Clinical Interventions in Aging (Feb 2018)
Vitrectomy in patients 85 years of age and older: surgical outcomes and visual prognosis
Abstract
Roi Anteby,1 Aya Barzelay,1,2 Adiel Barak1,2 1Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; 2Department of Ophthalmology, Tel Aviv-Sourasky Medical Center, Tel Aviv, Israel Purpose: To evaluate visual and surgical outcomes in very elderly patients (above 85 years of age) undergoing pars plana vitrectomy (PPV). Patients and methods: A single-center, retrospective study was carried out on the medical records of 82 patients aged 85 years and older who had undergone PPV from 2006 to 2013. Patients ranged in age from 86 to 99 years, with a mean age of 88.9 years (±2.88). Visual results and intraoperative and postoperative complications were the main outcome measures. Visual improvement/worsening was defined as at least ±0.1 logMAR change. Results: Mean follow-up was 7.25 months (±5.35), with a range of 1–28 months. General anesthesia was used in 63% of the operations. The most common indication was retinal detachment (27%). The ocular condition necessitating PPV was secondary to trauma (most commonly after a fall) in 10 eyes (12%). Mean visual acuity (VA) improved from 1/58 preoperatively to 1/29 at the final evaluation (p=0.014). Mean improvement in VA in eyes of patients with the comorbidity of age-related macular degeneration (n=34) was 41% lower compared to eyes of patients without the disease (n=48, p=0.013). In the subgroup of patients operated on for retinal detachment, 45.4% did not reach primary anatomic success and 45.4% needed additional retina-affecting surgery. One or more major ocular complications were reported in 24 eyes (29%), while 19 eyes (23%) had minor ocular complications. Conclusion: Improved VA was documented in more than half of the older adults aged 85–99 undergoing vitrectomy. Despite the rate of complications in the very elderly, the possibility of optimizing visual function may positively affect quality of life in this subgroup. Keywords: PPV, visual acuity, age-related macular degeneration, retinal detachment
