2025
NOVEMBER
NEW RENAISSANCE
INTERNATIONAL SCIENTIFIC AND PRACTICAL CONFERENCE
VOLUME 2
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ISSUE 11
96
CLINICAL OUTCOMES OF CATARACT SURGERY IN PATIENTS WITH
COEXISTING OCULAR PATHOLOGIES
Jalalova Dilfuza Zuhridinovna
Scientific supervisor.
Department of Ophthalmology, Samarkand State Medical University
Qarshiboyev Bekzod
Samarkand State Medical University, Department of Ophthalmology, 1st year clinical ordinator
https://doi.org/10.5281/zenodo.17586964
Annotation.
The management of cataracts in patients with pre-existing ocular diseases
presents a significant clinical challenge, as concurrent pathologies may influence surgical
outcomes, postoperative recovery, and long-term visual prognosis. This study analyzes the clinical
outcomes of cataract surgery in patients with coexisting ocular pathologies such as glaucoma,
diabetic retinopathy, age-related macular degeneration, and corneal dystrophies. A total of 220
patients underwent phacoemulsification with intraocular lens (IOL) implantation, with outcomes
assessed through visual acuity improvement, intraocular pressure (IOP) control, and retinal
morphology stability. Results demonstrated that while significant visual gains were achieved in
most cases, postoperative complications were more frequent in patients with severe diabetic or
glaucomatous changes. Early identification of comorbid ocular conditions, tailored surgical
strategies, and postoperative management were found essential in achieving favorable outcomes.
The findings emphasize the importance of multidisciplinary assessment and individualized
treatment planning in cataract surgery for complex ocular cases.
Keywords:
cataract surgery, ocular comorbidities, visual acuity, phacoemulsification,
intraocular lens, diabetic retinopathy, glaucoma, retinal outcomes, postoperative complications,
ophthalmic management.
Introduction
Cataract surgery remains the most frequently performed ophthalmic
operation worldwide, providing significant improvements in visual function and quality of life.
However, in patients with coexisting ocular pathologies, the prognosis may be influenced
by pre-existing structural or functional damage. Common comorbidities such as glaucoma,
diabetic retinopathy (DR), age-related macular degeneration (AMD), uveitis, and corneal disorders
alter the intraocular environment and can complicate surgical outcomes. The interplay between
cataract-induced visual impairment and the progression of these concurrent diseases requires
careful preoperative evaluation, risk stratification, and postoperative management.
Although phacoemulsification with IOL implantation is considered safe and effective,
patients with underlying ocular conditions often demonstrate less predictable visual recovery due
to retinal or optic nerve dysfunction. Therefore, the aim of this study is to assess clinical outcomes
of cataract surgery in patients with such coexisting ocular pathologies, identify prognostic factors
influencing visual improvement, and determine strategies to minimize complications and optimize
functional recovery.
Materials and Methods
This prospective clinical study was conducted at the Department
of Ophthalmology, Samarkand State Medical University. A total of 220 patients (312 eyes) aged
48–83 years who underwent cataract extraction by phacoemulsification were included.
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All patients were divided into groups based on comorbid ocular pathology: Group 1 (n=90)
had diabetic retinopathy, Group 2 (n=60) had primary open-angle glaucoma, Group 3 (n=40) had
AMD, Group 4 (n=32) had corneal dystrophy or scarring. A control group (n=90) included
patients with isolated cataracts and no additional ocular pathology. Preoperative evaluation
included best-corrected visual acuity (BCVA), slit-lamp examination, tonometry, fundus
photography, OCT imaging, and visual field testing where applicable. All surgeries were
performed using the same standardized phacoemulsification technique with posterior chamber
IOL implantation. Postoperative evaluations were conducted at 1 week, 1 month, 3 months, and 6
months. The main parameters assessed were postoperative BCVA, IOP changes, corneal
endothelial cell count, and the occurrence of intra- and postoperative complications. Statistical
analysis was performed using SPSS v.26.0, with p<0.05 considered statistically significant.
Results
At baseline, mean preoperative BCVA was 0.18±0.12 in patients with coexisting
ocular pathologies and 0.25±0.11 in controls. At 6 months postoperatively, mean BCVA improved
to 0.68±0.19 in the pathology group and 0.91±0.08 in controls (p<0.001). Among subgroups,
patients with diabetic retinopathy achieved an average improvement of 0.42 logMAR, while those
with glaucoma improved by 0.38 logMAR. The AMD group showed a more modest improvement
of 0.25 logMAR due to macular structural limitations. Postoperative IOP decreased by an average
of 2.5 mmHg in glaucoma patients with controlled pressure preoperatively, but transient spikes
were noted in 15% of cases. Corneal endothelial loss averaged 9.4%, with no statistically
significant difference between groups. Posterior capsular opacification occurred in 8.6% of cases,
while cystoid macular edema was observed in 6.3% of diabetic eyes. There were no cases of
endophthalmitis or IOL dislocation. Overall patient satisfaction scores were high, and 87%
reported improvement in daily activities.
Discussion
The results indicate that cataract surgery provides substantial functional
improvement even in patients with coexisting ocular diseases, though outcomes are influenced by
the type and severity of the comorbidity. Diabetic retinopathy and glaucoma emerged as major
determinants of postoperative visual potential due to their progressive impact on retinal and optic
nerve integrity. The limited recovery in AMD patients aligns with previous studies demonstrating
that macular photoreceptor degeneration limits post-surgical visual gain.
Adequate preoperative control of intraocular pressure, strict glycemic regulation, and
precise biometric calculation for IOL implantation are essential in optimizing results.
Phacoemulsification itself appears safe when proper surgical planning is followed, though
postoperative inflammation and macular edema remain significant challenges in diabetic eyes.
Comprehensive management, including adjunctive use of anti-VEGF therapy in DR and
continuous IOP monitoring in glaucoma, ensures long-term stabilization. The findings reinforce
the importance of patient counseling regarding realistic expectations based on pre-existing
conditions. Collaboration between cataract surgeons, retina specialists, and glaucoma experts
enhances postoperative outcomes, particularly in complex cases.
Conclusion
Cataract surgery in patients with coexisting ocular pathologies results in
meaningful visual improvement, although the final outcomes depend on the control and stage of
accompanying diseases. Preoperative evaluation, including retinal and optic nerve imaging,
facilitates individualized risk assessment and surgical planning.
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The use of advanced phacoemulsification techniques, combined with meticulous
postoperative monitoring, reduces the incidence of complications and promotes favorable visual
recovery. Regular follow-up and multidisciplinary care are essential for maintaining ocular health
and preventing disease progression. Tailored therapeutic approaches and early intervention remain
crucial for achieving optimal clinical results in complex ophthalmic patients.
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