Han JV, Patel DV, Liu K, Kim BZ, Sherwin T, McGhee CNJ. Auckland Cataract Study IV: Practical application of NZCRS cataract risk stratification to reduce phacoemulsification complications.
Clin Exp Ophthalmol 2019;
48:311-318. [PMID:
31804765 DOI:
10.1111/ceo.13696]
[Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 11/11/2019] [Accepted: 11/15/2019] [Indexed: 12/01/2022]
Abstract
IMPORTANCE
Reduction of intraoperative complications in phacoemulsification cataract surgery.
BACKGROUND
To assess practicability of a risk stratification system, the New Zealand Cataract Risk Stratification (NZCRS) system, in a major teaching hospital service, without investigator oversight, to ascertain whether benefits identified in research studies are maintained in busy clinical practice.
DESIGN
Prospective cohort study in a major public teaching hospital.
PARTICIPANTS
Five hundred cases of phacoemulsification cataract surgery.
METHODS
NZCRS system inserted into 621 consecutive preoperative cataract patient files. Recommendation to allocate higher-risk cases to experienced surgeons.
MAIN OUTCOME MEASURES
NZCRS system uptake and adherence, appropriate identification of high risk cases and intraoperative complication rates.
RESULTS
NZCRS scores calculated in 500 of 621 (80.5%) cases and 98 (19.6%) scored as "high risk." Cataract surgery (N = 500) performed by: 12 Registrars (20%), 4 Fellows (7.2%), 26 Consultants (72.8%). Risk scores adhered to in 99%. Overall intraoperative complications (3.0%) included iris prolapse 1.6% and posterior capsule tear 0.8%. No statistical difference in complication rates identified between surgeon grades. Mean best-corrected visual acuity was 6/10 (20/32). Postoperatively, cystoid macular oedema occurred in 3.2%. Rescoring by an experienced investigator noted a greater number of "high risk scores" (31.6% vs 19.6%) related to differences in subjective scoring of anterior chamber depth and cataract density.
CONCLUSIONS AND RELEVANCE
Practical uptake of cataract risk stratification was promising in this study with NZCRS calculated in 80.5% with 99% adherence to scoring recommendations. Compared to baseline studies, in the day-to-day clinical setting, a continued, decreasing trend in frequency and severity of intraoperative complications was noted. Subjective variability of risk scoring may be further improved by better, objective, standardization.
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