular structures, age takes its toll. We have explained how surgery in patients over age 90 is very different from patients who are in their 80s. When we reach a triple-digit age, the challenges are even greater.
The patient has a dense cataract, limited pupil dilation, and weak zonular support. The corneal endothelium has weakened and the cell count is lower with a resultant thickening in the central corneal pachymetry. The macula has extensive age-related changes, but fortunately is not compromised by macular degeneration.
With my best efforts, plenty of dispersive viscoelastic, phaco chop techniques, minimal phaco power, low flow fluidics and more, we were able to achieve a good outcome on post-op day 1.
However, closer examination reveals folds in Descemet’s layer and corneal edema. The left blue arrow in the picture below shows these folds and wrinkles in the cornea. The right blue arrow shows mild corneal edema with a ground glass or shower door appearance.
With treatment which included topical steroids, the corneal edema resolved within a week and the patient achieved 20/40 vision with a refraction of about plano. The limitation of the vision is due to the macular status which will prevent 20/20 acuity.
I asked the patient if he was happy with the new vision and he stated that he was amazed at how much more he could see. He only had one regret: he wished that he did the surgery 20 years ago when he first started to notice the cataract changes to his vision. He says, “I suffered with poor vision for 20 years because I was afraid of surgery.”
Click below to learn the pearls for cataract surgery in a 100-year-old patient:
