Surgical treatment of patients with visually stressful work from the standpoint of the occurrence of postoperative anisometropia: clinical case

BACKGROUND: To date, several debatable aspects of cataract phacoemulsification (PEC) in the literature exist, one of which is the study of the surgical features in patients with visually stressful work (VLT) and binocular cataract.

CLINICAL CASE DESCRIPTION: In this case, we evaluated the effectiveness of surgical treatment of binocular cataract in a patient with VLT from the standpoint of the occurrence of postoperative anisometropia (A). The patient complained of decreased visual acuity in both eyes. The patient is a chief accountant, and the time of daily visual work is at least 6 h a day. The results of the examination were as follows: A –0.1 relative units; quality of life (QOL) according to the questionnaire «KZS-22» — 152 points, which corresponds to the compensation stage of asthenopia. The patient underwent a standard PEC, and the target refraction was ±0.5 diopters. The operation on the second eye was performed on day 18 after the operation on the first. The results of the examination 7 days after the first operation were A of –0.2 relative; units and QOL of 176 points («normal»). The results of the examination before the second operation (18 days after the first) were A of –0.4 relative units and QOL of 138 points «decompensation of asthenopia»). The results of the examination 7 days after the second operation were A of 0.1 relative units and QOL of 189 points («normal»).

CONCLUSION: The surgical treatment of binocular cataract in patients with VLT is based on an earlier (7–10 days) operation on the second eye to reduce the adverse effects of anisometropia, manifested by severe asthenopia. If a second operation is possible within the specified timeframe, a one-stage binocular PEC should be considered.