1
|
Ramsden C, Shweikh Y, Kam R, Bunce C, Foot B, Viswanathan A. Estimating the rate of severe visual loss (wipe-out) following cataract surgery, a British Ophthalmological Surveillance Unit (BOSU) study. Eye (Lond) 2023; 37:3787-3792. [PMID: 37328508 PMCID: PMC10697986 DOI: 10.1038/s41433-023-02606-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 03/21/2023] [Accepted: 05/25/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND A sudden, irreversible reduction in visual acuity ('wipe-out') is a feared complication of cataract surgery. Current literature on wipe-out is limited in quantity and quality, and largely predates modern cataract surgery and imaging techniques. The objectives of our study were to estimate the incidence of wipe-out and to identify potential risk factors. METHODS We prospectively collated cases of wipe-out occurring in the UK during a 25-month study period using the British Ophthalmic Surveillance Unit reporting system. A total of 21 potential cases of wipe-out were reported, 5 of which met all inclusion and exclusion criteria. RESULTS The estimated incidence of wipe-out during the study period was 0.00000298, or approximately 3 cases per million cataract operations. All cases of wipe-out occurred exclusively in patients with advanced glaucoma (mean deviation -21.0 decibels or worse in the operated eye), with an over-representation of black people (40%) in our case series. A prior diagnosis of retinal vein occlusion (60%) and elevated post-operative IOP (40%) were more common among individuals suffering from wipe-out compared to the general population, suggesting these factors may contribute to the pathogenesis of wipe-out. CONCLUSIONS Our study shows that wipe-out is a rare complication, affecting approximately 3 per million undergoing cataract surgery. Patients with advanced glaucoma, black patients, and those with previous retinal vein occlusions may be at greater risk of wipe-out. We hope that the findings of our study will be used to help inform treatment decision-making and the cataract surgery consent process.
Collapse
Affiliation(s)
- Conor Ramsden
- West of England Eye Unit, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK.
- Institute of Ophthalmology, University College London, London, UK.
| | - Yusrah Shweikh
- Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
- Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Ronald Kam
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Catey Bunce
- Research Data & Statistics Unit (RDSU), Royal Marsden Clinical Trials Unit (RM-CTU), London, UK
| | - Barny Foot
- Royal College of Ophthalmologists, London, UK
| | - Ananth Viswanathan
- NIHR BRC at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| |
Collapse
|
2
|
Ahmad KT, Chauhan MZ, Soliman MK, Elhusseiny AM, Yang YC, Sallam AB. Impact of axial length on visual outcomes and complications in phacoemulsification surgery: a multicenter database study. Graefes Arch Clin Exp Ophthalmol 2023; 261:3511-3520. [PMID: 37347245 DOI: 10.1007/s00417-023-06120-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/07/2023] [Accepted: 05/18/2023] [Indexed: 06/23/2023] Open
Abstract
PURPOSE To analyze the impact of axial length (AL) on the visual outcome and rate of perioperative complications in phacoemulsification surgery. DESIGN Retrospective clinical database study. METHODS Cataract surgery data of 217,556 eyes was extracted from the electronic medical records of 8 ophthalmic centers in the United Kingdom from July 2003 to March 2015. A total of 88,774 eyes without ocular co-pathologies were grouped eyes according to AL (mm): short AL (< 22), average AL (22-26; reference group), and long AL (> 26). MAIN OUTCOMES AND MEASURES We analyzed visual acuity (VA) outcomes at 4 weeks, 4-12 weeks, and 12-24 weeks postoperatively, as well as the incidence of posterior capsular rupture (PCR), torn iris (TI), cystoid macular edema (CME), and retinal detachment (RD). RESULTS Mean pre-operative VA (logMAR) was the worst in eyes with long AL compared to average and short AL eyes (VA 0.59 vs. 0.58 and 0.56; p < 0.001). However, post-operative VA at 4-12 weeks was slightly better in the long AL group (0.14 in short and average AL; 0.12 in long AL, p < 0.001). We observed an increased odds of TI in the short AL group (OR 2.09, 95% CI 1.60-2.75). There was increased risk of RD in long AL eyes (p < 0.001). However, PCR and CME rates were not different. CONCLUSION In the absence of any coexisting ocular pathology, AL alone did not have an impact on VA improvement or the risk of encountering PCR or CME. The risk of TI was greater in the short AL group, and the risk of RD was higher in the long AL group.
Collapse
Affiliation(s)
- Kinza T Ahmad
- Jones Eye Institute, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72207, USA
| | - Muhammad Z Chauhan
- Jones Eye Institute, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72207, USA
| | - Mohamed K Soliman
- Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Abdelrahman M Elhusseiny
- Jones Eye Institute, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72207, USA
| | - Yit C Yang
- Wolverhampton Eye Infirmary, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, United Kingdom
| | - Ahmed B Sallam
- Jones Eye Institute, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72207, USA.
- Department of Ophthalmology, Gloucestershire Hospitals NHS Trust, Cheltenham, United Kingdom.
| |
Collapse
|
3
|
Triepels RJMA, Segers MHM, Rosen P, Nuijts RMMA, van den Biggelaar FJHM, Henry YP, Stenevi U, Tassignon MJ, Young D, Behndig A, Lundström M, Dickman MM. Development of machine learning models to predict posterior capsule rupture based on the EUREQUO registry. Acta Ophthalmol 2023. [PMID: 36789777 DOI: 10.1111/aos.15648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/23/2023] [Accepted: 01/31/2023] [Indexed: 02/16/2023]
Abstract
PURPOSE To evaluate the performance of different probabilistic classifiers to predict posterior capsule rupture (PCR) prior to cataract surgery. METHODS Three probabilistic classifiers were constructed to estimate the probability of PCR: a Bayesian network (BN), logistic regression (LR) model, and multi-layer perceptron (MLP) network. The classifiers were trained on a sample of 2 853 376 surgeries reported to the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO) between 2008 and 2018. The performance of the classifiers was evaluated based on the area under the precision-recall curve (AUPRC) and compared to existing scoring models in the literature. Furthermore, direct risk factors for PCR were identified by analysing the independence structure of the BN. RESULTS The MLP network predicted PCR overall the best (AUPRC 13.1 ± 0.41%), followed by the BN (AUPRC 8.05 ± 0.39%) and the LR model (AUPRC 7.31 ± 0.15%). Direct risk factors for PCR include preoperative best-corrected visual acuity (BCVA), year of surgery, operation type, anaesthesia, target refraction, other ocular comorbidities, white cataract, and corneal opacities. CONCLUSIONS Our results suggest that the MLP network performs better than existing scoring models in the literature, despite a relatively low precision at high recall. Consequently, implementing the MLP network in clinical practice can potentially decrease the PCR rate.
Collapse
Affiliation(s)
- Ron J M A Triepels
- Department of Data Analytics and Digitalisation, Maastricht University, Maastricht, the Netherlands
| | - Maartje H M Segers
- University Eye Clinic, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Paul Rosen
- Department of Ophthalmology, Oxford Eye Hospital, Oxford, UK
| | - Rudy M M A Nuijts
- University Eye Clinic, Maastricht University Medical Center+, Maastricht, the Netherlands
| | | | - Ype P Henry
- Department of Ophthalmology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Ulf Stenevi
- Department of Ophthalmology, Sahlgrenska University Hospital, Göteborg, Sweden
| | | | - David Young
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Anders Behndig
- Department of Clinical Sciences, Ophthalmology, Umeå University, Umeå, Sweden
| | - Mats Lundström
- Department of Clinical Sciences, Ophthalmology, Lund University, Lund, Sweden
| | - Mor M Dickman
- University Eye Clinic, Maastricht University Medical Center+, Maastricht, the Netherlands
| |
Collapse
|
4
|
Comparative visual outcomes of EDOF intraocular lens with FLACS vs conventional phacoemulsification. J Cataract Refract Surg 2023; 49:55-61. [PMID: 36104008 PMCID: PMC9788925 DOI: 10.1097/j.jcrs.0000000000001027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/20/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE To investigate the visual quality after femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification surgery (CPS) with the implantation of an extended depth-of-focus (EDOF) intraocular lens (IOL) TECNIS Symfony. SETTING Eye Center, the Second Affiliated Hospital of Zhejiang University, Zhejiang, China. DESIGN Prospective cohort study. METHODS Patients were given the option to choose FLACS or CPS and were implanted with a TECNIS Symfony. Main outcome measures were postoperative examinations that included defocus curves, contrast sensitivity (CS), optic path difference aberrometry scan, anterior segment photography, and questionnaires. RESULTS 261 patients (261 eyes) were enrolled. The circularity index of FLACS was more precise than that of CPS ( P = .001). FLACS demonstrated a significantly lower IOL decentration ( P = .011) and IOL tilt ( P = .009). FLACS presented a significantly lower total aberration ( P < .001), higher-order aberrations (HOAs) ( P = .001), coma ( P = .001), and spherical aberration ( P < .001). With IOL decentration of more than 0.40 mm, total internal aberration ( P = .023) and HOAs ( P = .045) were significantly deteriorated. As for defocus curve, FLACS was better at -1.00 diopter ( P < .01). The FLACS group achieved higher CS at 6 to 18 cycles per degree under glare condition ( P < .05). With regard to photic phenomena, the FLACS group received better outcomes ( P < .05). CONCLUSIONS With the implantation of an EDOF IOL, FLACS could precisely control the shape and size of the capsulotomy and induce a significantly better-centered IOL, leading to higher visual performance compared with CPS.
Collapse
|
5
|
Elhusseiny AM, Salim S. Cataract surgery in myopic eyes. Curr Opin Ophthalmol 2023; 34:64-70. [PMID: 36473016 DOI: 10.1097/icu.0000000000000914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW We discuss the preoperative, intraoperative, and postoperative considerations for cataract surgery in eyes with high myopia. We also reviewed the recent literature on refractive outcomes and complications of cataract surgery in myopic eyes. RECENT FINDINGS Several novel intraocular lens (IOL) power calculation formulas have recently been developed to optimize refractive outcomes. Haigis formula is the most accurate among the third-generation IOL formulas. Novel formulas such as Barrett Universal II, Kane, and modified Wang-Koch adjustment for Holladay I formula provide a better refractive prediction compared with old formulas. Intraoperatively, the chopping technique is preferred to minimize pressure on weak zonules and reduce the incidence of posterior capsule rupture. Anterior capsular polishing is recommended to reduce the risk of postoperative capsular contraction syndrome (CCS). Postoperatively, complications such as refractive surprises, intraocular pressure spikes, and CCS remain higher in myopic eyes. Only 63% of myopic patients with axial length more than 26 mm achieve a visual acuity at least 20/40 after cataract surgery, mainly because of coexisting ocular comorbidities. SUMMARY There are multiple preoperative, intraoperative, and postoperative considerations when performing cataract surgery in myopic eyes. Further research is needed to optimize the refractive outcomes in these eyes and determine the best IOL formula. Surgeons should be adept and knowledgeable with different techniques to manage intraoperative complications.
Collapse
Affiliation(s)
- Abdelrahman M Elhusseiny
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas.,Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School
| | - Sarwat Salim
- Department of Ophthalmology, Tufts University School of Medicine, Boston, Massachusetts, USA
| |
Collapse
|
6
|
Day AC, Norridge CFE, Donachie PHJ, Barnes B, Sparrow JM. Royal College of Ophthalmologists' National Ophthalmology Database study of cataract surgery: report 8, cohort analysis of the relationship between intraoperative complications of cataract surgery and axial length. BMJ Open 2022; 12:e053560. [PMID: 35985773 PMCID: PMC9396167 DOI: 10.1136/bmjopen-2021-053560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To describe the relationships between axial length and intraoperative complications in patients undergoing cataract surgery. DESIGN Cohort analysis of the Royal College of Ophthalmologists' National Ophthalmology Database (RCOphth NOD). SETTING 110 National Health Service Trusts in England, Health Boards in Wales, Independent Sector Treatment Centres and Guernsey. PARTICIPANTS 820 354 patients, aged 18 years or older, undergoing cataract surgery. Eligible operations were those from centres with at least 50 operations with a recorded axial length measurement and age at surgery between 1 April 2010 and 31 August 2019. INTERVENTIONS Phacoemulsification where the primary intention was cataract surgery alone. OUTCOME MEASURES Posterior capsule rupture (PCR) and other recorded intraoperative complications. RESULTS 1 211 520 eligible operations were performed by 3210 surgeons. The baseline axial length was <21 mm (short eyes) for 17 170 (1.4%) eyes, 21-28 mm (medium eyes) for 1 182 513 (97.6%) eyes and >28 mm (long eyes) for 11 837 (1.0%) eyes. The median age at surgery was younger for patients with long eyes than those with short or medium eyes. The rate of any intraoperative complication was higher for short eyes than medium or long with complication rates of 4.5%, 2.9% and 3.3%, respectively (p<0.001). PCR occurred in 1.40% surgeries overall, and in 1.53%, 1.40% and 1.61% of short, medium and long eyes, respectively (p=0.043, not significant at the 1% level). CONCLUSIONS Overall PCR rates for cataract surgery in RCOphth NOD contributing centres are lower than previously reported and there is little change in PCR rates by axial length. Short eyes were more likely to have an intraoperative complication than medium or long eyes.
Collapse
Affiliation(s)
- Alexander C Day
- Institute of Ophthalmology, UCL, London, UK
- Cataract Service, Moorfields Eye Hospital City Road Campus, London, UK
| | - Charlotte F E Norridge
- College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, UK
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Paul H J Donachie
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
- Royal College of Ophthalmologists, London, UK
| | - Beth Barnes
- Royal College of Ophthalmologists, London, UK
| | | |
Collapse
|
7
|
Gabriel M, Großpötzl M, Wallisch F, Djavid D, Pregartner G, Haas A, Wedrich A, Mayer‐Xanthaki C. In-depth analysis of risk factors for pseudophakic retinal detachments and retinal breaks. Acta Ophthalmol 2022; 100:e694-e700. [PMID: 34258879 PMCID: PMC9290023 DOI: 10.1111/aos.14974] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/18/2021] [Indexed: 11/28/2022]
Abstract
Purpose To provide a detailed analysis of risk factors for pseudophakic retinal detachments (PRD) and pseudophakic retinal breaks (PRB). Materials and methods We reviewed the medical records of cataract surgeries between 1996 and 2017 at a tertiary care hospital in Austria. A Cox proportional‐hazard regression model was used to analyse risk factors for PRD and PRB. Results Sixty‐five thousand six hundred and sixty‐two eyes (45 043 patients) underwent phacoemulsification, and 393 eyes (cumulative incidence 0.6%) were diagnosed with PRD (327 eyes) or PRB (66 eyes) during the follow‐up (median 7.1 years, range 0–21). Calculation of adjusted hazard ratios (HR) revealed a hierarchy of risk factors for either event including (from the highest to the lowest risk) posterior capsular rupture (PCR), patient age <65 years (compared with the age group >75 years), male gender and high myopia. Diabetes mellitus was associated with a lower risk. PCR was the strongest risk factor for PRD both in patients with and without perioperative vitrectomy (i.e. vitreous loss), but time to PRD was significantly reduced only following PCR with vitrectomy. Conclusions Posterior capsular rupture, young patient age, male gender and high myopia were risk factors for PRD, but diabetes mellitus was associated with a lower risk. PCR had the strongest association with PRD, regardless of the need for perioperative vitrectomy due to vitreous loss. Time to PRD was reduced in patients with PCR and vitrectomy compared with PCR without the need for vitrectomy or uneventful surgery.
Collapse
Affiliation(s)
| | - Manuel Großpötzl
- Department of Ophthalmology Medical University of Graz Graz Austria
| | - Fabian Wallisch
- Department of Ophthalmology Medical University of Graz Graz Austria
| | - Daniel Djavid
- Department of Ophthalmology Medical University of Graz Graz Austria
| | - Gudrun Pregartner
- Institute for Medical Informatics, Statistics and Documentation Medical University of Graz Graz Austria
| | - Anton Haas
- Department of Ophthalmology Medical University of Graz Graz Austria
| | - Andreas Wedrich
- Department of Ophthalmology Medical University of Graz Graz Austria
| | | |
Collapse
|
8
|
Femtosecond Laser-Assisted Cataract Surgery. Ophthalmology 2022; 129:946-954. [PMID: 35570159 PMCID: PMC10123052 DOI: 10.1016/j.ophtha.2022.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate refractive outcomes, safety, and cost-effectiveness of femtosecond laser-assisted cataract surgery (FLACS) compared with phacoemulsification cataract surgery (PCS). METHODS A PubMed search of FLACS was conducted in August 2020. A total of 727 abstracts were reviewed and 33 were selected for full-text review. Twelve articles met inclusion criteria and were included in this assessment. The panel methodologist assigned a level of evidence rating of I to all 12 studies. RESULTS No significant differences were found in mean uncorrected distance visual acuity, best-corrected distance visual acuity, or the percentage of eyes within ± 0.5 and ± 1 diopter of intended refractive target between FLACS and PCS. Intraoperative and postoperative complication rates were similar between the 2 groups, and most studies showed no difference in endothelial cell loss between FLACS and PCS at various time points between 1 and 6 months. In large randomized controlled studies in the United Kingdom and France, FLACS was less cost-effective than PCS. CONCLUSIONS Both FLACS and PCS have similar excellent safety and refractive outcomes. At this time, one technique is not superior to the other, but economic analyses performed in some populations have shown that FLACS is less cost-effective.
Collapse
|
9
|
Bjerager J, Dijk EHC, Holm LM, Singh A, Subhi Y. Previous intravitreal injection as a risk factor of posterior capsule rupture in cataract surgery: a systematic review and meta-analysis. Acta Ophthalmol 2022; 100:614-623. [PMID: 35060678 DOI: 10.1111/aos.15089] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/25/2021] [Accepted: 12/29/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Intravitreal injections and cataract surgery are two common procedures in the elderly. Posterior capsular rupture (PCR) is a rare but important complication of cataract surgery. We systematically reviewed the literature on previous intravitreal injections as a risk factor of PCR and performed meta-analyses to provide pooled summary risk estimates. METHODS We searched 13 literature databases on 1 June 2021 for studies evaluating the risk of PCR in eyes undergoing cataract surgery with data on previous intravitreal injections. Data extraction was made independently by two authors and discussed afterwards until reaching consensus. Random effects meta-analyses on the pooled odds ratio (OR) of PCR in eyes with previous intravitreal injections were made using MetaXL 5.3. RESULTS Six studies on 1 051 097 eyes undergoing cataract surgery were eligible for the qualitative and quantitative review. Previous history of intravitreal injections was present in 7034 eyes (majority was anti-VEGF). Our meta-analyses revealed that any previous intravitreal injection was a risk factor for PCR with an OR of 2.30 (95% CI 1.39-3.81). For each previous intravitreal injection, the risk of PCR was OR 1.04 (95% CI 1.01-1.08) (equivalent of relative risk ~1.04). In other words, risk of PCR increases by 4% for each previous intravitreal injection. CONCLUSIONS Previous intravitreal injection is a risk factor for PCR and should be taken into account when planning cataract surgery. However, to be regarded as a clinically significant risk of PCR, a substantial number of previous intravitreal injection (e.g. ≥10) should have been administered, considering that the a priori risk of PCR is very low (~1%).
Collapse
Affiliation(s)
- Jakob Bjerager
- Department of Ophthalmology Rigshospitalet Glostrup Denmark
| | - Elon H. C. Dijk
- Department of Ophthalmology Leiden University Medical Center Leiden The Netherlands
| | - Lars Morten Holm
- Department of Ophthalmology Rigshospitalet Glostrup Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Amardeep Singh
- Department of Ophthalmology Rigshospitalet Glostrup Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Yousif Subhi
- Department of Ophthalmology Rigshospitalet Glostrup Denmark
- Department of Clinical Research University of Southern Denmark Odense Denmark
| |
Collapse
|
10
|
Segers MHM, Behndig A, van den Biggelaar FJHM, Brocato L, Henry YP, Nuijts RMMA, Rosen P, Tassignon MJ, Young D, Stenevi U, Lundström M, Dickman MM. Risk factors for posterior capsule rupture in cataract surgery as reflected in the European Registry of Quality Outcomes for Cataract and Refractive Surgery. J Cataract Refract Surg 2022; 48:51-55. [PMID: 34074994 DOI: 10.1097/j.jcrs.0000000000000708] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 05/26/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To analyze the incidence and risk factors for posterior capsule rupture (PCR) in cataract surgery. SETTING European clinics affiliated with the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO). DESIGN Retrospective cross-sectional register-based study. METHODS Data were obtained from the EUREQUO. The database contains data on demographics, comorbidities, and intraoperative complications, including PCR for the study period from January 1, 2008, to December 31, 2018. Univariate and multivariate logistic regression analyses were performed to estimate the (adjusted) odds ratio (OR) and 95% confidence intervals (CIs). RESULTS We analyzed EUREQUO registry data of 2,853,376 patients, and 31,749 (1.1%) cataract surgeries were complicated by a PCR. Data were available of 2 853 376 patients, and 31 749 (1.1%) cataract surgeries were complicated by a PCR. The PCR rate ranged from 0.60% to 1.65% throughout the years, with a decreasing trend (P < .001). The mean age of the PCR cohort was 74.8 ± 10.5 years, and 17 29 (55.5%) patients were female. Risk factors most significantly associated with PCR were corneal opacities (OR 3.21, 95% CI, 3.02-3.41, P < .001), diabetic retinopathy (OR 2.74, 95% CI, 2.59-2.90, P < .001), poor preoperative visual acuity (OR 1.98, 95% CI, 1.88-2.07, P < .001), and white cataract (OR 1.87, 95% CI, 1.72-2.03, P < .001). CONCLUSIONS Risk factors for PCR were identified based on the EUREQUO, and the incidence of this complication is decreasing over time.
Collapse
Affiliation(s)
- Maartje H M Segers
- From the University Eye Clinic, Maastricht University Medical Center+, Maastricht, the Netherlands (Segers, van den Biggelaar, Nuijts, Dickman); Department of Clinical Sciences, Ophthalmology, Umeå University, Umeå, Sweden (Behndig); ESCRS, Dublin, Ireland (Brocato); Department of Ophthalmology, Amsterdam UMC, Amsterdam, the Netherlands (Henry); Department of Ophthalmology, Oxford Eye Hospital, Oxford, United Kingdom (Rosen); Department of Ophthalmology, Antwerp University Hospital, Antwerp, Belgium (Tassignon); Department of Mathematics and Statistics, University of Strathclyde, Glasgow, United Kingdom (Young); Department of Ophthalmology, Sahgrenska University Hospital, Mölndal, Sweden (Stenevi); Department of Clinical Sciences, Ophthalmology, Lund University, Lund, Sweden (Lundström)
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Stuart M, Mooney C, Hrabovsky M, Silvestri G, Stewart S. Surgical planning during a pandemic: Identifying patients at high risk of severe disease or death due to COVID-19 in a cohort of patients on a cataract surgery waiting list. THE ULSTER MEDICAL JOURNAL 2022; 91:19-25. [PMID: 35169334 PMCID: PMC8835415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/22/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND The delivery of cataract surgery during the COVID-19 pandemic is challenging because of the risk of nosocomial SARS-CoV-2 infection when patients attend hospital for elective care. In order to ascertain the risk to patients awaiting cataract surgery, this study aimed to identify the presence of systemic comorbidities that are associated with a high risk of severe disease or death due to COVID-19. METHODS A prospective study of 315 patients (630 eyes) was conducted from 3rd June to 31st July 2020. An electronic health record was used to identify any systemic comorbidities that would render a patient 'clinically extremely vulnerable' to COVID-19, as outlined by the Department of Health for Northern Ireland. Patient demographics, best-corrected visual acuity (VA) and risk of postoperative anisometropia were also recorded. RESULTS The median age of patients awaiting cataract surgery was 76 years (range 22-97). Of the 315 patients, 72% were aged over 70 and 16% were aged over 85. A systemic comorbidity that would confer high risk status was identified in 21% of patients. This high risk status was attributable to severe respiratory disease, cancer, and immunosuppression therapies in the majority of cases. The high risk group were younger than those deemed non-high risk, but there were no significant differences with respect to gender, anticipated degree of surgical difficulty, VA, or whether the patient was undergoing first or second eye surgery. Of those patients awaiting first eye cataract surgery, the mean VA in the listed eye was 0.84 logMAR and 39% (70/179) had a VA <0.3 logMAR (6/12 Snellen acuity) in their fellow eye. 57% of patients were awaiting first eye surgery, and 32% of those patients would be at risk of symptomatic anisometropia postoperatively. CONCLUSION One-fifth of patients awaiting cataract surgery were found to be at high risk of severe disease or death from COVID-19 and these patients may experience delays in their surgical care. Additional planning is required in order to minimise the morbidity associated with delayed cataract surgery.
Collapse
Affiliation(s)
- Mark Stuart
- Department of Ophthalmology, Belfast Health and Social Care Trust,School of Medical Sciences, University of Manchester
| | - Ciaran Mooney
- Department of Ophthalmology, Belfast Health and Social Care Trust,School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast
| | - Monica Hrabovsky
- Department of Ophthalmology, Belfast Health and Social Care Trust
| | | | - Stephen Stewart
- Department of Ophthalmology, Belfast Health and Social Care Trust
| |
Collapse
|
12
|
Yao Y, Lu Q, Wei L, Cheng K, Lu Y, Zhu X. Efficacy and complications of cataract surgery in high myopia. J Cataract Refract Surg 2021; 47:1473-1480. [PMID: 33929806 DOI: 10.1097/j.jcrs.0000000000000664] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/20/2021] [Indexed: 11/26/2022]
Abstract
To evaluate the efficacy and complications of cataract surgery in high myopia, a comprehensive search query was conducted from January 2000 to August 2020. A total of 19 586 highly myopic eyes from 28 studies were included. Modern cataract surgery turns out efficacious in highly myopic eyes with significant improvement of visual acuity. However, phacoemulsification-related complications such as posterior capsular rupture (3.91%, 95% CI, 1.98%-6.37%), retinal detachment (1.74%, 95% CI, 1.36%-2.15%), progressed myopic traction maculopathy (5.07%, 95% CI, 1.80%-9.37%), capsular contraction syndrome (2.1%), intraocular lens dislocation (0.58%), and transient intraocular pressure elevation (28.15%, 95% CI, 20.29%-36.70%) occurred more frequently in the highly myopic population. Separate analyses were also conducted based on follow-up period. In conclusion, modern cataract surgery was effective for highly myopic cataract patients, whereas careful precautions and sufficient follow-ups were of great value because of higher incidences of intraoperative and postoperative complications.
Collapse
Affiliation(s)
- Yunqian Yao
- From the Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China; NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China; Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | | | | | | | | | | |
Collapse
|
13
|
Matarazzo F, Phylactou M, Aiello F, Gallo Afflitto G, Yue Sim S, Maurino V. Incidence and complications of retained lens fragment in the anterior chamber after uneventful cataract surgery in a United Kingdom tertiary center. J Cataract Refract Surg 2021; 47:1064-1070. [PMID: 34292892 DOI: 10.1097/j.jcrs.0000000000000585] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 01/12/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To analyze the outcomes of retained lens fragment (RLF) in the anterior chamber after uneventful cataract surgery. SETTING Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom. DESIGN Retrospective, observational cross-sectional study. METHODS A single-center, retrospective review was performed to identify patients who underwent RLF removal after uneventful phacoemulsification surgery between October 2012 and November 2018; 122 eyes from 121 patients were identified. Patient characteristics, clinical findings, visual outcomes, and need for subsequent surgical procedure were recorded. Main outcomes were change in corrected distance visual acuity (CDVA), and number and risk factors associated with additional surgery following RLF removal. RESULTS One hundred twenty-two RLF over a total of 98 467 uneventful phacoemulsification surgeries were identified, with an incidence of 1 (0.124%) in 807 operations. The mean CDVA improved significantly after RLF removal from 0.32 to 0.26 logMAR (SD 0.26) (P = .001). Six eyes (4.9%) had persistent corneal edema that required endothelial keratoplasty (EK) after a mean of 13 months after RLF removal (SD 12 months; median 8; range 4 to 35). Risk factors for EK include α-receptor blocker use (odds ratio [OR], 6.75; 95% CI, 1.069, 42.63), increased interval (month) between cataract surgery and diagnosis of RLF (OR, 1.29; CI: 1.080, 1.541), increased interval between cataract surgery and RLF washout (OR, 1.28; CI, 1.075, 1.522), and RLF diagnosis on gonioscopy (OR, 10.60; CI, 1.885, 59.59). CONCLUSIONS RLF is a rare complication of uneventful cataract surgery and appears more frequently in challenging cataract cases and myopic eyes. CDVA improved significantly after RLF removal, but approximately 1 in 20 eyes needed additional surgery-mainly EK for corneal decompensation.
Collapse
Affiliation(s)
- Francesco Matarazzo
- From the Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom (Matarazzo, Phylactou, Sim, Mauriono); and Ophthalmology Unit, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy (Aiello, Afflitto)
| | | | | | | | | | | |
Collapse
|
14
|
The effect of surgical abstinence on the risk of posterior capsule rupture during cataract surgery. J Cataract Refract Surg 2021; 48:173-176. [PMID: 34261984 DOI: 10.1097/j.jcrs.0000000000000741] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/28/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the impact of surgery restrictions on cataract surgery performance. SETTING Moorfields Eye Hospital, NHS Foundation Trust, London, UK. DESIGN Retrospective, observational cross-sectional study. METHODS Single-centre, retrospective review of all patients that underwent phacoemulsification surgery at Moorfields Eye Hospital, between September 2019 and January 2021. Our main outcome measure was Posterior Capsule Rupture (PCR) rate before and after COVID-19 imposed restrictions to elective cataract surgery. RESULTS We identified a total of 15689 surgeries in the period of the study performed by 256 different surgeons. In the pre-surgery restriction period (September 2019 to March 2020), the PCR rate was 0.99% while on surgery restarting after 19 weeks, the PCR rate spiked to 1.62% (Odds Ratio 1.65; p=0.001; CI 1.24-2.20; Relative Risk: 1.64). CONCLUSIONS COVID-19 pandemic provided a unique opportunity to assess a large group of surgeons' performances after prolonged surgical abstinence. A 19-weeks period of restrictions in surgical activity showed an increased incidence of PCR complications. This is relevant as it can concern any surgeon on extended time off work such as sickness, sabbatical, research and parental leave. Supporting strategies should be implemented by associated regulators to minimize this negative impact.
Collapse
|
15
|
Fernández-Vega Cueto A, Rodríguez-Una I, Rodríguez-Calvo PP, Alfonso JF. Femtosecond laser-assisted cataract surgery in shallow anterior chamber cases. Int Ophthalmol 2020; 41:707-717. [PMID: 33099746 DOI: 10.1007/s10792-020-01628-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 10/17/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess the effectiveness, safety and predictability of femtosecond laser-assisted cataract surgery (FLACS) in eyes with shallow anterior chamber (AC). METHODS This is a prospective consecutive clinical study. All eyes presented an anterior chamber depth (ACD) ≤ 2.1 mm and were submitted to FLACS with monofocal intraocular lens (mIOL) or trifocal intraocular lens (tIOL) implantation. Uncorrected distance visual acuity (VA) and corrected distance VA values were used to assess efficacy and safety of the surgery. Refraction, intraocular pressure (IOP), endothelial cell density (ECD) and ACD were evaluated before and 6 months post-surgery. RESULTS Phacoemulsification was carried out successfully in all eyes, without intra- or postoperative complications. Efficacy and safety indexes were 0.96 and 1.26 for the mIOL group, and 0.87 and 1.01 for the tIOL group, respectively. The mean postoperative spherical equivalent was - 0.06 ± 0.28D and - 0.14 ± 0.38D for the mIOL and tIOL groups, respectively. The ECD varied from 2470 ± 483 to 2009 ± 538 cells/mm2 (p < 0.05) and from 2443 ± 319 to 2245 ± 628 cells/mm2 (p = 0.06) for the mIOL and tIOL groups, respectively. IOP significantly decreased (p < 0.05) after the surgery from 14.34 to 12.85 mmHg for the mIOL group and from 14.37 to 11.91 mmHg for the tIOL group, with a general reduction of medical hypotensive treatment in both groups (85% of cases required ≤ number of medications). ACD changed significantly (p < 0.05) from 1.96 ± 0.15 mm to 3.75 ± 0.30 mm after the surgery in the mIOL group and from 1.94 ± 0.15 mm to 3.23 ± 0.21 mm for the tIOL group. CONCLUSION FLACS with implantation of either mIOL or tIOL may provide good efficacy, safety and predictability in eyes with shallow AC.
Collapse
Affiliation(s)
- Andrés Fernández-Vega Cueto
- Fernández-Vega Ophthalmological Institute, University of Oviedo, Avda. Dres. Fernández-Vega, 34, 33012, Oviedo, Spain
| | - Ignacio Rodríguez-Una
- Fernández-Vega Ophthalmological Institute, University of Oviedo, Avda. Dres. Fernández-Vega, 34, 33012, Oviedo, Spain.
| | - Pedro P Rodríguez-Calvo
- Fernández-Vega Ophthalmological Institute, University of Oviedo, Avda. Dres. Fernández-Vega, 34, 33012, Oviedo, Spain
| | - José F Alfonso
- Fernández-Vega Ophthalmological Institute, University of Oviedo, Avda. Dres. Fernández-Vega, 34, 33012, Oviedo, Spain
| |
Collapse
|
16
|
Zetterberg M, Kugelberg M, Nilsson I, Lundström M, Behndig A, Montan P. A Composite Risk Score for Capsule Complications Based on Data from the Swedish National Cataract Register: Relation to Surgery Volumes. Ophthalmology 2020; 128:364-371. [PMID: 32710994 DOI: 10.1016/j.ophtha.2020.07.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 07/09/2020] [Accepted: 07/16/2020] [Indexed: 02/02/2023] Open
Abstract
PURPOSE To investigate case mix in relation to capsule complication, possible associations between case mix and operation volume, and change in case mix over time. DESIGN Register-based study. PARTICIPANTS Swedish patients who underwent cataract surgery between 2007 and 2016. METHODS Demographics and data on ocular comorbidity, intraoperative difficulties, and capsule complications were registered from 2007 to 2016 and analyzed retrospectively in relation to coded data on individual surgeons' operation volume. Single factor analysis and logistic regression were performed, and a composite risk score was created. MAIN OUTCOME MEASURES Risk of capsule complication, given as adjusted and composite odds ratio in relation to cataract surgery volume. RESULTS Preoperative and intraoperative variables significantly associated with capsule complications were best-corrected visual acuity (BCVA) ≤0.1 (decimal, adjusted odds ratio [aOR], 1.82; P < 0.001); pseudoexfoliation (PEX) (aOR, 1.53; P < 0.001); sight-threatening ocular comorbidity other than age-related macular degeneration (AMD), diabetic retinopathy, glaucoma, or cornea guttata (aOR, 1.35; P = 0.006); use of Trypan blue (aOR, 1.76; P < 0.001); mechanical pupil dilation (aOR, 1.36; P = 0.024); and iris hooks at the rhexis margin (aOR, 6.99; P < 0.001). The composite risk score was 3.09 ± 6.40 (mean ± standard deviation) for patients with capsule complication and 1.28 ± 1.66 for uncomplicated procedures (P < 0.001). High-volume cataract surgeons (≥500 procedures yearly) had a significantly lower composite risk score (mean risk score ≤1.28; range, 1.01-2.02) compared with low- and medium-volume cataract surgeons (1.34 ± 0.56; range, 1.00-4.55 and 1.49 ± 0.58; range, 1.01-5.19), respectively. During the period 2007-2016, the proportion of patients aged >88 years, patients with BCVA ≤0.1, and patients with intraoperative difficulties decreased. CONCLUSIONS Case mix, as calculated from a composite risk score based on preoperative and intraoperative parameters registered in the National Cataract Register (NCR), may contribute to the decrease in capsule complications from 2007 to 2016 and the lower complication rate observed in cases managed by high-volume cataract surgeons.
Collapse
Affiliation(s)
- Madeleine Zetterberg
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Department of Ophthalmology, Sahlgrenska University Hospital, Mölndal, Sweden.
| | - Maria Kugelberg
- Department of Clinical Neuroscience, Division of Ophthalmology and Vision, Karolinska Institute, Stockholm, Sweden; St Erik Eye Hospital, Stockholm, Sweden
| | - Ingela Nilsson
- Capio Medocular AB, Malmö, Department of Clinical Sciences/Ophthalmology, Malmö, Sweden
| | - Mats Lundström
- EyeNet Sweden, Blekinge Hospital, Karlskrona, Sweden; Faculty of Medicine, Lund University, Lund, Sweden
| | - Anders Behndig
- EyeNet Sweden, Blekinge Hospital, Karlskrona, Sweden; Department of Clinical Sciences/Ophthalmology, Umeå University, Umeå, Sweden
| | - Per Montan
- Department of Clinical Neuroscience, Division of Ophthalmology and Vision, Karolinska Institute, Stockholm, Sweden; St Erik Eye Hospital, Stockholm, Sweden
| |
Collapse
|
17
|
Pantalon AD, Barata ADDO, Georgopoulos M, Ratnarajan G. Outcomes of phacoemulsification combined with two iStent inject trabecular microbypass stents with or without endocyclophotocoagulation. Br J Ophthalmol 2020; 104:1378-1383. [PMID: 31980421 DOI: 10.1136/bjophthalmol-2019-315434] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/09/2020] [Accepted: 01/13/2020] [Indexed: 11/04/2022]
Abstract
AIM Comparing outcomes after combined phacoemulsification, two iStents insertion and endocyclophotocoagulation (ECP) versus phacoemulsification-iStents alone. METHODS This is a longitudinal retrospective 12 months study in eyes with ocular hypertension or early-to-moderate open angle glaucoma. Level of disease, intraocular pressure (IOP) and tolerance of glaucoma medication were considered before planning surgery. Best-corrected visual acuity (BCVA-logMAR), IOP (mm Hg), number of medications were assessed at baseline, week 1, week 5, month 3, 6, 12 postop. MAIN OUTCOME percentage (%) in IOP reduction at 12 months vs medicated baseline. SECONDARY OUTCOMES absolute values of IOP/medication reduction, BCVA and postop complications. RESULTS The ICE2 (two iStents-cataract extraction-ECP) group included 63 eyes and Phaco-iStent group included 46 eyes. Baseline IOP was higher in the ICE2 than phaco-iStent group (19.97±4.31 mm Hg vs 17.63±3.86 mm Hg, p=0.004) and mean deviation was lower (-7.20±2.58 dB vs -4.94±4.51 dB, p=0.037). Number of medications were comparable at baseline: 2.22±1.06 (ICE2) vs 2.07±1.02 (phaco-iStent), p=0.442. At month 12 postop, IOP in the ICE2 group decreased 35% from baseline vs 21% in the phaco-iStent group (p=0.03); absolute IOP reduction was significantly lower than baseline in each group (p<0.001), yet final IOP was lower in the ICE2 group than phaco-iStent group (13.05±2.18 mm Hg vs 14.09±1.86 mm Hg, p=0.01). Similar results were found for glaucoma medication (1.24±1.05 in ICE2 group vs 1.39±1.03 in phaco-iStent group, p=0.01). Final BCVA was 0.11±0.18 (phaco-iStent group) vs 0.08±0.08 (ICE2 group), p=0.309. Safety outcomes were comparable between groups. CONCLUSION ICE2 procedure offers better results in IOP/medication reduction at 12 months than phacoemulsification-iStents alone.
Collapse
Affiliation(s)
- Anca Delia Pantalon
- Eye Unit and Eye Bank, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK.,Ophthalmology, "St. Spiridon" University Hospital, Iasi, Romania
| | - Andre Diogo De Oliveira Barata
- Eye Unit and Eye Bank, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK.,Ophthalmology, Santa Maria Central Hospital, Lisbon, Portugal
| | - Minas Georgopoulos
- Eye Unit and Eye Bank, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK.,Ophthalmology, East Surrey Hospital, Redhill, UK
| | - Gokulan Ratnarajan
- Eye Unit and Eye Bank, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
| |
Collapse
|
18
|
Buchan JC, Donachie PHJ, Cassels-Brown A, Liu C, Pyott A, Yip JLY, Zarei-Ghanavati M, Sparrow JM. The Royal College of Ophthalmologists' National Ophthalmology Database study of cataract surgery: Report 7, immediate sequential bilateral cataract surgery in the UK: Current practice and patient selection. Eye (Lond) 2020; 34:1866-1874. [PMID: 31911654 PMCID: PMC7608287 DOI: 10.1038/s41433-019-0761-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 12/18/2019] [Accepted: 12/19/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Cataract extraction is the most frequently performed surgical intervention in the world and demand is rising due to an ageing demography. One option to address this challenge is to offer selected patients immediate sequential bilateral cataract surgery (ISBCS). This study aims to investigate patient and operative characteristics for ISBCS and delayed bilateral cataract surgery (DSCS) in the UK. METHODS Data were analysed from the Royal College of Ophthalmologists' National Ophthalmology Database Audit (NOD) of cataract surgery. Eligible patients were those undergoing bilateral cataract extraction from centres with a record of at least one ISBCS operation between 01/04/2010 and 31/08/2018. Variable frequency comparison was undertaken with chi-square tests. RESULTS During the study period, 1073 patients had ISBCS and 248,341 DSCS from 73 centres. A higher proportion of ISBCS patients were unable to lie flat (11.3% vs. 1.8%; p < 0.001), unable to cooperate (9.7% vs. 2.7%; p < 0.001); underwent general anaesthesia (58.7% vs. 6.6% (p < 0.001)); had brunescent/white/mature cataracts (odds ratio (OR) 5.118); no fundal view/vitreous opacities (OR 8.381); had worse pre-operative acuity 0.60 LogMAR ISBCS vs. 0.50 (first) and 0.40 (second eye) DSCS and were younger (mean ages, 71.5 vs. 75.6 years; p < 0.001). Posterior capsular rupture (PCR) rates adjusted for case complexity were comparable (0.98% ISBCS and 0.78% DSCS). CONCLUSIONS ISBCS was performed on younger patients, with difficulty cooperating and lying flat, worse pre-operative vision, higher rates of known PCR risk factors and more frequent use of general anaesthesia than DSCS in centres recorded on NOD.
Collapse
Affiliation(s)
- John C Buchan
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK. .,Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK.
| | - Paul H J Donachie
- The Royal College of Ophthalmologists' National Ophthalmology Audit, 18 Stephenson Way, London, NW1 2HD, UK.,Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, GL53 7AN, UK
| | - Andy Cassels-Brown
- Centre for Sustainable Healthcare, Oxford, OX2 7JQ, UK.,NHS Highland, Inverness, IV2 7GE, UK
| | - Christopher Liu
- Tongdean Eye Clinic. Sussex Eye Hospital, Brighton and Sussex University Hospitals NHS Trust, Brighton and Sussex Medical School, Eastern Road, Brighton, BN2 5BF, UK
| | | | - Jennifer L Y Yip
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Mehran Zarei-Ghanavati
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - John M Sparrow
- The Royal College of Ophthalmologists' National Ophthalmology Audit, 18 Stephenson Way, London, NW1 2HD, UK.,Bristol Eye Hospital, Lower Maudlin Street, Bristol, BS1 2LX, UK
| |
Collapse
|
19
|
Haripriya A, Chang DF, Ravindran RD. Endophthalmitis reduction with intracameral moxifloxacin in eyes with and without surgical complications: Results from 2 million consecutive cataract surgeries. J Cataract Refract Surg 2019; 45:1226-1233. [DOI: 10.1016/j.jcrs.2019.04.018] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 04/12/2019] [Accepted: 04/16/2019] [Indexed: 01/21/2023]
|
20
|
Levitz L, Reich J, Hodge C. Posterior capsular complication rates with femtosecond laser-assisted cataract surgery: a consecutive comparative cohort and literature review. Clin Ophthalmol 2018; 12:1701-1706. [PMID: 30233133 PMCID: PMC6134952 DOI: 10.2147/opth.s173089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Purpose The aim of the study was to determine whether femtosecond-assisted laser cataract surgery (FLACS) reduces the posterior capsular complication (PCC) rate compared to manual cataract surgery when performed by an experienced surgeon. Patients and methods We reviewed 2,021 consecutive FLACS procedures between 1 June 2012 and 30 August 2017. All cases of posterior capsular rupture (PCR) with or without vitreous prolapse or zonular dialysis (ZD) that prevented an in-the-bag placement of the intraocular lens were included. Risk factors were noted and outcomes documented. Results Six eyes of 2,021 (0.3%) who underwent FLACS had either a PCR or ZD. One eye (0.25%) of 403 eyes that had manual cataract surgery had a PCR. There was no significant difference in outcomes. Risk factors included advanced age, dense nuclei, pseudoexfoliation and small pupil. Only a single case in the FLACS series may have been directly attributed to the FLACS procedure. Conclusion This study provides evidence that there is no significant difference in the PCC rate between FLACS and manual cataract surgery in the hand of an experienced surgeon who performs >350 cases annually. This low rate of complications may be achieved by less experienced surgeons adopting FLACS.
Collapse
Affiliation(s)
- Lewis Levitz
- Vision Eye Institute Camberwell, Hawthorn East, VIC, Australia,
| | - Joseph Reich
- Vision Eye Institute Camberwell, Hawthorn East, VIC, Australia,
| | - Chris Hodge
- Vision Eye Institute Camberwell, Hawthorn East, VIC, Australia, .,Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| |
Collapse
|
21
|
Day AC, Cooper D, Burr J, Foster PJ, Friedman DS, Gazzard G, Che-Hamzah J, Aung T, Ramsay CR, Azuara-Blanco A. Clear lens extraction for the management of primary angle closure glaucoma: surgical technique and refractive outcomes in the EAGLE cohort. Br J Ophthalmol 2018; 102:1658-1662. [PMID: 29453222 DOI: 10.1136/bjophthalmol-2017-311447] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/04/2018] [Accepted: 01/31/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND To describe the surgical technique and refractive outcomes following clear lens extraction (CLE) in the Effectiveness, in Angle-closure Glaucoma, of Lens Extraction trial. METHODS Review of prospectively collected data from a multicentre, randomised controlled trial comparing CLE and laser peripheral iridotomy. Eligible participants were ≥50 years old and newly diagnosed with (1) primary angle closure (PAC) with intraocular pressure above 30 mm Hg or (2) PAC glaucoma. We report the postoperative corrected distance visual acuity (CDVA) and refractive outcomes at 12 and 36 months postoperatively for those who underwent CLE. RESULTS Of the 419 participants, 208 were randomised to CLE. Mean baseline CDVA was 77.9 (SD 12.4) letters and did not change significantly at 36 months when mean CDVA was 79.9 (SD 10.9) letters. Mean preoperative spherical equivalents were +1.7 (SD 2.3) and +0.08 (SD 0.95) diopters (D) at 36 months. Fifty-nine per cent and 85% eyes were within ±0.5D and ±1.0D of predicted refraction, respectively, at 36 months. CONCLUSIONS Mean CDVA in patients undergoing CLE for angle-closure glaucoma appeared stable over the 3-year study period. Refractive error was significantly reduced with surgery but refractive predictability was suboptimal. TRIAL REGISTRATION NUMBER
Collapse
Affiliation(s)
- Alexander C Day
- NIHR Biomedical Research Centre, Moorfields Eye Hospital and University College London, London, UK
| | - David Cooper
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Jennifer Burr
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Paul J Foster
- NIHR Biomedical Research Centre, Moorfields Eye Hospital and University College London, London, UK
| | | | - Gus Gazzard
- NIHR Biomedical Research Centre, Moorfields Eye Hospital and University College London, London, UK
| | | | - Tin Aung
- Singapore Eye Research Institute, Singapore
| | - Craig R Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | |
Collapse
|
22
|
Lawless M, Levitz L, Hodge C. Reviewing the visual benefits of femtosecond laser-assisted cataract surgery: Can we improve our outcomes? Indian J Ophthalmol 2017; 65:1314-1322. [PMID: 29208811 PMCID: PMC5742959 DOI: 10.4103/ijo.ijo_736_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Femtosecond laser-assisted cataract surgery (FLACS) was introduced in 2009 and has increasingly been incorporated into surgical practice. The automation of three key aspects of cataract surgery was expected to deliver a significant improvement in both refractive and safety outcomes. The published literature has not yet shown consistent refractive improvement above conventional techniques. The purpose of this paper is to review current FLACS refractive outcomes and explore factors that may have contributed to the current findings and whether future improvements are possible.
Collapse
Affiliation(s)
- Michael Lawless
- Vision Eye Institute; Department of Ophthalmology, Sydney Medical School, Save Sight Institute, University of Sydney, Australia
| | | | - Chris Hodge
- Vision Eye Institute; Discipline of Orthoptics, Graduate School of Health, University of Technology Sydney, Sydney NSW, Australia
| |
Collapse
|