Why are patients with mature cataract admitted to hospital? Challenges for cataract surgery

BACKGROUND: A lot of patients are admitted to hospital with mature cataract, this raises the risk of complications and makes longer the rehabilitation period.

AIM: To identify the reasons for admission of patients with advanced forms of cataract, and associated factors complicating the surgery in these patients.

MATERIALS AND METHODS: 674 operated patients with various degrees of lens opacity; out of them, 145 (21.5%) cases were with mature cataracts.

RESULTS: 95.2% (n = 138) of patients did not seek ophthalmological attention, 4.8% (n = 7) of patients noted that they were referred late due to the fault of their local ophthalmologists. In 31.9% of cases (138 patients), the main cause was “absence of an ophthalmologist in the outpatient polyclinic”. The patient’s lack of funds for the purchase of an intraocular lens (IOL) was the reason in 26.1%. In 15.2% of cases, patients refused surgery due to domestic problems. 14.5% of patients lived with the idea of self-restoration of vision. Low transportable patients amounted to 5.1%; in 4.3% of cases, elderly patients did not perceive the loss of spatial vision in one eye. Remaining 2.9% of patients from the psychoneurological dispensary were admitted for phacoemulsification having intumescent cataracts. The maturity of the cataract leads to certain intraoperative difficulties, which are accompanied by additional manipulations, increasing the risk of complications and the duration of procedures. These include: pupil diameter less than 5 mm – 37.2%; pseudoexfoliation syndrome – 22.8%; the presence of an advanced intumescent cataract in 36.6%; shallow anterior chamber – 44.8%; lens subluxation – 24.1%; atrophy of the pupillary margin – 39.3%; fibrosis of the posterior capsule diagnosed intraoperatively – 13.8%. Phacoemulsification was carried out using the Optimed phaco machine (Russia). For an immature cataract, we used a power of 30% and the time spent was 2.73 seconds; with a mature one – 60% and 9.96 seconds respectively. The best corrected visual acuity on Day 1 after cataract extraction was 0.53 ± 0.27, on Day 7 – 0.73 ± 0.22, after 3 months – 0.76 ± 0.25.

CONCLUSIONS: Mature cataract is encountered in 21.5% of all cataract surgeries. In 95.2% of cases, patients themselves did not seek medical help. The maturity of the cataract led to certain factors complicating the course of surgery: pupil diameter less than 5 mm, swelling of the lens cortical masses, shallow anterior chamber, lens subluxation, atrophy of the pigment border of the iris. The ultrasound power used in the mature cataract surgery was 2 times higher than in that of immature ones; and the operating time of ultrasound increased by 3.6 times.