Development and external validation of a predictive model for prolonged length of hospital stay in elderly patients undergoing lumbar fusion surgery: comparison of three predictive models.

PURPOSE: This study aimed to develop a predictive model for prolonged length of hospital stay (pLOS) in elderly patients undergoing lumbar fusion surgery, utilizing multivariate logistic regression, single classification and regression tree (hereafter, "classification tree") and random forest machine-learning algorithms. METHODS: This study was a retrospective review of a prospective Geriatric Lumbar Disease Database. The primary outcome measure was pLOS, which was defined as the LOS greater than the 75th percentile. All patients were grouped as pLOS group and non-pLOS. Three models (including logistic regression, single-classification tree and random forest algorithms) for predicting pLOS were developed using training dataset and internal validation using testing dataset. Finally, online tool based on our model was developed to assess its validity in the clinical setting (external validation). RESULTS: The development set included 1025 patients (mean [SD] age, 72.8 [5.6] years; 632 [61.7%] female), and the external validation set included 175 patients (73.2 [5.9] years; 97[55.4%] female). Multivariate logistic analyses revealed that older age (odds ratio [OR] 1.06, p < 0.001), higher BMI (OR 1.08, p = 0.002), number of fused segments (OR 1.41, p < 0.001), longer operative time (OR 1.02, p < 0.001), and diabetes (OR 1.05, p = 0.046) were independent risk factors for pLOS in elderly patients undergoing lumbar fusion surgery. The single-classification tree revealed that operative time ≥ 232 min, delayed ambulation, and BMI ≥ 30 kg/m2 as particularly influential predictors for pLOS. A random forest model was developed using the remaining 14 variables. Intraoperative EBL, operative time, delayed ambulation, age, number of fused segments, BMI, and RBC count were the most significant variables in the final model. The predictive ability of our three models was comparable, with no significant differences in AUC (0.73 vs. 0.71 vs. 0.70, respectively). The logistic regression model had a higher net benefit for clinical intervention than the other models. The nomogram was developed, and the C-index of external validation for PLOS was 0.69 (95% CI, 0.65-0.76). CONCLUSION: This investigation produced three predictive models for pLOS in elderly patients undergoing lumbar fusion surgery. The predictive ability of our three models was comparable. Logistic regression model had a higher net benefit for clinical intervention than the other models. Our predictive model could inform physicians about elderly patients with a high risk of pLOS after surgery.

Analysis of the aqueous humor lipid profile in patients with polypoidal choroidal vasculopathy.

This study aimed to investigate the lipid profiles of aqueous humor from polypoidal choroidal vasculopathy (PCV) patients and identify potential biomarkers to increase the understanding of PCV pathomechanism. An ultra-high performance liquid chromatography-tandem mass spectrometry based untargeted lipidomic analysis was performed to acquire lipid profiles of aqueous humor of PCV patients and control subjects. Differentially expressed lipids were identified by univariate and multivariate analyses. A receiver operator characteristic curve (ROC) analysis was conducted to confirm the potential of identified lipids as biomarkers. Sixteen PCV patients and twenty-eight control subjects were enrolled in this study. In total, we identified 33 lipid classes and 639 lipid species in aqueous humor using the LipidSearch software. Of them, 50 differential lipids were obtained by combining univariate and multivariate statistical analyses (VIP>1 and P < 0.05), and 19 potential lipid biomarkers were identified by ROC analysis. In addition, significant alterations were found in several metabolic pathways, including glycerophospholipid, glycerolipid, and glycosylphosphatidylinositol-anchor biosynthesis. This study is the first to systematically characterize the alterations in lipid profiles in aqueous humor of PCV patients and screen for the potential lipid biomarkers for PCV diagnosis and treatment intervention. The results of this study are likely to broaden our understanding of the pathogenesis of PCV and contribute to improvements in the diagnosis and treatment of the disease.

A prospective comparative study of the MNA-SF and GNRI nutritional screening tools in predicting infectious complications among elderly patients over 70 years undergoing posterior lumbar arthrodesis.

Malnutrition is a risk factor for postoperative infectious complications of elderly patients undergoing posterior lumbar arthrodesis. At present, there is no gold standard for nutrition screening tools. We analyzed the value of predicting infectious complications among elderly patients over 70 years undergoing posterior lumbar arthrodesis by comparing the MNA-SF and GNRI. Demographic data, anthropometric measurements, serum albumin, surgical data and the occurrence of infectious complications and LOS were collected. Mini Nutritional Assessment short form (MNA-SF), Geriatric Nutritional Risk Index (GNRI) were performed within 24 h before surgery. Multivariable logistic regression analyses were used to identify predictors of infectious complications. The discriminatory performances of GNRI and MNA-SF scores for the occurrence of infectious complications were determined by receiver operating characteristic curves (ROC) analyses and the area under the curve (AUC). The study included 252 patients with a median age of 76.82 ± 6.41 years (range 70-84 years), and 142 patients (56.3%) were female. There were no significant differences in infectious complications (p = 0.236) and LOS (p = 0.580) among different GNRI categories. 27.3% malnourished patients evaluated by the MNA-SF suffered from infectious complications and 10.1% patients at risk of malnourished had infectious complications. Those patients had statistically significant higher prevalence of infectious complications (p = 0.002) and longer LOS (p = 0.023) than well-nourished patients. Multivariable analysis revealed that preoperative malnutrition and at risk of malnourished by the MNA-SF was significantly associated with infections. The area under the curve (AUC) of MNA-SF was 0.754, which was significantly high than AUC of GNRI (0.623) (Delong's test, p = 0.033). This study demonstrated that MNA-SF is a simple and effective tool for predicting the risk of infectious complications in elderly patients undergoing posterior lumbar arthrodesis.

Comparative short-term outcomes of enhanced recovery after surgery (ERAS) program and non-ERAS traditional care in elderly patients undergoing lumbar arthrodesis: a retrospective study.

BACKGROUND: Enhanced recovery after surgery (ERAS) program is an evidence-based improvement over non-ERAS traditional care. The aim of the present study was to analyze the safety, feasibility, and efficacy of an ERAS program in patients over 70 years undergoing lumbar arthrodesis by comparison with non-ERAS traditional care. METHODS: During January 2018 to December 2018, patients enrolled received non-ERAS traditional care, while the ERAS program was implemented from January to December 2019. Demographic characteristics, comorbidities, surgical data and postoperative recovery parameters were collected from all patients. Postoperative pain scores were evaluated by visual analog scales (VAS). The clinical outcomes were length of stay (LOS), postoperative complications and postoperative pain scores. Compliance results were also collected. RESULT: A total of 127 patients were enrolled, including 67 patients in the non-ERAS traditional care group and 60 patients in the ERAS group. The demographic characteristics and comorbidities of the two groups showed no significant differences. The LOS of patients treated with ERAS program (13.6 ± 4.0 days) was significantly less than that of patients treated with non-ERAS traditional care (15.6 ± 3.9 days) (p = 0.034). Complication rate was 8.3% in the ERAS group versus 20.9% in the non-ERAS traditional care group (p = 0.048). VAS (back) in the ERAS group was significantly lower on postoperative day (POD) 1 and POD2. Postoperative recovery parameters were improved in the ERAS group. The overall compliance with the ERAS program was 94%. CONCLUSIONS: Based on our results, ERAS program is safer and more effective for elderly patients over 70 undergoing lumbar arthrodesis than non-ERAS traditional care.

LSTMs and Deep Residual Networks for Carbohydrate and Bolus Recommendations in Type 1 Diabetes Management.

To avoid serious diabetic complications, people with type 1 diabetes must keep their blood glucose levels (BGLs) as close to normal as possible. Insulin dosages and carbohydrate consumption are important considerations in managing BGLs. Since the 1960s, models have been developed to forecast blood glucose levels based on the history of BGLs, insulin dosages, carbohydrate intake, and other physiological and lifestyle factors. Such predictions can be used to alert people of impending unsafe BGLs or to control insulin flow in an artificial pancreas. In past work, we have introduced an LSTM-based approach to blood glucose level prediction aimed at "what-if" scenarios, in which people could enter foods they might eat or insulin amounts they might take and then see the effect on future BGLs. In this work, we invert the "what-if" scenario and introduce a similar architecture based on chaining two LSTMs that can be trained to make either insulin or carbohydrate recommendations aimed at reaching a desired BG level in the future. Leveraging a recent state-of-the-art model for time series forecasting, we then derive a novel architecture for the same recommendation task, in which the two LSTM chain is used as a repeating block inside a deep residual architecture. Experimental evaluations using real patient data from the OhioT1DM dataset show that the new integrated architecture compares favorably with the previous LSTM-based approach, substantially outperforming the baselines. The promising results suggest that this novel approach could potentially be of practical use to people with type 1 diabetes for self-management of BGLs.

Epigallocatechin gallate protects the human lens epithelial cell survival against UVB irradiation through AIF/endo G signalling pathways in vitro.

OBJECTIVE: Oxidative stress has been recognised as an important mediator of apoptosis in lens epithelial cells. It also plays an important role in the pathogenesis of cataracts. It is reported that (-)-Epigallocatechin gallate (EGCG), the most abundant component in green tea, exhibits potent antioxidant activity against oxidative stress. This study aimed to investigate the protective effect of EGCG against Ultraviolet B (UVB) induced apoptotic death and the underlying mechanism in human lens epithelial cells (HLECs). METHODS: HLECs were exposed to various concentrations of EGCG under UVB (30 mJ/cm2), and cell viability was monitored by the MTT assay. Next, mitochondrial membrane potential (Δψm), reactive oxygen species (ROS) and apoptosis were detected by flow cytometry. Meanwhile, the total antioxigenic capacity (T-AOC) was determined by enzyme standard instrument, and the expression of apoptosis inducing factor (AIF) and endonuclease G (Endo G) was measured by quantitative PCR (Q-PCR) and western blotting, respectively. Moreover, the localisation of AIF and Endo G within cells was further detected by confocal optical microscopy. RESULTS: The results indicated that EGCG could enhance the cell viability and protect against cell apoptosis caused by UVB irradiation in HLECs. EGCG could also decrease the UVB-induced generation of ROS and collapse of Δψm, increase the T-AOC level. In addition, EGCG could also inhibit the UVB-stimulated increase of AIF and Endo G expression at mRNA and protein levels and ameliorate the UVB-induced mitochondria-nuclear translocation of AIF and Endo G. CONCLUSIONS: UVB irradiation could damage HLECs viability, while EGCG exhibits antioxidant effect and inhibits UVB-induced apoptosis in HLECs through AIF/Endo G signalling pathways. Our findings reveal the underlying mechanism of EGCG against UVB-induced oxidative stress in HLECs.

Ocular surface changes after strabismus surgery with different incisions.

OBJECTIVES: To compare ocular surface changes after strabismus surgery with different incisions. METHODS: One hundred and twenty eyes with exotropia were randomly assigned to Group A (limbal incision) or Group B (fornix incision). Dry eye questionnaire, corneal sensitivity, tear film breakup time (TFBUT), Schirmer I test (SIT), and corneal fluorescein staining (CFS) were assessed at 1 day preoperatively and at different postoperative times. RESULTS: In the A group, dry eye questionnaire scores increased and TFBUT decreased at postoperative weeks 1, 2, and 4. Corneal sensitivity decreased at postoperative weeks 1 and 2. In the B group, dry eye questionnaire scores increased and TFBUT decreased at postoperative weeks 1 and 2. Corneal sensitivity did not change. Postoperative between-group differences were significant in dry eye questionnaire scores (P = 0.0009, 1 week; P < 0.0001, 2 weeks; P = 0.0001, 4 weeks) and TFBUT (P = 0.004, 1 week; P = 0.0003, 2 weeks; P = 0.0001, 4 weeks). Between-group differences in CFS were significant postoperatively (P = 0.045, 1 week; P = 0.020, 2 weeks). CONCLUSION: Compared to fornix incision, limbal incision results in more serious dry eye symptoms and has a greater impact on corneal sensitivity and tear film stability.

Development and external validation of a nomogram for predicting postoperative adverse events in elderly patients undergoing lumbar fusion surgery: comparison of three predictive models.

BACKGROUND: The burden of lumbar degenerative diseases (LDD) has increased substantially with the unprecedented aging population. Identifying elderly patients with high risk of postoperative adverse events (AEs) and establishing individualized perioperative management is critical to mitigate added costs and optimize cost-effectiveness to the healthcare system. We aimed to develop a predictive tool for AEs in elderly patients with transforaminal lumbar interbody fusion (TLIF), utilizing multivariate logistic regression, single classification and regression tree (hereafter, "classification tree"), and random forest machine learning algorithms. METHODS: This study was a retrospective review of a prospective Geriatric Lumbar Disease Database (age ≥ 65). Our outcome measure was postoperative AEs, including prolonged hospital stays, postoperative complications, readmission, and reoperation within 90 days. Patients were grouped as either having at least one adverse event (AEs group) or not (No-AEs group). Three models for predicting postoperative AEs were developed using training dataset and internal validation using testing dataset. Finally, online tool was developed to assess its validity in the clinical setting (external validation). RESULTS: The development set included 1025 patients (mean [SD] age, 72.8 [5.6] years; 632 [61.7%] female), and the external validation set included 175 patients (73.2 [5.9] years; 97 [55.4%] female). The predictive ability of our three models was comparable, with no significant differences in AUC (0.73 vs. 0.72 vs. 0.70, respectively). The logistic regression model had a higher net benefit for clinical intervention than the other models. A nomogram based on logistic regression was developed, and the C-index of external validation for AEs was 0.69 (95% CI 0.65-0.76). CONCLUSION: The predictive ability of our three models was comparable. Logistic regression model had a higher net benefit for clinical intervention than the other models. Our nomogram and online tool ( https://xuanwumodel.shinyapps.io/Model_for_AEs/ ) could inform physicians about elderly patients with a high risk of AEs within the 90 days after TLIF surgery.

Quantitative Evaluation of Binocular Visual Perception in Patients With Strabismus: An Observational Study.

PURPOSE: To quantitatively evaluate and compare binocular visual perception between normal individuals and patients with different types of strabismus using a binocular phase combination paradigm. METHODS: A total of 117 participants were included in the study and were divided into the normal control group, exophoria group, comitant exotropia group, comitant esotropia group, and special strabismus group according to the type of strabismus. The effective contrast ratio (ECR) was measured to quantitatively evaluate binocular visual perception. Binocular fusion was evaluated using the Worth 4-dots flashlight. Stereoacuity was detected by the Titmus stereo test. RESULTS: The mean ECRs in the normal control group, exophoria group, comitant exotropia group, comitant esotropia group, and special strabismus group were 0.896 ± 0.214, 0.824 ± 0.234, 0.520 ± 0.279, 0.261 ± 0.139, and 0.461 ± 0.243, respectively. Within-group differences in the ECR were statistically significant. In addition, there was no statistically significant difference between the normal control group and exophoria group, and the concomitant exotropia group and special strabismus group and the other groups were statistically significant in pairwise comparison. The binocular visual perception was basically balanced in the exotropia group and most imbalanced in the comitant esotropia group, followed by the comitant exotropia group and the special strabismus group. The results also indicated that the decreased ECR was related to poor stereopsis and ECR had a significant positive correlation with binocular fusion function. CONCLUSIONS: Different types of strabismus have different degrees of visual perception imbalance. The binocular phase combination paradigm applied in this study can quickly and accurately quantify the degree of binocular visual perception imbalance in patients with strabismus by measuring ECR. [J Pediatr Ophthalmol Strabismus. 2023;60(2):120-130.].

Effect of surgery on sensory eye balance in patients with intermittent exotropia: An observational study.

To evaluate the impact of strabismus surgery on sensory eye balance in patients with intermittent exotropia (IXT). In total, 112 IXT patients with ocular alignment at the first strabismus surgery and 34 controls were enrolled from January 2015 to December 2016 in this retrospective study. The effective contrast ratio (ECR) of non-dominant eyes was measured by binocular phase combination paradigm before and 3 months after surgery, and the degree of sensory eye balance was quantitatively evaluated and compared between IXT patients and controls. The preoperative and postoperative mean ECRs of IXT patients were 0.492 ±â€…0.182 and 0.684 ±â€…0.198, respectively, which were significantly lower than those of the control group (0.896 ±â€…0.214, both P < .001). In addition, the postoperative ECR was significantly higher than the preoperative ECR (P < .001). The ECR change was not correlated with age orstrabismus degree measured with a6 m accommodative target (both P > .05), while significant negative correlation was observed between the ECR change and strabismus degree measured with a 33 cm accommodative target (P = .002). Strabismus surgery can significantly reduce the degree of sensory eye imbalance in patients with IXT, while further treatment aimed at rebalancing the ocular dominance might be necessary for more efficient binocular visual processing in the long-term.

Endogenous endophthalmitis caused by urinary tract infection: A case report.

RATIONALE: Endogenous endophthalmitis is a vision-threatening intraocular infection caused by hematogenous spread of infectious organisms from distant sites. PATIENT CONCERNS: A 71-year-old man with a history of fever and dysuria 5 days prior to presentation presented with sudden loss of vision in his left eye. The patient had no history of ocular surgery or trauma, and ocular examination revealed a large amount of exudative plaque covering the pupil. Therefore, fundus examination was not feasible. B-scan ultrasonography revealed a dome-shaped subretinal mass with an exudative retinal detachment. DIAGNOSIS: Endogenous endophthalmitis was diagnosed on the basis of these findings. INTERVENTIONS: The patient underwent pars plana vitrectomy and the early postoperative course was favorable. OUTCOMES: Vitreous cultures grew gram-negative bacilli, identified as Klebsiella pneumonia. Urinalysis revealed white blood cells (++) and urinary tract infection was the only identifiable risk factor for endogenous endophthalmitis. LESSONS: Urinary tract infection is an independent risk factor for endogenous endophthalmitis.

Frailty and Post-Operative Outcomes in the Older Patients Undergoing Elective Posterior Thoracolumbar Fusion Surgery.

BACKGROUND AND AIM: Frailty is an independent predictor of mortality and adverse events (AEs) in patients undergoing surgery. This study aimed to quantify the ability of Modified Frailty Index (mFI) to predict AEs in older patients undergoing elective posterior thoracolumbar fusion surgery. METHODS: We retrospectively reviewed the results of 426 patients with the following diagnoses and follow-up evaluations of at least 12 months duration: lumbar disc herniation, 125; degenerative spondylolisthesis, 81; lumbar spinal canal stenosis, 187; and adult spinal deformities, 33. The cases were divided into two groups. The long spinal fusion (LSF) group was defined as ≥3 spinal levels with segmental pedicle-screw fixation. Short spinal fusion (SSF) were defined with at most two levels. The mFI used in the present study is an 11-variable assessment. The association of frailty with AEs was determined after adjusting for known and suspected confounders. RESULTS: Frailty was presented in 66 patients (15.5%) within the total population (LSF, 21.9% and SSF, 11.8%). Rates of AEs assessed in the study increased stepwise with an increase in the mFI for the two groups. The severity of frailty was an independent predictor of any, major, and minor complications in the LSF group and any, minor complication in the SSF group (P<0.05). A comparison of post-operative clinical outcomes showed that the ODI and SF-36 scores deteriorated as the mFI increased. CONCLUSION: Frailty was shown to be an independent predictor of AEs in older patients undergoing elective posterior thoracolumbar fusion surgery, especially for patients undergoing LSF.

Enhanced recovery after surgery (ERAS) program for elderly patients with short-level lumbar fusion.

BACKGROUND: Degenerative disorders of the lumbar spine decrease the mobility and quality of life of elderly patients. Lumbar fusion surgery is the primary method of treating degenerative lumbar spine disorders; however, the surgical stress response associated with major surgery has been linked to pathophysiological changes in the elderly, resulting in undesirable postoperative morbidity, complications, pain, fatigue, and extended convalescence. In the present study, we aimed to determine whether enhanced recovery after surgery significantly improved satisfaction and outcomes in elderly patients (> 65 years old) with short-level lumbar fusion. METHODS: The study enrolled lumbar disc herniation or lumbar spinal stenosis patients if they were over the age of 65 years old underwent lumbar fusion at one or two levels. Data including demographic, comorbidity, and surgical information were collected from electronic medical records. Enhanced recovery after surgery interventions was categorized as preoperative, intraoperative, and postoperative. We also evaluated primary outcome, surgical complication, length of stay, postoperative pain scores, and 30-day readmission rates. RESULTS: A total of 192 patients were included, 96 in the enhanced recovery after surgery group and 96 case-matched patients in the non- enhanced recovery after surgery group. There were no statistically significant intergroup differences in regards to demographics, comorbidities, American Society of Anaesthesiologists grade, or the number of fusion levels. There were also no differences between mean surgery time of intraoperative blood loss between the enhanced recovery after surgery and non- enhanced recovery after surgery groups. In addition, the mean preoperative Japanese Orthopaedic Association score, visual analog score for the back and legs, and Oswestry Disability Index score were not significantly different between the two groups. Overall, enhanced recovery after surgery pathway compliance was 92.1%. There were no significant differences in the number of complications or the mortality rates between the enhanced recovery after surgery and non-enhanced recovery after surgery groups. Furthermore, the mean postoperative Japanese Orthopaedic Association score, Visual analog score for the back and legs, Oswestry Disability Index score, and readmission rates score revealed no significant differences between the groups at 30-day follow-up point. However, we observed a statistically significant decrease in length of stay in the enhanced recovery after surgery group (12.30 ± 3.03 of enhanced recovery after surgery group versus 15.50 ± 1.88 in non- enhanced recovery after surgery group, p = 0). Multivariable linear regression showed that comorbidities (p = 0.023) and implementation of enhanced recovery after surgery program (p = 0.002) were correlated with prolonged length of stay. Multivariable logistic regression showed that no characteristics were associated with complications. CONCLUSIONS: This report describes the first enhanced recovery after surgery protocol used in elderly patients after short-level lumbar fusion surgery. Our enhanced recovery after surgery program is safe and could help decrease length of stay in elderly patients with short-level lumbar fusion.

Impact of Compliance with an Enhanced Recovery After Surgery Program on the Outcomes Among Elderly Patients Undergoing Lumbar Fusion Surgery.

BACKGROUND AND AIM: The benefits of the enhanced recovery after surgery (ERAS) program to elderly patients have not been evaluated in lumbar fusion surgery. Compliance with the ERAS program is associated with prognosis. There is currently no adequate assessment about the importance of the individual components of ERAS program in lumbar fusion surgery. The aim of the study was to analyze the effect of compliance with our ERAS program and the relative importance of the individual ERAS program components among elderly patients undergoing lumbar fusion surgery. METHODS: A retrospective case-review study was conducted from March 2018 to March 2020. The ERAS program for lumbar fusion surgery at our department was implemented. Overall compliance was found to be 92.9%, and this was used as a cutoff for dividing patients into higher compliance and lower compliance groups. Patient characteristics and clinical outcomes were compared between groups. RESULTS: The overall compliance rate was 92.9%, distributing 91 patients into the higher compliance group and 169 patients into the lower compliance group. Patients with higher compliance were younger (p=0.045). The length of stay (LOS) of patients with higher compliance was significantly shorter than that of patients with lower compliance. Patients with higher compliance had significantly fewer complications (p=0.031). A multivariate analysis showed that surgical time (p=0.029), lower compliance (p=0.034), and early oral feeding (p=0.026) were predictors of any postoperative complications. On multivariate analysis, the following items remained correlated with prolonged LOS (LOS≥12 days): older age (p=0.010), lower compliance (p<0.0001), early ambulation (p=0.018), and stick to discharge criteria (p=0.040). CONCLUSION: Low compliance with ERAS program among elderly patients undergoing lumbar fusion surgery was associated with a higher incidence of complications and prolonged LOS. The failure of early oral feeding was associated with increased complications, and the failure of early ambulation or sticking to discharge criteria was significantly more influential on prolonged LOS.

Optical correction of aphakia following unilateral infantile cataract removal.

PURPOSE: To compare primary intra-ocular lens (IOL) implantation with use of press-on spherical lens for aphakia correction following unilateral infantile cataract removal. METHODS: Sixty infants with a unilateral cataract underwent cataract surgery and were randomly assigned to the IOL (A group) or no IOL group (B group). Residual refractive error was corrected with spectacles in the A group and a press-on spherical lens was used to treat aphakia in the B group. Grating visual acuity (VA) was measured and patients were followed for up to 1 year. RESULTS: LogMAR VA in the operated eyes of both groups was significantly better 1 year than 1 month after surgery. Mean logMAR VA difference between 1 year and 1 month after surgery was higher in the A group (0.457 ± 0.110) than in the B group (0.323 ± 0.114, p < 0.0001). Serious inflammation occurred significantly more often in the A group than in the B group (p = 0.007). Visual axis opacity occurred more often in the A group than in the B group (pupillary membrane: A: six eyes, 20%, B: none, p = 0.024; lens reproliferation: A: 10 eyes, 33%, B: two eyes, 7%, p = 0.021). Glaucoma occurred equally in both groups (p = 0.612). No other complications occurred. CONCLUSIONS: Primary IOL implantation appears to be a relatively safe, effective optical correction strategy following unilateral cataract extraction in this age group. Patients for whom an IOL is not suitable can be treated with a press-on spherical lens for optical correction.