Anesthetic Considerations in Geriatric Patients Undergoing Cataract Surgery: A Review of Perioperative Management and Outcomes

Cataract surgery is one of the most frequently performed procedures worldwide and is particularly common in elderly patients due to the increased prevalence of age-related visual impairment. However, aging is associated with physiological, pharmacological, and clinical changes that significantly influence anesthetic management and perioperative outcomes. Age-related alterations in cardiovascular function, including reduced cardiac reserve, increased arterial stiffness, and impaired autonomic regulation, increase susceptibility to intraoperative hypotension and hemodynamic instability. Respiratory changes such as decreased lung elasticity, reduced vital capacity, and impaired gas exchange further contribute to the risk of hypoventilation and hypoxemia, particularly during sedation. In addition, neurological changes and increased sensitivity to sedatives and opioids elevate the risk of postoperative cognitive dysfunction and delirium. Comprehensive preoperative evaluation is essential for minimizing perioperative risk in elderly patients. This assessment should include a detailed medical history, identification of comorbidities such as hypertension, diabetes, and renal impairment, cardiovascular and respiratory evaluation, and careful review of the patient’s medication regimen. Functional and cognitive assessments also play an important role in predicting recovery and guiding perioperative planning. In most cases, cataract surgery is performed under topical or regional anesthesia, which offers advantages such as rapid recovery and fewer systemic complications compared with general anesthesia. Intravenous sedation may be used selectively to improve patient comfort, although careful dosing is required due to increased pharmacodynamic sensitivity in elderly individuals. Perioperative complications in this population include cardiovascular instability, respiratory depression, prolonged sedation, and postoperative delirium. Strategies to optimize outcomes include careful preoperative optimization, individualized anesthetic selection, continuous intraoperative monitoring, and a multidisciplinary perioperative approach.