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I. De Monchy, C. Rohart, J.–B. Daudin, G. Chaine; Outcomes Of Cataract Surgery In Monocular Patients . Invest. Ophthalmol. Vis. Sci. 2006;47(13):645.
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To evaluate the best corrected visual acuity (BCVA) outcomes, surgical complications and therapeutic management in a consecutive series of functionally monocular patients who had phacoemulsification and intraocular lens (IOL) implantation.
Retrospective observational case series of 50 functionally monocular patients operated of cataract between January 2001 and September 2005. Patients were considered to be monocular if Snellen BCVA in their fellow eye (not having the surgery) was worse than 20/200. A review of clinical features, anesthesia method, reason for poor vision in the unoperated eye, co–morbidities in the operated eye associated, preoperative and postoperative BCVA, intraoperative and postoperative complications were obtained.
Mean age was 83.6 years, mean follow–up was 6 months and the female / male ratio was 1.7. Forty–eight patients (96%) were monocular because of medical conditions: diabetic retinopathy in 16 patients (34.8%), age–related macular degeneration in 18 patients (39.1%) and others conditions in 12 patients (26.1%). Two patients (4%) were monocular from complications of surgery. Ocular co–morbidities were present in 37 patients (72%) of eyes having surgery: diabetic retinopathy in 17 patients (46%), age–related macular degeneration in 18 patients (48.5%) and glaucoma in 2 patients (5.5%). Phacoemulsification and intraocular lens implantation were performed under local anaesthesia in every patient. Intraoperative or early post–operative complications occurred in 3 patients (6%) and late complications in 4 patients (8%). Preoperative median BCVA in the operated eye was 20/125. Preoperative BCVA was under 20/100 in 31 patients (62.1%). Postoperative median BCVA was 20/100 one month after cataract surgery and 20/80 at the end of follow–up. During the follow–up clinical evaluation has confirmed an improvement of BCVA in 25 patients (50%) and final BCVA was was 20/40 or better in 18 patients (36%).
The final BCVA reflecting efficacy of cataract surgery improved in 50 % of patients. The safety of surgical procedure and experience of the surgeon explain the small number of complications. Considering this data, there is no reason to postpone surgery for monocular patients more than binocular patients. However, ocular co–morbidities affecting both eyes as age–related macular degeneration or diabetic maculopathy were present in 72% and may limit visual acuity improvement after cataract surgery.
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