Cataract surgery in patients with advanced cognitive impairment who cannot consent for surgery: an evaluation of surgical outcomes, review of the literature and recommendations for the cataract pathway

IF 3.7 2区 医学 Q1 OPHTHALMOLOGY British Journal of Ophthalmology Pub Date : 2025-03-12 DOI:10.1136/bjo-2024-326437
Mumta Kanda, Alasdair Warwick, Giulio Pocobelli, Rajesh Deshmukh, Lucy Barker, Vincenzo Maurino
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Abstract

Background Patients with advanced cognitive impairment and cataract are an under-represented group with limited data on surgery outcomes and best practice. The burden of cataract in these groups is significant, and its functional impact can be severe and poorly recognised. We aimed to evaluate cataract surgery outcomes and optimise the surgical pathway for this group at our unit. Methods We conducted a retrospective observational study of adult patients with advanced dementia or learning disability and no capacity to consent to having cataract surgery between January 2021 and May 2023 at Moorfields Eye Hospital in London, UK. Data were collected on clinic assessment, consent, choice of anaesthetic, choice of immediate versus delayed sequential bilateral cataract surgery and intraoperative and postoperative findings. Results 51 patients (67 eyes), 40 (78%) with dementia and 17 (22%) with a learning disability, were included. 24 (36%) eyes had advanced cataract, and 15 (22%) of eyes had corrected distance visual acuity (CDVA) of counting fingers or worse. Surgery was performed under local anaesthetic (± sedation) in 37 (55%) cases. There were no intraoperative complications. Subjective visual improvement was recorded in 49 (73%) cases. There was a median improvement in CDVA of 0.55 LogMAR. The refractive outcome was within 1D of the target outcome in 31 (72%) eyes. 35 (81%) eyes had a hyperopic outcome. Conclusions These patients present late with advanced cataract. Multidisciplinary and family/carer input for assessment, consent and anaesthesia selection is necessary. Surgery was most often performed under local anaesthesia, and the complication rate and visual outcomes were acceptable. Data are available upon reasonable request. Additional data may be available upon reasonable request from the corresponding author (ORCID [0000-0001-6122-1104][1]). [1]: http://orcid.org/0000-0001-6122-1104
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背景 晚期认知障碍和白内障患者是一个代表性不足的群体,有关手术效果和最佳实践的数据十分有限。白内障给这些群体带来了沉重的负担,其对功能的影响可能非常严重,但却鲜为人知。我们的目标是评估白内障手术的效果,并优化本单位对这一群体的手术路径。方法 我们对 2021 年 1 月至 2023 年 5 月期间在英国伦敦 Moorfields 眼科医院接受白内障手术的晚期痴呆或学习障碍且无能力同意手术的成年患者进行了回顾性观察研究。研究收集的数据包括门诊评估、同意书、麻醉选择、立即与延迟双侧顺序白内障手术的选择以及术中和术后结果。结果 51 名患者(67 只眼睛)中有 40 人(78%)患有痴呆症,17 人(22%)有学习障碍。24(36%)只眼睛患有晚期白内障,15(22%)只眼睛的矫正远距离视力(CDVA)为数指或更差。37例(55%)患者在局部麻醉(±镇静剂)下进行了手术。术中无并发症。49例(73%)患者的主观视力得到改善。CDVA 改善的中位数为 0.55 LogMAR。31眼(72%)的屈光度在目标值的1D以内。35(81%)只出现远视。结论 这些患者患晚期白内障的时间较晚。在评估、征得同意和选择麻醉方式时,需要多学科人员和家属/护理人员的参与。手术多在局部麻醉下进行,并发症发生率和视觉效果均可接受。如有合理要求,可提供相关数据。更多数据可向通讯作者(ORCID [0000-0001-6122-1104][1] )索取。[1]: http://orcid.org/0000-0001-6122-1104
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来源期刊
CiteScore
10.30
自引率
2.40%
发文量
213
审稿时长
3-6 weeks
期刊介绍: The British Journal of Ophthalmology (BJO) is an international peer-reviewed journal for ophthalmologists and visual science specialists. BJO publishes clinical investigations, clinical observations, and clinically relevant laboratory investigations related to ophthalmology. It also provides major reviews and also publishes manuscripts covering regional issues in a global context.
期刊最新文献
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