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Cnaany Y, Goldstein A, Lavy I, Halpert M, Chowers I, Ben-Eli H. Ophthalmology Residents' Experience in Cataract Surgery: Preoperative Risk Factors, Intraoperative Complications, and Surgical Outcomes. Ophthalmol Ther 2024; 13:1783-1798. [PMID: 38696047 PMCID: PMC11109032 DOI: 10.1007/s40123-024-00947-6] [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: 02/23/2024] [Accepted: 03/26/2024] [Indexed: 05/22/2024] Open
Abstract
INTRODUCTION This retrospective study explores the connection between preoperative patient risk factors, the experience of ophthalmology residents, and the outcomes of cataract surgeries performed at Hadassah Medical Center. It is hypothesized that with increased experience, residents may demonstrate greater proficiency in handling surgeries on higher-risk patients, potentially leading to improved surgical outcomes overall. METHODS Data were examined from 691 consecutive cataract surgeries in 590 patients, conducted by ophthalmology residents at Hadassah Medical Center (January 2018 to February 2022). Demographics, surgeon experience, preoperative cataract risk assessment score, and pre- and postoperative corrected distance visual acuity (CDVA) were analyzed. The risk score was based on cataract density, previous vitrectomy, presence of phacodonesis, small pupil, extreme axial length (> 30 mm or < 21.5 mm) or abnormal axial length (26-30 mm), shallow anterior chamber (< 2.5 mm), poor patient cooperation, oral alpha-1 blocker use, diabetic retinopathy (DR), Fuchs endothelial dystrophy, and having one functioning eye. This study focused on the correlation of risk scores with residents' surgical experience and surgical outcomes. RESULTS As residents gained experience, surgeries on patients with at least one risk factor increased from 54% (first year) to 75% (second year; p < 0.001) and fluctuated between 75%, 82%, and 77% (third, fourth, and fifth years, respectively), with initial preoperative CDVA declining progressively. Despite handling more complex cases over time, the percentage of intraoperative complications per patient decreased with each year of residents' experience (17%, 13%, 11%, 17%, 6%; respectively). Patients without any risk factor had higher postoperative CDVA than those with one or more risk factors (mean ± standard deviation [SD] in logMAR, 0.16 ± 0.26 vs. 0.27 ± 0.35; p < 0.001) and a higher percentage of CDVA improvement (63% vs. 57%, p = 0.016). CONCLUSIONS The use of a preoperative risk assessment scoring system to allocate surgeries to residents at varying experience levels may reduce the risk for surgical complications, thereby ensuring patient safety and providing residents with a gradual learning experience.
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Affiliation(s)
- Yaacov Cnaany
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, POB 12000, 91120, Jerusalem, Israel
| | - Ayelet Goldstein
- Department of Computer Science, Hadassah Academic College, Jerusalem, Israel
| | - Itay Lavy
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, POB 12000, 91120, Jerusalem, Israel
| | - Michael Halpert
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, POB 12000, 91120, Jerusalem, Israel
| | - Itay Chowers
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, POB 12000, 91120, Jerusalem, Israel
| | - Hadas Ben-Eli
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, POB 12000, 91120, Jerusalem, Israel.
- Department of Optometry and Vision Science, Hadassah Academic College, Jerusalem, Israel.
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Kang C, Lee MJ, Chomsky A, Oetting TA, Greenberg PB. Risk factors for complications in resident-performed cataract surgery: A systematic review. Surv Ophthalmol 2024:S0039-6257(24)00032-8. [PMID: 38648911 DOI: 10.1016/j.survophthal.2024.04.002] [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: 12/22/2023] [Revised: 04/02/2024] [Accepted: 04/08/2024] [Indexed: 04/25/2024]
Abstract
We assessed risk factors for complications associated with resident-performed cataract surgery. Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, we searched 4databases in September, 2023. We included peer-reviewed, full-text, English-language articles assessing risk factors for complications in resident performed cataract surgery. We excluded studies describing cataract surgeries performed by fellows, combined surgeries, and studies with insufficient information. Our initial search yielded 6244 articles; 15 articles were included after title/abstract and full-text review. Patient-related risk factors included older age, hypertension, prior vitrectomy, zonular pathology, pseudoexfoliation, poor preoperative visual acuity, small pupils, and selected types of cataracts. Surgeon-related risk factors included resident postgraduate year and surgeon right-handedness. Other risk factors included absence of supervision, long phacoemulsification time, and phacoemulsification with high power and torsion. The quality of the studies was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation; most studies graded as moderate, primarily due to risk of bias. When assigning cases to residents, graduate medical educators should consider general and resident-specific risk factors to facilitate teaching and preserve patient safety.
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Affiliation(s)
- Chaerim Kang
- Program in Liberal Medical Education, Brown University, Providence, RI, USA; Division of Ophthalmology, Alpert Medical School, Brown University, Providence, RI, USA
| | - Matthew J Lee
- Division of Ophthalmology, Alpert Medical School, Brown University, Providence, RI, USA
| | - Amy Chomsky
- Department of Ophthalmology and Visual Sciences, Vanderbilt University, Nashville, TN, USA; Section of Ophthalmology, VA Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Thomas A Oetting
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Paul B Greenberg
- Division of Ophthalmology, Alpert Medical School, Brown University, Providence, RI, USA; Section of Ophthalmology, VA Providence Healthcare System, Providence, RI, USA.
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Lundström M, Kugelberg M, Zetterberg M, Nilsson I, Viberg A, Bro T, Behndig A. Ten-year trends of immediate sequential bilateral cataract surgery (ISBCS) as reflected in the Swedish National Cataract Register. Acta Ophthalmol 2024; 102:68-73. [PMID: 37133405 DOI: 10.1111/aos.15688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/14/2023] [Accepted: 04/21/2023] [Indexed: 05/04/2023]
Abstract
PURPOSE To analyse trends of ISBCS reported to the Swedish National Cataract Register (NCR) over a 10-year period. METHODS Since 2010 the NCR contains social security number of all individuals in the list of parameters reported to NCR after each cataract procedure. Bilateral surgeries were mapped out using social security numbers. When dates of both-eye surgeries are identical for an individual it is classified as an immediate sequential bilateral cataract surgery (ISBCS). This study includes all data reported during the period 1st of January 2010 to 31st of December 2019. During the study period 113 cataract surgery clinics affiliated to the NCR reported their data on consecutive cataract cases. RESULTS For the whole period 54 194 ISBCS were reported. The total number of bilateral cataract extractions was 422 300. There was a significant trend of increasing ISBCS over time with linear regression (Beta = 1.75, p < 0.001). In ISBCS the occurrence of an ocular comorbidity decreased over time. The use of a capsular tension ring was significantly more common in ISBCS than in delayed sequential bilateral cataract surgery (DSBCS). All other measures taken during surgery were more common in DSBCS. The use of multifocal IOL was significantly more frequent in ISBCS compared to DSBCS (p < 0.001). CONCLUSIONS The use of ISBCS has increased over the study period. The operated eyes have less risk factors than eyes going through a DSBCS, but both ocular comorbidities and surgical complications occur in ISBCS eyes.
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Affiliation(s)
- Mats Lundström
- Department of Clinical Sciences, Ophthalmology, Faculty of Medicine, Lund University, Lund, Sweden
| | - Maria Kugelberg
- SöderÖgon, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Andreas Viberg
- Department of Clinical Sciences, Ophthalmology, Umea University, Umeå, Sweden
| | - Tomas Bro
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Anders Behndig
- Department of Clinical Sciences, Ophthalmology, Umea University, Umeå, Sweden
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Arad T, Engel X, Ackermann H, Schmack I, Kohnen T. Association between anterior chamber biometry and posterior capsular defects. J Cataract Refract Surg 2023; 49:1086-1091. [PMID: 37532253 DOI: 10.1097/j.jcrs.0000000000001274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/24/2023] [Indexed: 08/04/2023]
Abstract
PURPOSE To analyze the association between anterior chamber biometric factors and posterior capsular defects (PCDs) that occur during extracapsular cataract extraction. SETTING University Eye Hospital, Goethe University Frankfurt, Germany. DESIGN Population-based study. PATIENTS AND METHODS Extracapsular cataract extractions for inpatient cases within 4 years were retrospectively analyzed. The data on the occurrence of PCDs, age, sex, surgeon, and biometry were obtained. For cases with PCDs, the secondary ocular diseases, number of procedures, lens implant, visual acuity, and course were also recorded. Swept-source optical coherence tomography measurements allowed the measurement of lens thickness (LT) in addition to the usual biometry values. RESULTS A total of 1967 cataract surgeries (patients age: 70.56 ± 8.42, 1005 women; 962 men) were included, and PCDs were documented for 59 (2.54%; 31 women, 28 men) cases (patient age: 70.95 ± 8.52 years). There were no differences ( P = .76) related to the surgeons (n = 9) with minimal effect sizes. The mean LT, axial length, corneal curvature, and anterior chamber depth were 4950.36 ± 466.63 μm, 23.73 ± 1.77 mm, 43.89 ± 1.36 diopters, and 3.02 ± 0.71 mm, respectively. The Wilcoxon-Mann-Whitney test showed significant associations between LT ( P = .01) and PCDs with moderate relevance for the Rosenthal effect size (LT R = 0.34; ACD R = 0.29). CONCLUSIONS In addition to ACD, a tendency for the occurrence of PCD could be proven, especially for LT. Therefore, special attention should be paid to LT preoperatively for comprehensive risk stratification.
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Affiliation(s)
- Tschingis Arad
- From the Department of Ophthalmology, Goethe University, Frankfurt, Germany (Arad, Engel, Schmack, Kohnen); Institute for Biostatistics, Goethe University, Frankfurt, Germany (Ackermann)
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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.
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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
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Oustoglou E, Tzamalis A, Banou L, Christou CD, Tsinopoulos I, Samouilidou M, Mataftsi A, Ziakas N. When should cataract surgeons seek assistance from experienced colleagues? Int Ophthalmol 2023; 43:387-395. [PMID: 35864285 DOI: 10.1007/s10792-022-02434-y] [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: 11/18/2021] [Accepted: 07/05/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess which cases should be assorted exclusively to high-volume surgeons and identify when should a cataract surgeon seek assistance from a senior colleague. METHODS The medical records of 2853 patients with age-related cataract were reviewed. Preoperative risk factors were documented for each case, and they were divided into surgeons who had more (> 400 surgeries/year) or less experience (< 400 surgeries/year). Ophthalmology residents were excluded from this review. The cases that involved posterior capsule rupture, dropped nucleus, zonular dehiscence and anterior capsular tear with or without vitreous loss were defined as "complicated". RESULTS From the 3247 cataract extraction surgeries that were reviewed, we were unable to identify any statistically significant difference in the complication rates between the two surgeon groups. In the stepwise regression analysis, both groups supported advanced age (> 85) and mature cataracts with up to fourfold odds ratios (OR). Low-volume surgeons had a fivefold OR in the presence of phacodonesis and a fourfold OR in the case of posterior polar cataract. Finally, the low- and high-volume groups had their highest complication rates in the cumulative four and five risk factors, respectively. CONCLUSION In the presence of advanced age, mature cataracts, phacodonesis and posterior polar cataract, the complication rates appear to be higher for the less experienced surgeons. Meticulous preoperative assessment with detailed documentation of each patient's risk factors can result in fewer complications. The medical complexity of each case can be used as indicator of whether a more experienced surgeon should perform the surgery or not.
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Affiliation(s)
- Eirini Oustoglou
- 2nd Department of Ophthalmology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Argyrios Tzamalis
- 2nd Department of Ophthalmology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lamprini Banou
- 2nd Department of Ophthalmology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Chrysanthos D Christou
- 2nd Department of Ophthalmology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Tsinopoulos
- 2nd Department of Ophthalmology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Samouilidou
- 2nd Department of Ophthalmology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Asimina Mataftsi
- 2nd Department of Ophthalmology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Ziakas
- 2nd Department of Ophthalmology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Shah M, Shah S, Kataria A, Korane A. Proposed predictive score for visual outcome in cataracts with comorbidities following small-incision cataract surgery. JOURNAL OF CLINICAL OPHTHALMOLOGY AND RESEARCH 2023. [DOI: 10.4103/jcor.jcor_48_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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Doyle JM, Haq AS, Aslam SA. Surgical outcomes in only eye cataract surgery. Eur J Ophthalmol 2023; 33:223-229. [PMID: 35369780 DOI: 10.1177/11206721221092221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Performing cataract surgery in the setting of only one seeing-eye has significant benefits but also potential negative consequences for both patient and surgeon. This study investigates the surgical outcomes in patients undergoing cataract surgery on their only seeing-eye. METHODS A retrospective analysis was conducted in a single tertiary centre of all adult patients who had undergone cataract surgery on their only eye, where the fellow eye had a vision of 1.0 LogMAR or worse. Complication rates and visual outcomes were compared against data from the National Ophthalmology Database (NOD) Audit. RESULTS 918 patients underwent cataract surgery on their only seeing-eye and had their postoperative visual acuity recorded. The overall unadjusted complication rate was 4.0% (versus 2.5% from NOD data) with the rate of posterior capsule rupture (PCR) being 1.9% (versus 1.14% from NOD data). 72.5% (versus 91.5% from NOD data) of patients attained a post-operative visual acuity of 0.3 LogMAR or better. The grade of surgeon performing the surgery did not have a statistically significant effect on the risk of complications. DISCUSSION In this cohort of only-eye patients undergoing cataract surgery, there was a small increased risk of operative complications including an increased, unadjusted risk of PCR, and fewer eyes achieved 0.3 LogMAR vision post-operatively compared to the NOD audit data. Grade of surgeon did not have an impact on the complication rate, indicating that with appropriate supervision, trainee surgeons may gain experience in only-eye surgery without additional risk to the patient. Further multicentre studies are recommended to assess reproducibility across units.
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Affiliation(s)
| | - Aaminah S Haq
- 574106Oxford Eye Hospital, John Radcliffe Hospital, Oxford, UK
| | - Sher A Aslam
- 574106Oxford Eye Hospital, John Radcliffe Hospital, Oxford, UK
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Bhat KT, Wadgaonkar SP, Undre AA, Heda AS. Evaluation of efficacy of intracameral lidocaine and tropicamide injection in manual small-incision cataract surgery: A prospective clinical study. Indian J Ophthalmol 2022; 70:3849-3852. [PMID: 36308110 PMCID: PMC9907293 DOI: 10.4103/ijo.ijo_2050_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose The study was conducted to evaluate efficacy of intracameral lidocaine hydrochloride 1% and tropicamide injection 0.02% for anaesthesia and mydriasis in manual small-incision cataract surgery (MSICS) and to report any adverse drug reaction. Methods This was a randomized, prospective, observational study on 32 participants that took place from October 2021 to March 2022 (6 months). Patients between age group 40-75 year with nuclear sclerosis cataract and pupil diameter >6 mm in preoperative evaluation were included in the study. Patients with pseudoexfoliation, rigid pupil, senile miosis, history of uveitis, ocular trauma, recent ocular infections, with known allergy to tropicamide, all types of glaucoma were excluded from the study. Results Thirty-two eyes with nuclear sclerosis cataract who underwent MSICS were studied. Fixed dose combination of 2 ml phenyl epinephrine (0.31%), tropicamide (0.02%), and lidocaine (1%) intracamerally was used for mydriasis and analgesia. More than 7 mm pupillary dilatation was achieved within 20 seconds of injection in 29 cases (90.6%). Mild pain and discomfort was noted in 12 cases (37.5%). Postoperative day 1 unaided visual acuity was in the range of 6/18-6/12 for all patients and grade 1 iritis was seen in 7 cases (21.8%) which was self-limiting. No adverse event like corneal decompensation or TASS were noted. Conclusion Thus, Intracameral injection of mydriatic provides rapid and sustainable mydriasis and analgesia for manual SICS.
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Affiliation(s)
- Ketaki T Bhat
- Department of Ophthalmology, JMF’S ACPM Medical College, Dhule, Maharashtra, India
| | | | - Ashish A Undre
- Department of Ophthalmology, JMF’S ACPM Medical College, Dhule, Maharashtra, India
| | - Aarti S Heda
- Cataract, Cornea and Glaucoma Services, National Institute of Ophthalmology, Pune, Maharashtra, India,Correspondence to: Dr. Aarti S Heda, National Institute of Ophthalmology, Off Ghole Road, Pune, Maharashtra - 411 005, India. E-mail:
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Gajraj M, Mohan A. Safety and efficacy of manual small-incision cataract surgery in patients with brunescent and black cataracts and other ocular comorbidities. Indian J Ophthalmol 2022; 70:3898-3903. [PMID: 36308123 PMCID: PMC9907312 DOI: 10.4103/ijo.ijo_1565_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose To determine the safety and efficacy of manual small-incision cataract surgery (MSICS) for brunescent and black cataracts in patients with other ocular comorbidities. Methods Medical records of patients with hard cataracts (grade 4 nuclear opalescence and above) with other ocular comorbidities such as spheroidal degeneration of the cornea (SDC), pseudoexfoliation (PXF), non-dilating pupil, and high myopia who underwent MSICS were retrieved retrospectively. Intraoperative and postoperative complications were noted. Preoperative and postoperative visual outcome comparisons were performed using paired t-tests. Statistical significance was set at P < 0.05. Results A total of 124 cataract patients with brunescent or black cataracts and other ocular comorbidities underwent surgery during the study period. They ranged in age from 56 to 89 years (mean: 68.9 + 11.9 years), with 55.66% (n = 69) of the patients being female and 44.35% (n = 55) male. Of the 124 cases, 45.16% (n = 56) had SDC, 31.45% (n = 39) had PXF, 14.51% (n = 18) had non-dilating pupils, and 8.87% (n = 11) had high myopia. Preoperatively all patients had visual acuity <6/60. At 1 month postoperatively 77.4% of patients achieved good vision >6/18, 16.9% had a borderline vision (6/18-6/60), and 5.6% had a poor vision (<6/60). No serious complications were observed. One patient had posterior capsular rent in a case of high myopia, and two cases had zonular dialysis for pseudoexfoliation. Conclusion MSICS with intraocular lens implantation is safe and effective in eyes with brunescent/black cataracts if associated with SDC, PXF, high myopia, and non-dilating pupils and provides good visual outcomes with minimal complications.
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Affiliation(s)
- Manju Gajraj
- Department of Pediatric Ophthalmology & Strabismus, Global Hospital Institute of Ophthalmology, Abu Road, Rajasthan, India,Upgraded Department of Ophthalmology, Sawai Man Singh (SMS) Medical College, Jaipur, Rajasthan, India
| | - Amit Mohan
- Department of Pediatric Ophthalmology & Strabismus, Global Hospital Institute of Ophthalmology, Abu Road, Rajasthan, India,Department of Cataract & IOL Services, Shri Adinath Fateh Global Eye Hospital, Jalore, Rajasthan, India,Correspondence to: Dr. Amit Mohan, Department of Pediatric Ophthalmology and Strabismus, Global Hospital Institute of Ophthalmology, Talehati, Shantivan, Abu Road - 307 510, Rajasthan, India. E-mail:
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Anitha V, Madkaikar A, Ravindran M, Siddique MU. Preferred practice of cataract surgery in brown cataract: A questionnaire-based survey among Indian ophthalmic surgeons. Indian J Ophthalmol 2022; 70:3893-3897. [PMID: 36308122 PMCID: PMC9907254 DOI: 10.4103/ijo.ijo_1555_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose To determine the most preferred method of operating brown cataracts among ophthalmologists in India. Methods A cross-sectional, questionnaire-based study was conducted among ophthalmologists all over India through electronic and social media from May 1 to June 15, 2022. All single, voluntary entries within the stipulated time period were accepted for analysis. Results A total of 230 ophthalmologists participated in the study among which 198 (86%) preferred Manual small-incision cataract surgery (mSICS) as the first option. This was preferred due to the high risk of complications associated (40, 33.6%) as well as endothelial damage due to increased Phaco power (53, 47.9%). The majority of the surgeons (162, 70.4%) preferred a superior tunnel for SICS, and 51.7% (119) performed continuous curvilinear capsulorhexis in 100% of their cases. The most common complication encountered was posterior capsular rupture (PCR) (66%), followed by zonular dialysis (ZD) (18.7%), whole bag removal (8.3%), and Descemet's membrane detachment (7%). Conclusion Despite diverse recent new modalities of Femto Laser assisted cataract surgery (FLACS). Phakonit, and Smart Intraocular Lens (IOLs), the majority of ophthalmologists still find the manual small-incision cataract surgery (mSICS) procedure a safe surgery for mature brown cataracts.
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Affiliation(s)
- Venugopal Anitha
- Cornea, Ocular Surface, Trauma and Refractive Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India,Correspondence to: Dr. Venugopal Anitha, Cornea, Ocular Surface, Trauma and Refractive Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India. E-mail:
| | - Aditee Madkaikar
- Cornea and Refractive Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Meenakshi Ravindran
- Paediatrics and Strabismology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Mohammed Uduman Siddique
- Biostatistics, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
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AlRyalat SA, Atieh D, AlHabashneh A, Hassouneh M, Toukan R, Alawamleh R, Alshammari T, Abu-Ameerh M. Predictors of visual acuity improvement after phacoemulsification cataract surgery. Front Med (Lausanne) 2022; 9:894541. [PMID: 36213668 PMCID: PMC9532505 DOI: 10.3389/fmed.2022.894541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 08/25/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose This study aimed to assess preoperative predictors of visual outcome after phacoemulsification cataract surgery in Jordan, a Middle Eastern country. Methods This was a retrospective longitudinal study of adult patients who underwent phacoemulsification cataract surgery from January 2019 to July 2021. For each patient, we included only the first operated eye. We obtained pre-operative ocular history, cataract surgery complication risk based on a predesigned score, visual acuity, best correction, and best corrected visual acuity. We recorded intraoperative complications. We also obtained postoperative best corrected visual acuity and refractive error for correction after 1–3 months. Results A total of 1,370 patients were included in this study, with a mean age of 66.39 (± 9.48). 48.4% of patients achieved visual acuity ≥ 0.8, and 72.7% achieved visual acuity ≥ 0.5. The mean visual acuity improvement after phacoemulsification cataract surgery was 0.33 (95% CI 0.31–0.35). In the regression model, significant predictors that affected visual acuity improvement included the presence of diabetic retinopathy, glaucoma, and complication risk factors (i.e., high-risk surgery). Conclusion Predictors of visual acuity improvement vary between studies. This study was conducted in a developing country; we defined predictors of visual acuity improvement. We also provided a new preoperative phacoemulsification cataract surgery complication risk score.
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Affiliation(s)
- Saif Aldeen AlRyalat
- Department of Special Surgery, The University of Jordan, Amman, Jordan
- *Correspondence: Saif Aldeen AlRyalat, ;
| | - Duha Atieh
- Intern, University of Jordan Hospital, Amman, Jordan
| | | | | | - Rama Toukan
- Intern, University of Jordan Hospital, Amman, Jordan
| | | | - Taher Alshammari
- Department of Special Surgery, Prince Mohammed Medical City, Al-Jouf, Saudi Arabia
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13
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Helayel HB, Alyahya AA, Al Owaifeer AM, Khan AM, Al Zahrani AT, Badawi AH, Khandekar R, Al-Swailem SA. Risk factors, complications, and outcomes of phacoemulsification cataract surgery complicated by retained lens fragments in Asian eyes: A 10-year retrospective study. Saudi J Ophthalmol 2022; 36:171-176. [PMID: 36211313 PMCID: PMC9535911 DOI: 10.4103/sjopt.sjopt_122_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/14/2022] [Accepted: 08/18/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To study the risk factors, visual outcomes, and sequelae of phacoemulsification surgery complicated by retained lens fragments (RLFs). METHODS This single-center case-control study enrolled consecutive eyes complicated by RLF and compared them to age- and gender-matched uneventful cataract surgery cases at a tertiary care teaching hospital. Biometric, intraoperative, and postoperative data were collected. The primary outcome measures were risk factors, visual outcomes, and rate of postoperative complications. RESULTS The study and control groups included 282 and 289 eyes, respectively. The estimated incidence of RLF was 1.47% during the study. We found a statistically higher risk of RLF among diabetics (P < 0.001), those with a history of intravitreal injections (P = 0.001), eyes with dense nuclear sclerosis, anterior capsular cataract (P < 0.001), and posterior polar cataract (P = 0.01). There was a statistically higher risk of RLF in eyes with a higher mean preoperative visual acuity (logarithm of the minimum angle of resolution) (P < 0.001) and in cases performed by trainees (P < 0.001). Most eyes in the RLF group (n = 207, 73.4%) retained their preoperative vision or experienced a one-line improvement in visual acuity and 14 eyes (5.3%) experienced more than one-line improvement in vision. CONCLUSION Although RLFs are rare, they can affect the quality of postoperative vision and outcomes of complicated phacoemulsification surgery.
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Affiliation(s)
- Halah B. Helayel
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Ahmed A. Alyahya
- Department of Ophthalmology, King Saud University Hospitals, Riyadh, Saudi Arabia
| | - Adi M. Al Owaifeer
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia,Faculty of Ophthalmology, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Abdullah M. Khan
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | | | | | - Rajiv Khandekar
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia,Department of Ophthalmology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Samar A. Al-Swailem
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia,Address for correspondence: Dr. Samar A. Al-Swailem, Department of Research, King Khaled Eye Specialist Hospital, PO Box: 7191, Riyadh 11462, Saudi Arabia. E-mail:
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14
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Moussa O, Frank T, Valenzuela IA, Aliancy J, Gong D, De Rojas JO, Dagi Glass LR, Winn BJ, Cioffi GA, Chen RWS. Efficacy of Preoperative Risk Stratification on Resident Phacoemulsification Surgeries. Clin Ophthalmol 2022; 16:2137-2144. [PMID: 35800673 PMCID: PMC9255418 DOI: 10.2147/opth.s368633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/20/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate efficacy of a novel risk stratification system in minimizing resident surgical complications and to evaluate whether the system could be used to safely introduce cataract surgery to earlier levels of training. Materials and Methods This is a retrospective cross-sectional study on 530 non-consecutive cataract cases performed by residents at Columbia University. Risk scores, preoperative best corrected visual acuity (BCVA), intraoperative complications, postoperative day 1 (POD1), and month 1 (POM1) exam findings were tabulated. The relationship between risk scores and POD1 and POM1 BCVA was modeled using linear regression. The relationship between risk scores and complication rates was modeled using logistic regression. Logistic regression was used to model the rates of complications across different levels of training. Rates of complications were compared between diabetic versus non-diabetic patients using t-tests. Results Risk scores did not have significant association with intraoperative complications. Risk scores were predictive of corneal edema (OR = 1.36, p = 0.0032) and having any POM1 complication (OR = 1.20, p = 0.034). Risk scores were predictive of POD1 (β = 0.13, p < 0.0001) and POM1 (β = 0.057, p = 0.00048) visual acuity. There was no significant association between level of training and rates of intraoperative (p = 0.9) or postoperative complications (p = 0.06). Rates of intraoperative complication trended higher among diabetic patients but was not statistically significant (p = 0.2). Conclusion Higher risk scores were predictive of prolonged corneal edema but not risk of intraoperative complications. Our risk stratification system allowed us to safely introduce earlier phacoemulsification surgery.
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Affiliation(s)
- Omar Moussa
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Tahvi Frank
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Ives A Valenzuela
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Joah Aliancy
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Dan Gong
- Department of Ophthalmology, Retina Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | | | - Lora R Dagi Glass
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Bryan J Winn
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - George A Cioffi
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Royce W S Chen
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
- Correspondence: Royce WS Chen, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 W. 165th St, New York, NY, 10032, USA, Tel +1 212-305-9535, Email
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15
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Phacoemulsification with vitreous loss using phacoemulsifier and vitrector concurrently: bimanual-bipedal technique. J Cataract Refract Surg 2022; 48:504-507. [PMID: 35027522 DOI: 10.1097/j.jcrs.0000000000000884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 01/06/2022] [Indexed: 12/30/2022]
Abstract
Vitreous loss is one of the adverse complications that can occur during phacoemulsification. Once vitreous loss is identified, procedural guidelines advise that phacoemulsification be ceased and the probe carefully withdrawn to minimize traction on the vitreous. Bimanual-bipedal technique described in this study holds the phacoemulsification probe in place and inserts the vitrectomy cutter through the pars plana port with the other hand. After removal of vitreous around the phacoemulsification tip, the vitrectomy cutter is switched to a cutting rate of zero. phacoemulsification can then be resumed with the vitrectomy cutter as a retainer of the lens fragments, similar to the hook of bimanual technique. Lens fragments are synergistically retained through aspiration between the vitrectomy cutter and phacoemulsification probe to prevent displacement. The bimanual-bipedal technique may offer a more streamlined and potentially safer approach for phacoemulsification with vitreous loss.
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16
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Keenan TDL, Chen Q, Agrón E, Tham YC, Lin Goh JH, Lei X, Ng YP, Liu Y, Xu X, Cheng CY, Bikbov MM, Jonas JB, Bhandari S, Broadhead GK, Colyer MH, Corsini J, Cousineau-Krieger C, Gensheimer W, Grasic D, Lamba T, Magone MT, Maiberger M, Oshinsky A, Purt B, Shin SY, Thavikulwat AT, Lu Z, Chew EY. Deep Learning Automated Diagnosis and Quantitative Classification of Cataract Type and Severity. Ophthalmology 2022; 129:571-584. [PMID: 34990643 PMCID: PMC9038670 DOI: 10.1016/j.ophtha.2021.12.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/10/2021] [Accepted: 12/27/2021] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To develop and evaluate deep learning models to perform automated diagnosis and quantitative classification of age-related cataract, including all three anatomical types, from anterior segment photographs. DESIGN Application of deep learning models to Age-Related Eye Disease Study (AREDS) dataset. PARTICIPANTS 18,999 photographs (6,333 triplets) from longitudinal follow-up of 1,137 eyes (576 AREDS participants). METHODS Deep learning models were trained to detect and quantify nuclear cataract (NS; scale 0.9-7.1) from 45-degree slit-lamp photographs and cortical (CLO; scale 0-100%) and posterior subcapsular (PSC; scale 0-100%) cataract from retroillumination photographs. Model performance was compared with that of 14 ophthalmologists and 24 medical students. The ground truth labels were from reading center grading. MAIN OUTCOME MEASURES Mean squared error (MSE). RESULTS On the full test set, mean MSE values for the deep learning models were: 0.23 (SD 0.01) for NS, 13.1 (SD 1.6) for CLO, and 16.6 (SD 2.4) for PSC. On a subset of the test set (substantially enriched for positive cases of CLO and PSC), for NS, mean MSE for the models was 0.23 (SD 0.02), compared to 0.98 (SD 0.23; p=0.000001) for the ophthalmologists, and 1.24 (SD 0.33; p=0.000005) for the medical students. For CLO, mean MSE values were 53.5 (SD 14.8), compared to 134.9 (SD 89.9; p=0.003) and 422.0 (SD 944.4; p=0.0007), respectively. For PSC, mean MSE values were 171.9 (SD 38.9), compared to 176.8 (SD 98.0; p=0.67) and 395.2 (SD 632.5; p=0.18), respectively. In external validation on the Singapore Malay Eye Study (sampled to reflect the distribution of cataract severity in AREDS), MSE was 1.27 for NS and 25.5 for PSC. CONCLUSIONS A deep learning framework was able to perform automated and quantitative classification of cataract severity for all three types of age-related cataract. For the two most common types (NS and CLO), the accuracy was significantly superior to that of ophthalmologists; for the least common type (PSC), the accuracy was similar. The framework may have wide potential applications in both clinical and research domains. In the future, such approaches may increase the accessibility of cataract assessment globally. The code and models are publicly available at https://XXX.
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Affiliation(s)
- Tiarnan D L Keenan
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Qingyu Chen
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD, USA.
| | - Elvira Agrón
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Yih-Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, Singapore
| | | | - Xiaofeng Lei
- Institute of High Performance Computing, A*STAR, Singapore
| | - Yi Pin Ng
- Institute of High Performance Computing, A*STAR, Singapore
| | - Yong Liu
- Duke-NUS Medical School, Singapore; Institute of High Performance Computing, A*STAR, Singapore
| | - Xinxing Xu
- Duke-NUS Medical School, Singapore; Institute of High Performance Computing, A*STAR, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, Singapore; Institute of High Performance Computing, A*STAR, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Institute of Molecular and Clinical Ophthalmology Basel, Switzerland; Privatpraxis Prof Jonas und Dr Panda-Jonas, Heidelberg, Germany
| | - Sanjeeb Bhandari
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Geoffrey K Broadhead
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marcus H Colyer
- Department of Ophthalmology, Madigan Army Medical Center, Tacoma, WA, USA; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jonathan Corsini
- Warfighter Eye Center, Malcolm Grow Medical Clinics and Surgery Center, Joint Base Andrews, MD, USA
| | - Chantal Cousineau-Krieger
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - William Gensheimer
- White River Junction Veterans Affairs Medical Center, White River Junction, VT, USA; Geisel School of Medicine, Dartmouth, NH, USA
| | - David Grasic
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Tania Lamba
- Washington DC Veterans Affairs Medical Center, Washington DC, USA
| | - M Teresa Magone
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Arnold Oshinsky
- Washington DC Veterans Affairs Medical Center, Washington DC, USA
| | - Boonkit Purt
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Department of Ophthalmology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Soo Y Shin
- Washington DC Veterans Affairs Medical Center, Washington DC, USA
| | - Alisa T Thavikulwat
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Zhiyong Lu
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD, USA.
| | - Emily Y Chew
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA.
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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.
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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)
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18
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Vazquez-Ferreiro P, Carrera-Hueso FJ, Rodriguez LB, Diaz-Rey M, Barrios MAR, Jornet JEP. Determinants of the risk of intraoperative complications in phacoemulsification among patients with pseudoexfoliation. Saudi J Ophthalmol 2021; 35:5-8. [PMID: 34667925 PMCID: PMC8486038 DOI: 10.4103/1319-4534.325774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 11/07/2020] [Accepted: 12/07/2020] [Indexed: 11/04/2022] Open
Abstract
PURPOSE The purpose of the study was to study the relationship between pseudoexfoliation (PES) and other predictors in the development of complications in cataract surgery by phacoemulsification in patients with PES. METHODS A retrospective cohort study of patients undergoing cataract surgery by phacoemulsification in the health area of Cee in northwestern Spain during the 2-year period from 2009 to 2010. Capsule rupture, choroidal hemorrhage, and vitreous loss were included as complications and intraoperative nucleus or lens dislocation as the independent variable. PES, age, hardness, type of cataract, myopia, preoperative visual acuity, antiplatelet use, anticoagulant uses, alpha agonist use, mydriasis prior to surgery, anterior chamber depth, and axial length were included as predictor variables. All predictive hierarchical models were tested using as a selection criterion the one minimizing the Akaike index. RESULTS A total of 551 patients were initially identified from hospital register, of which 48 were excluded due to the presence of an exclusion factor. After the initial selection, the final sample was 681 eyes of 503 patients. Of the 8192 possible models, a model with the following seven variables was selected: PES, steroid use, alpha agonist use, nuclear hardness, mydriasis, anterior chamber depth, and axial length. The selected model had an Akaike index of 435.4 and an area under the curve of 0.7895 corresponding to a sensitivity of 6.2% and a specificity of 98.5%. CONCLUSION PES, nuclear hardness, and alpha agonist use are risk factors strongly predictive of complications.
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Affiliation(s)
- Pedro Vazquez-Ferreiro
- Department of Ophthalmology, Hospital Virxen da Xunqueira, Cee, A Coruña, Spain.,Department of Pharmacy and Pharmaceutical Technology, University of Granada, Granada, Spain
| | | | | | - Marta Diaz-Rey
- Department of Ophthalmology, Hospital Virxen da Xunqueira, Cee, A Coruña, Spain
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Nussinovitch H, Tsumi E, Tuuminen R, Malyugin B, Lior Y, Naidorf Rosenblatt H, Boyko M, Achiron A, Knyazer B. Cataract Surgery in Very Old Patients: A Case-Control Study. J Clin Med 2021; 10:jcm10204658. [PMID: 34682778 PMCID: PMC8537740 DOI: 10.3390/jcm10204658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 09/15/2021] [Accepted: 10/08/2021] [Indexed: 11/16/2022] Open
Abstract
Advancements in surgical techniques and increased life expectancy have made cataract surgery more common among very old patients. However, surgical outcomes seem impaired in patients older than 90 years, especially with ocular comorbidities. A retrospective case-control study of 53 eyes of 53 very old patients (mean 92.6 ± 3.0) and 140 eyes of 140 matched patients (mean 75.2 ± 7.6) was undertaken. Groups were matched in terms of gender and systemic and ocular comorbidities. In very old patients, higher phacoemulsification energy (cumulative dissipated energy [CDE], 25.0 ± 22.4 vs. 16.1 ± 10.7, p = 0.01) and rate of intraoperative floppy iris syndrome (IFIS, 9.4% vs. 1.4%, p = 0.02) were observed compared to controls. Uncorrected (UCVA) and best-corrected distance visual acuity (BCVA) gains were significantly poorer among the very old patients than among the control at postoperative day 30 (0.20 ± 0.70 vs. 0.56 ± 0.61 logMAR, p < 0.001 and 0.27 ± 0.64 vs. 0.55 ± 0.62 logMAR, p = 0.006, respectively). Even after including CDE and IFIS as covariates, age remained an independent factor for poor visual gain at 30 days (p < 0.001). Cataract surgery in very old patients may demand more experienced surgeons due to higher nuclear density and the rates of IFIS. Expectations in visual acuity gains should be aligned with the patient’s age.
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Affiliation(s)
- Hanan Nussinovitch
- Department of Ophthalmology, Shaarei Zedek Medical Center, Jerusalem 9103102, Israel;
| | - Erez Tsumi
- Department of Ophthalmology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba 8410501, Israel;
| | - Raimo Tuuminen
- Helsinki Retina Research Group, Faculty of Medicine, University of Helsinki, 00100 Helsinki, Finland;
- Department of Ophthalmology, Kymenlaakso Central Hospital, 48210 Kotka, Finland
| | - Boris Malyugin
- S. Fyodorov Eye Microsurgery Federal State Institution, 127486 Moscow, Russia;
- Department of Eye Diseases, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, 127473 Moscow, Russia
| | - Yotam Lior
- Division of Anesthesiology and Critical Care, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba 8410501, Israel; (Y.L.); (M.B.)
| | | | - Matthew Boyko
- Division of Anesthesiology and Critical Care, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba 8410501, Israel; (Y.L.); (M.B.)
| | - Asaf Achiron
- Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv 6997801, Israel
- Correspondence: (A.A.); (B.K.)
| | - Boris Knyazer
- Department of Ophthalmology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba 8410501, Israel;
- Correspondence: (A.A.); (B.K.)
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20
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Uy HS, Cruz FM, Kenyon KR. Efficacy of a hinged pupil expansion device in small pupil cataract surgery. Indian J Ophthalmol 2021; 69:2688-2693. [PMID: 34571616 PMCID: PMC8597469 DOI: 10.4103/ijo.ijo_2857_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose: To evaluate the efficacy and safety of a hinged pupil expansion device (PED) in eyes with small pupils undergoing phacoemulsification. Methods: In this prospective, multicenter, interventional case series of 57 eyes with suboptimal pharmacologic pupil dilation (<5 mm diameter), a hinged PED (I-Ring, Beaver-Visitec International, Waltham, MA) was applied to facilitate surgical visualization during cataract surgery. The pupil diameters (PD) were measured at different stages of the procedure and at the 1-month follow-up visit. Rate of successful intraoperative PED deployment, pupil size, and shape were assessed. Results: The mean patient age was 70.5 ± 12.1 years. The I-Ring PED was successfully applied in all eyes. The mean PD at various stages were 4.1 ± 1.1 mm (dilation with eye drops only preoperatively), 4.3 ± 1.1 mm (dilation after intracameral epinephrine and ophthalmic viscoelastic device), 6.80 ± 0.00 mm (with PED applied), and 5.7 ± 1.1 mm (end of surgery). A statistically significant difference (P < 0.001) was observed between the mean PD with intracameral medications and with PED application. Postoperative circular pupil was observed in 54 of 57 eyes (94.7%) and the mean eccentricity index (n = 57 eyes) was 0.11 ± 0.22. No significant adverse events were observed. Conclusion: The I-Ring PED safely and effectively provided and maintained adequate pupil expansion and surgical visualization in eyes with small pupils undergoing cataract surgery. Postoperatively 95% of eyes attained circular pupils. This hinged PED is an additional instrumentation option for the safe and effective expansion of inadequately sized pupils during cataract surgery.
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Affiliation(s)
- Harvey S Uy
- Peregrine Eye and Laser Institute, Makati City; Department Ophthalmology and Visual Sciences, University of the Philippines, Manila, Philippines
| | - Franz M Cruz
- Peregrine Eye and Laser Institute, Makati City; Department Ophthalmology and Visual Sciences, University of the Philippines, Manila, Philippines
| | - Kenneth R Kenyon
- Department of Ophthalmology, New England Eye Centre, Tufts University School of Medicine, Boston, MA, USA
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21
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Cataract surgery risk stratification in phacoemulsification and manual small incision cataract surgery in a teaching hospital. Int Ophthalmol 2021; 42:201-209. [PMID: 34532818 DOI: 10.1007/s10792-021-02014-6] [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: 03/23/2021] [Accepted: 08/13/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate a system that objectively assesses the risk of cataract surgery complications performed with phacoemulsification and manual small incision cataract surgery (MSICS) techniques. METHODS The study was a retrospective comparative interventional case series. Electronic medical records of consecutive eyes that underwent cataract surgery from January 2019 to December 2019 were evaluated. Patient's demographic data and preoperative risk factors were identified, and cataract was categorized as per Lens Opacities Classification System (III). Cataract eyes were grouped into normal cataract cases (G1) and complex cataract cases (G2 and G3), based on the risk factors. The rate of complications in each group and the rate of each complication were calculated and compared. RESULTS The overall rate of anyone complication was 2.2% with 2.3% in G1, 1.0% in G2 and 3.9% in G3 (p < 0.001). MSICS technique, mostly used for complex cases (54.2%), reported a higher complication rate than the phacoemulsification technique (2.9% vs 1.4%, p < 0.001). However, the complication rates among the normal and complex cases were similar (2.3% vs 2.2%, p = 0.376). The total posterior capsular tear rate was 1.1% with no vitreous loss in nearly 1 in eight eyes. CONCLUSION A preoperative risk stratification system is crucial for obtaining informed consent and better allocation of cases to surgeons based on their expertise to minimize intraoperative complications.
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22
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Development of a reliable preoperative risk stratification system for phacoemulsification. J Cataract Refract Surg 2021; 46:1132-1137. [PMID: 32355078 DOI: 10.1097/j.jcrs.0000000000000223] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To present a statistically validated risk classification system for intraoperative complications in cataract surgery. SETTING 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece. DESIGN Prospective observational study. METHODS All patients underwent phacoemulsification surgery by experienced, high-volume surgeons for cases with intraoperative complications. The presence of several risk factors was statistically assessed with the help of multiple correspondence analysis to determine the more reliable rank categorization for severity and to calculate a total risk score. RESULTS This study included 1572 consecutive patients. The proposed system had 3 risk groups and a no-risk group and had high statistical reliability. A comparison of this system against a previously asserted empirical system showed higher internal reliability. CONCLUSIONS Previous efforts to construct a risk classification system for intraoperative complications in cataract surgery have been empirically defined and tested against practice-as-usual. The system in this study quantified risk more accurately and provided an experienced clinician with a reliable means of assessing the preoperational likelihood of intraoperative complications.
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Outcomes of cataract surgery in patients previously treated with orbital radiotherapy. J Cataract Refract Surg 2021; 48:162-167. [PMID: 34133403 DOI: 10.1097/j.jcrs.0000000000000717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/11/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aims to quantify the risks of cataract surgery in patients who have previously undergone external beam radiotherapy (EBRT). Cataract is a side effect of this treatment, and the risk of complications following cataract surgery in this cohort is poorly understood. SETTING Tertiary ophthalmology and oncology hospital. DESIGN Retrospective case series. METHODS Patients treated with orbital EBRT at the Beatson West of Scotland Cancer Centre between 2001 and 2019 were identified, and clinical records were reviewed to identify those who had subsequently undergone cataract surgery. Pre- and post-operative case records, and operation records, were reviewed to identify demographic data, and data regarding complications and surgical outcomes. RESULTS Forty-six eyes (of 33 patients) were included in this study. The indications for EBRT included thyroid eye disease, lymphoma, choroidal metastases and other orbital malignancies. Mean corrected pre-operative Snellen visual acuity (VA) was 20/100 (range 20/30-20/2000) improving to 20/25 (20/12 to 20/160, one-way ANOVA p<0.01). Mean visual gain was 0.5 LogMAR (-0.9 to 1.9). There was one case of posterior capsule (PC) rupture with vitreous loss (2%). Dense PC plaque was noted intra-operatively in 19.5% (n=9). 13% (n=6) required Nd:YAG laser posterior capsulotomy. There were six cases (13%) of cystoid macular oedema (CMO). CONCLUSION Visual outcomes following cataract surgery are similar in this cohort of patients to those obtained in a nationwide cohort. EBRT seems to be associated with an increased incidence of intra-operative PC plaque, post-operative CMO (which in most cases settled with treatment), and need for posterior capsulotomy.
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Engelhard SB, Haripriya A, Namburar S, Pistilli M, Daniel E, Kempen JH. Dropped Nucleus during Cataract Surgery in South India: Incidence, Risk Factors, and Outcomes. Ophthalmic Epidemiol 2021; 29:271-278. [PMID: 33980111 DOI: 10.1080/09286586.2021.1923756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: To determine incidence, risk factors for, and outcomes of dropped nucleus (DN) during cataract surgery.Methods: This is a matched case-control study at the Aravind Eye Hospital in Madurai, India. Out of 184 consecutive DN cases, 171 were included. The case immediately preceding the DN case by the same surgeon served as matched concurrent control. The proportion of cataract surgeries with DN was calculated with a 95% confidence interval (CI). Conditional logistic regression was used to generate odds ratios for potential risk factors.Results: Among 415,487 consecutive cataract surgeries, incidence risk of DN was 0.044% [95% CI 0.038%, 0.051%], or 0.44 per 1,000 surgeries in 52 months. Significant preoperative risk factors were posterior polar cataract (adjusted odds ratio [aOR] 21.73, p = .003); suspected loose zonules (aOR 8.85, p < .001); older age (aOR 1.57, p = .001); and presence of diabetes mellitus (aOR 1.79, p = .03). Associated intraoperative complications included zonular dialysis (OR 34.49, p < .001), vitreous disturbance (OR 193.36, p < .001), and posterior capsule rent (OR 384.39, p < .001). Phacoemulsification and manual small incision cataract surgery did not significantly differ in DN incidence. DN most commonly occurred during nucleus removal (35.1%) or during/immediately following hydrodissection (24.0%). Visual outcomes of DN were worse than controls on average, but 51.9% achieved visual acuity 20/40 or better at 1 month.Conclusions: DN occurred rarely, with low absolute risk even when a strong risk factor was present. Nearly all cases followed posterior capsular rent or zonular dialysis, usually with observed vitreous loss. In spite of increased risk of postoperative complications in the DN group, the majority achieved favorable results.
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Affiliation(s)
- Stephanie B Engelhard
- Department of Ophthalmology, NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York, USA
| | | | - Sathvik Namburar
- Geisel School of Medicine, Dartmouth Medical College, Hanover, New Hampshire, USA
| | - Maxwell Pistilli
- Center for Preventative Ophthalmology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ebenezer Daniel
- Department of Ophthalmology/Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John H Kempen
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.,MyungSung Christian Medical Center (MCM) Eye Unit, MCM General Hospital and MyungSung Medical School, Addis Ababa, Ethiopia
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Yu X, Sun N, Yang X, Zhao Z, Su X, Zhang J, He Y, Lin Y, Ge J, Fan Z. Nanophthalmos-Associated MYRF Gene Mutation Causes Ciliary Zonule Defects in Mice. Invest Ophthalmol Vis Sci 2021; 62:1. [PMID: 33646289 PMCID: PMC7937999 DOI: 10.1167/iovs.62.3.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Purpose Patients with nanophthalmos who undergo intraocular surgery often present with abnormal ciliary zonules. In a previous study, we reported mutation in MYRF that is implicated in the pathogenesis of nanophthalmos. The aim of this study was to model the mutation in mice to explore the role of MYRF on zonule structure and its major molecular composition, including FBN1 and FBN2. Methods Human MYRF nanophthalmos frameshift mutation was generated in mouse using the CRISPR-Cas9 system. PCR and Sanger sequencing were used for genotype analysis of the mice model. Anterior chamber depth (ACD) was measured using hematoxylin and eosin–stained histology samples. Morphologic analysis of ciliary zonules was carried out using silver staining and immunofluorescence. Transcript and protein expression levels of MYRF, FBN1, and FBN2 in ciliary bodies were quantified using quantitative real-time PCR (qRT-PCR) and Western blot. Results A nanophthalmos frameshift mutation (c.789delC, p.N264fs) of MYRF in mice showed ocular phenotypes similar to those reported in patients with nanophthalmos. ACD was reduced in MYRF mutant mice (MYRFmut/+) compared with that in littermate control mice (MYRF+/+). In addition, the morphology of ciliary zonules showed reduced zonular fiber density and detectable structural dehiscence of zonular fibers. Furthermore, qRT-PCR analysis and Western blot showed a significant decrease in mRNA expression levels of MYRF, FBN1, and FBN2 in MYRFmut/+ mice. Conclusions Changes in the structure and major molecular composition of ciliary zonules accompanied with shallowing anterior chamber were detected in MYRFmut/+ mice. Therefore, MYRF mutant mice strain is a useful model for exploring pathogenesis of zonulopathy, which is almost elusive for basic researches due to lack of appropriate animal models.
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Affiliation(s)
- Xiaowei Yu
- State Key Laboratory of Ophthalmology, Department of Glaucoma, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Nannan Sun
- State Key Laboratory of Ophthalmology, Department of Glaucoma, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xue Yang
- State Key Laboratory of Ophthalmology, Department of Glaucoma, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhenni Zhao
- State Key Laboratory of Ophthalmology, Department of Glaucoma, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiaoqian Su
- State Key Laboratory of Ophthalmology, Department of Glaucoma, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jiamin Zhang
- State Key Laboratory of Ophthalmology, Department of Glaucoma, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yuqing He
- State Key Laboratory of Ophthalmology, Department of Glaucoma, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yixiu Lin
- State Key Laboratory of Ophthalmology, Department of Glaucoma, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jian Ge
- State Key Laboratory of Ophthalmology, Department of Glaucoma, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhigang Fan
- State Key Laboratory of Ophthalmology, Department of Glaucoma, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
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Ah-See KL, Blaikie A, Boyle N, Foulds J, Wheeldon C, Wilson P, Styles C, Sutherland S, Sanders R. Cataract Surgery Redesign: Meeting Increasing Demand, Training, Audit and Patient-Centered Care. Clin Ophthalmol 2021; 15:289-297. [PMID: 33531794 PMCID: PMC7846846 DOI: 10.2147/opth.s268190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/21/2020] [Indexed: 11/23/2022] Open
Abstract
Objective The demand for cataract surgery in Fife (a well-defined region in southeast Scotland) was steadily increasing over 15 years. Cataract surgery was therefore being outsourced to meet demand with consequences on list mix, training needs, patient experience and staff morale. We aimed to redesign our services to meet local demand, retain a patient-centered service and continue to fulfil training needs. Methods We quantified cataract surgery delivery over an 18-month period: before, during and after redesign of services. We studied numbers of operations, trainee cases and number of outsourced cases. We also considered the economic implications of the redesign. Results We studied three periods (each of six months duration): before redesign (BR), redesign period (RP) and post-redesign (PR). Data were collected on total operation numbers, number of cases performed by trainees, and numbers performed out with normal working hours (weekend lists) and external providers. An economic analysis examined the cost of outsourcing cataracts during BR and RP and the costs of the redesign, including building, equipment and additional nursing staff. Conclusion Regional fulfilment of cataract surgery provision remains a continuous challenge within the NHS. We show that with minimal investment, smart redesign process and collaborative working, increased local provision is possible while fulfilling trainee needs and achieving the necessary clinical audits and national standards.
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Affiliation(s)
- Kim Lawrence Ah-See
- Department of Ophthalmology, Princess Alexandra Eye Pavilion, Edinburgh, Scotland, UK
| | - Andrew Blaikie
- School of Medicine, University of St Andrews, St Andrews, Scotland, UK
| | - Natalie Boyle
- Department of Ophthalmology, Queen Margaret Hospital, Dunfermline, Fife, UK
| | - Jonathan Foulds
- Department of Ophthalmology, Queen Margaret Hospital, Dunfermline, Fife, UK
| | - Catherine Wheeldon
- Department of Ophthalmology, Queen Margaret Hospital, Dunfermline, Fife, UK
| | - Peter Wilson
- Department of Ophthalmology, Queen Margaret Hospital, Dunfermline, Fife, UK
| | - Caroline Styles
- Department of Ophthalmology, Queen Margaret Hospital, Dunfermline, Fife, UK
| | - Shona Sutherland
- Department of Ophthalmology, Queen Margaret Hospital, Dunfermline, Fife, UK
| | - Roshini Sanders
- Department of Ophthalmology, Queen Margaret Hospital, Dunfermline, Fife, UK
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Lanza M, Koprowski R, Boccia R, Krysik K, Sbordone S, Tartaglione A, Ruggiero A, Simonelli F. Application of Artificial Intelligence in the Analysis of Features Affecting Cataract Surgery Complications in a Teaching Hospital. Front Med (Lausanne) 2020; 7:607870. [PMID: 33363188 PMCID: PMC7759659 DOI: 10.3389/fmed.2020.607870] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/24/2020] [Indexed: 01/02/2023] Open
Abstract
Aims: To evaluate the ocular and systemic factors involved in cataract surgery complications in a teaching hospital using artificial intelligence. Methods: One eye of 1,229 patients with a mean age of 70.2 ± 10.3 years old that underwent cataract surgery was selected for this study. Ocular and systemic details of the patients were recorded and then analyzed by means of artificial intelligence. A total of 1.25 billion simulations of artificial intelligence learning and testing were conducted on several variables and a customized model of analysis was developed. Results: A total of 73 complications were recorded in this study. According to the analysis performed, the main factors involved in cataract surgery complications were: a surgeon in training, axial length and intraocular lens power. The model predicted how long surgery would last with an error of <6 min compared to the effective time needed. Conclusions: According to the data here obtained, artificial intelligence could be an interesting option to build customized models able to prevent complications and to predict actual surgery time. The customized algorithm option allows the development of better models adaptable to different units as well as the possibility to be calibrated for the same unit along time.
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Affiliation(s)
- Michele Lanza
- Multidisciplinary Department of Medical, Surgical and Dental Specialities, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Robert Koprowski
- Institute of Biomedical Engineering, Faculty of Science and Technology, University of Silesia in Katowice, Sosnowiec, Poland
| | - Rosa Boccia
- Multidisciplinary Department of Medical, Surgical and Dental Specialities, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Katarzyna Krysik
- Department of Ophthalmology with Pediatric Unit, St. Barbara Hospital, Trauma Center, Sosnowiec, Poland
| | - Sandro Sbordone
- Multidisciplinary Department of Medical, Surgical and Dental Specialities, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Antonio Tartaglione
- Multidisciplinary Department of Medical, Surgical and Dental Specialities, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Adriano Ruggiero
- Multidisciplinary Department of Medical, Surgical and Dental Specialities, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Francesca Simonelli
- Multidisciplinary Department of Medical, Surgical and Dental Specialities, University of Campania Luigi Vanvitelli, Naples, Italy
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Oustoglou E, Tzamalis A, Mamais I, Dermenoudi M, Tsaousis KT, Ziakas N, Tsinopoulos I. Reoperations After Cataract Surgery: Is the Incidence Predictable Through a Risk Factor Stratification System? Cureus 2020; 12:e10693. [PMID: 33133858 PMCID: PMC7593208 DOI: 10.7759/cureus.10693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction The objective of the study was to quantify the number of procedures needed to achieve the best possible surgical outcome, depending on the number and type of risk factors identified. Methods Two independent observers reviewed the medical records of 1,502 patients who underwent phacoemulsification surgery, during a two-year period (January 1, 2014 to December 31, 2015). Preoperative risk factors were documented according to the stratification system used. Based on the total risk score, each case was allocated to one of four risk groups with 0, 1-2, 3-5, and >6 total risk factors, respectively. All qualitative and quantitative characteristics were gathered and included in a multivariate analysis. Results A total of 1,792 eyes were included. Αge over 88 years, low cooperation ability with the patient, and surgeries performed by residents tended to have more often complications, while white/intumescent cataract, iridodonesis/phacodonesis, α1 blockers intake, and male gender are risk factors positively associated with more than one surgery. Conclusions Risk factors tend to be prognostic for possible intraoperative complications. The number of procedures needed for the best possible surgical outcome seems to depend on these preoperative risk factors. A stratification method increases the level of awareness of the surgeon, and therefore may decrease the number of complications and even procedures while enhancing the "safe" practice and skills of residents.
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Affiliation(s)
- Eirini Oustoglou
- 2nd Department of Ophthalmology, Papageorgiou General Hospital/Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Argyrios Tzamalis
- 2nd Department of Ophthalmology, Papageorgiou General Hospital/Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Ioannis Mamais
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Medical School, Athens, Greece, Athens, GRC.,Department of Health and Life Sciences/Epidemiology, Biostatistics and Methodology Research, European University of Cyprus, Nicosia, CYP
| | - Maria Dermenoudi
- Department of Ophthalmology, Health Center of Neapolis, Thessaloniki, GRC
| | - Konstantinos T Tsaousis
- 2nd Department of Ophthalmology, Papageorgiou General Hospital/Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Nikolaos Ziakas
- 2nd Department of Ophthalmology, Papageorgiou General Hospital/Aristotle University of Thessaloniki, Thessaliniki, GRC
| | - Ioannis Tsinopoulos
- 2nd Department of Ophthalmology, Papageorgiou General Hospital/Aristotle University of Thessaloniki, Thessaloniki, GRC
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Pooprasert P, Hansell J, Young-Zvandasara T, Muhtaseb M. Can Applying a Risk Stratification System, Preoperatively, Reduce Intraoperative Complications during Phacoemulsification? Curr Eye Res 2020; 46:318-323. [PMID: 32730130 DOI: 10.1080/02713683.2020.1801759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
SIGNIFICANCE Adopting a risk stratification system and appropriate listing of cases reduces the rates of intraoperative complications during phacoemulsification. Such listing would allow both safe surgery and enhance training, by ensuring an appropriately experienced surgeon is available to operate on a case or supervise and teach a junior surgeon. PURPOSE To assess if the application of a simple, robust, validated preoperative scoring system can reduce the rates of intraoperative complications if patients are assigned to the appropriately experienced surgeon's list and surgical time is modified accordingly. METHODS Prospective data collection. One thousand one hundred and thirty five (1135) consecutive patients undergoing phakoemulsification cataract surgery were assessed preoperatively according to weighted criteria. According to the points of risk they accumulated using this system, the patients were preoperatively allocated to one of the four risk groups. The total rate of intraoperative complications for each risk group as well as the rate of each reported complication for each risk group was calculated. RESULTS The rate of intraoperative complications through the risk groups was 1 = 0.62%, 2 = 0.44%, 3 = 0.18%, and 4 = 0% (P = .005). Thirty-seven per cent 37% (n = 420) of all operations were performed on eyes of patients carrying at least one risk factor for intraoperative complications. The overall rate of any intraoperative complication was 1.2% (n = 14). There was a 0.4% (n = 5) rate of a posterior capsule tear with 2 of these cases with vitreous loss. CONCLUSIONS Risk stratification, allowing adequate theatre time and appropriate surgical experience, can reduce the rates of intraoperative complications. The risk stratification system allows for better planning of surgical lists and could be used as a transition for those trainees deemed to have sufficient experience for the more 'challenging' cases under adequate supervision.
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Affiliation(s)
| | - James Hansell
- Department of Ophthalmology, Royal Glamorgan Hospital , South Wales, UK
| | | | - Mohammed Muhtaseb
- Department of Ophthalmology, Royal Glamorgan Hospital , South Wales, UK
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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.
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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
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Incidence, characteristics, outcomes and confidence in managing posterior capsular rupture during cataract surgery in the UK: an ophthalmology trainees' perspective. Eye (Lond) 2020; 35:1213-1220. [PMID: 32612171 DOI: 10.1038/s41433-020-1057-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To examine the incidence, characteristics and outcomes of posterior capsular rupture (PCR) cases amongst the ophthalmology trainees and to evaluate the trainees' confidence in managing PCR. METHODS A two-staged cross-sectional study was carried out between September 2017 and April 2018 in the North East of England, UK. All ophthalmology trainees were surveyed on their confidence level in managing PCR and the characteristics and outcomes of their PCR cases. RESULTS Fifteen (71.4%) out of 21 trainees completed the study. The mean number of phacoemulsification was 268.9 ± 250.9 cases (range, 0-705) per trainee. There were 82 (1.9%) cases of PCR reported among 4303 phacoemulsification. PCR occurred most commonly during quadrant removal (44.0%) and cortex removal (21.3%). The best-corrected visual acuity (in logMAR) improved significantly from 0.47 ± 0.32 preoperatively to 0.20 ± 0.19 postoperatively (p < 0.001). The supervising consultant took over 80.5% of the PCR cases. The PCR rate decreased significantly from 3.1% at 0-100 cases to 0.6% at 301-400 cases (p = 0.004) and to 0.4% at >500 cases (p = 0.005). Confidence in managing PCR (without supervision) improved from 0% (9/9) at junior level to 50% (3/6) at senior level, and the average number of anterior vitrectomies performed was 0.6 ± 0.9 (range: 0.0-2.0). CONCLUSIONS We observed a low PCR rate among the trainees in our region, with the majority of cases achieving good visual outcome. A significant reduction in PCR rate was observed at the threshold of >500 cases. There is however a lack of confidence among trainees in managing PCR, highlighting the need for devising new training strategies in this area.
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Outcomes and complications in scleral-fixated intraocular lens implantations. Int Ophthalmol 2020; 40:2969-2977. [PMID: 32613460 DOI: 10.1007/s10792-020-01480-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/20/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE This study compares outcomes and complications of scleral-fixated intraocular lens implantation between 2 levels of surgeons. METHODS A retrospective case series of patients undergoing scleral-fixated intraocular lens implantation at Prince of Wales Hospital, Hong Kong, between May 2012 and April 2017 were reviewed. Data collected included age, gender, affected eye, preoperative and postoperative visual acuities, refractive target and outcome, surgeon profile, operative details including method of scleral fixation, intraoperative and postoperative complications and length of follow-up. RESULTS Ninety eyes of 90 patients were included for analyses. The mean LogMAR visual acuities were 1.17 ± 0.70 at postoperative week 1, 0.81 ± 0.56 at 1 month, 0.66 ± 0.55 at 3 months, 0.56 ± 0.59 at 6 months, and 0.51 ± 0.60 at 1 year, respectively. After adjusting for age at operation, operative time, axial length, subspecialty of the surgeon and preoperative LogMAR, surgeon seniority was not significantly associated with final visual outcomes. There was no statistically significant difference between the mean improvement in visual acuities between eyes operated by consultants and fellows under direct supervision of a senior surgeon. CONCLUSION Scleral-fixated intraocular lens implantation is safe and effective in improving visual acuity in aphakic adults without capsular support. Under good supervision, fellows were able to produce comparable results compared with experienced specialists.
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Gharaee H, Jahani M, Banan S. A Comparative Assessment of Intraoperative Complication Rates in Resident-Performed Phacoemulsification Surgeries According to Najjar-Awwad Preoperative Risk Stratification. Clin Ophthalmol 2020; 14:1329-1336. [PMID: 32546939 PMCID: PMC7244740 DOI: 10.2147/opth.s252418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/04/2020] [Indexed: 01/29/2023] Open
Abstract
Introduction Phacoemulsification cataract surgery presents a challenge to resident surgeons with lower experience, which confronts with patient safety. In this study, we compared major intraoperative surgical complications of resident-performed phacoemulsification surgeries between cases with low intraoperative risk and random cases with unknown intraoperative risk. Methods This prospective randomized controlled study was done on patients who underwent phacoemulsification surgery by third- and fourth-year residents in Khatam-al-Anbia eye hospital, Mashhad, Iran. Preoperative risk was calculated using Najjar-Awwad risk score after slit lamp examination and the patients with scores 7 or higher were considered high-risk. Patients were randomly assigned into a study group, in which only low-risk cases were operated by third-year residents, or control group, in which third-year residents were able to operate any patient regardless of the risk score. In both groups, the remaining patients were operated by fourth-year residents. All intraoperative complications were recorded. Data were analyzed using SPSS, considering P<0.05 significant. Results Overall, 475 patients with cataract in the study (N=232) and control (N=243) groups were operated. Mean overall Najjar-Awwad risk scores did not differ significantly between the groups, but pseudoexfoliation and poor pupil dilatation occurred significantly more frequently in the control group (P=0.010 and P=0.014, respectively). Overall, 36 surgeries in the study group (15.5%) and 47 surgeries in the control group (19.3%) were complicated (P=0.273). There was a significant difference between the third- and fourth-year residents regarding the inability to complete continuous curvilinear capsulorhexis (P=0.033). The risk of overall and major complications in high-risk cases was significantly higher among those operated by 3rd-year residents compared with those operated by 4th-year residents (OR=3.45, 95% CI=1.2–9.9, P=0.016 and OR=6.37, 95% CI=1.99–20.34, P=0.001, respectively). Conclusion Although supervised resident-performed phacoemulsification has a relatively safe learning curve in our residency program, it is best to stratify preoperative risk and assign high-risk cases to senior residents with higher experience.
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Affiliation(s)
- Hamid Gharaee
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masoud Jahani
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saeed Banan
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Cataract phacoemulsification performed by resident trainees and staff surgeons: intraoperative complications and early postoperative intraocular pressure elevation. J Cataract Refract Surg 2020; 46:555-561. [PMID: 32271522 DOI: 10.1097/j.jcrs.0000000000000105] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the incidence of intraoperative complications of phacoemulsification cataract surgery in a teaching hospital and to compare the intraoperative complication rate between resident trainees and staff ophthalmologists, to ascertain the overall rate of intraocular pressure (IOP) elevation on postoperative day 1 (POD1), and, again, to compare this value between resident trainees and staff surgeons. SETTING Centro Hospitalar São João, Oporto, Portugal. DESIGN Retrospective study. METHODS This study included eyes submitted for phacoemulsification cataract surgery from January 1, 2017, to December 31, 2017. There were no exclusion criteria. Data collected included the type of surgeon, level of resident training, case complexity, and intraoperative complications. From all noncomplicated surgeries, preoperative IOP and IOP-POD1 were collected. RESULTS A total of 2937 surgeries were included; 25.6% were performed by resident trainees. The complication rate was 6.3% with resident trainees and statistically significantly lower (3.3%) in staff surgeons. The complication rate of resident trainees did not differ according to their level of residency. There was a significantly increased incidence of IOP-POD1 elevation in the resident trainee group compared with the staff surgeon group. Surgeries performed by resident trainees, a preexisting history of glaucoma, and pseudoexfoliation were significant risk factors for IOP elevation. CONCLUSIONS To our knowledge, this is the first European study comparing the incidence of intraoperative and postoperative complications in cataract surgery performed by resident trainees and staff surgeons. We report a significantly higher rate of intraoperative complications and IOP elevation on POD1 in resident trainees vs staff surgeons.
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Zetterberg M, Montan P, Kugelberg M, Nilsson I, Lundström M, Behndig A. Cataract Surgery Volumes and Complications per Surgeon and Clinical Unit. Ophthalmology 2020; 127:305-314. [DOI: 10.1016/j.ophtha.2019.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 09/14/2019] [Accepted: 10/04/2019] [Indexed: 10/25/2022] Open
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McGhee CNJ, Zhang J, Patel DV. A perspective of contemporary cataract surgery: the most common surgical procedure in the world. J R Soc N Z 2020. [DOI: 10.1080/03036758.2020.1714673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Charles N. J. McGhee
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jie Zhang
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Dipika V. Patel
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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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: 2.4] [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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Affiliation(s)
- Jina V Han
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Ophthalmology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
| | - Dipika V Patel
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Ophthalmology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
| | - Kevin Liu
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Ophthalmology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
| | - Bia Z Kim
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Ophthalmology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
| | - Trevor Sherwin
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Charles N J McGhee
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Ophthalmology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
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Refractive Laser-Assisted Cataract Surgery versus Conventional Manual Surgery: Comparing Efficacy and Safety in 3144 Eyes. Am J Ophthalmol 2019; 206:32-39. [PMID: 31009596 DOI: 10.1016/j.ajo.2019.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/12/2019] [Accepted: 04/13/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE To report on outcomes of the efficacy and safety in 1 of the largest series of eyes undergoing either conventional manual cataract surgery (MCS) or refractive femtosecond laser-assisted cataract surgery (ReLACS). DESIGN Retrospective, consecutive, interventional comparative case series. METHODS This study included 3144 consecutive eyes, of which 1580 were treated via MCS, and 1564 were treated via ReLACS at Uptown Surgical Centre in Vaughan, Ontario, Canada. Preoperative characteristics, best corrected visual acuity (BCVA), mean absolute spherical error (MAE), rates of intraoperative posterior capsular rupture, and postoperative complications were evaluated. RESULTS Across all eyes, ReLACS was superior to MCS for reducing surgical time (MCS: 7.7 ± 0.1 min vs ReLACS: 6.8 ± 0.1 min, P < 0.001); was less commonly associated with postoperative cystoid macular edema (OR = 0.36, 95% CI: 0.14-0.91, P = 0.031) and more commonly reduced MAE (MCS: 0.60 ± 0.02 diopters (D) vs ReLACS: 0.54 ± 0.02 D, P = 0.02). There were no differences in rates of posterior capsular rupture (P = 0.918), overall postoperative complications (P = 0.088) or final BCVA (P = 0.881). When analyzing a subgroup of more difficult cases (n = 833), ReLACS was superior to MCS for: 1) being more likely to yield an improvement of more than 0.1 logarithm of the minimum angle of resolution BCVA (OR = 1.80, 95% CI: 1.15-2.74, P = 0.01); 2) reducing MAE (MCS: 0.73 ± 0.3 D vs ReLACS: 0.60 ± 0.27 D, P = 0.04); and 3) being more likely to yield an MAE within 0.5 D (OR = 1.61, 95% CI: 1.11-2.33, P = 0.012). CONCLUSIONS Across all eyes, our results support that ReLACS and MCS yield similar outcomes. However, our results show trends toward a more pronounced benefit of ReLACS compared to MCS when treating more difficult eyes.
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Chen X, Zafar S, Sikder S, Srikumaran D, Boland M, Ramanathan S, Woreta F. National survey and outcomes of resident-performed cataract surgery in monocular patients in the United States. J Cataract Refract Surg 2019; 45:939-945. [PMID: 31126781 DOI: 10.1016/j.jcrs.2019.02.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/09/2019] [Accepted: 02/12/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To identify nationwide policies surrounding cataract surgery in monocular patients and compare outcomes of those surgeries between residents and attending surgeons. SETTING Wilmer Eye Institute, Baltimore, Maryland, USA. DESIGN Retrospective case series. METHOD Cataract surgery educators across the United States were surveyed on their policies concerning residents performing cataract surgery on monocular patients. A second survey assessed resident opinions on performing surgery in such patients. In addition, a retrospective chart review was performed of all monocular patients (n = 72) who had resident-performed and attending-performed cataract surgery at the same academic institution. RESULTS Forty-seven residency programs responded to the survey. Although the majority of cataract surgery educators from these programs thought it was ethical for residents to perform cataract surgery on monocular patients, only 18 programs (38.3%) had implemented specific policies. The resident survey response rate was 39.1%. Residents were more anxious and did more preparation for monocular cases than for routine cataract surgery cases. Analysis of the comparative case series found intraoperative complications (9.7% versus 5.6%; P = .37) and postoperative visual outcomes were comparable between resident and attending surgeon monocular cases. The resident status of the surgeon was not predictive of an increased risk for complications (odds ratio, 0.98; 95% confidence interval, 0.13-7.55; P = .99). CONCLUSIONS Although most educators and resident trainees deemed resident-performed cataract surgery on monocular patients to be acceptable, the majority of residency programs did not have specific guidelines for residents performing surgery on such patients. Outcomes of resident-performed cataract surgeries on monocular patients at the same institution were comparable to surgeries performed by attending surgeons.
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Affiliation(s)
- Xinyi Chen
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sidra Zafar
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Shameema Sikder
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Divya Srikumaran
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael Boland
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Saras Ramanathan
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Fasika Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Han JV, Patel DV, Wallace HB, Kim BZ, Sherwin T, McGhee CN. Auckland Cataract Study III: Refining Preoperative Assessment With Cataract Risk Stratification to Reduce Intraoperative Complications. Am J Ophthalmol 2019; 197:114-120. [PMID: 30278159 DOI: 10.1016/j.ajo.2018.09.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 09/18/2018] [Accepted: 09/25/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To assess intraoperative complications of phacoemulsification surgery in public teaching hospital settings using modified preoperative risk stratification systems. DESIGN Prospective cohort study. METHODS Preoperative risk stratification of 500 consecutive cataract cases using the New Zealand Cataract Risk Stratification (NZCRS) scoring system. Recommended allocation of higher-risk phacoemulsification procedures to experienced surgeons in public teaching hospital setting. MAIN OUTCOME MEASURE Intraoperative complications relative to adherence to stratification recommendations. RESULTS NZCRS classified 192 cases (38%) as high-risk, recommended for fellows or consultants (attendings). Primary surgeons were residents (n = 142, 28%), fellows (n = 88, 18%), and consultants (n = 270, 54%). Overall rate (N = 500) of any intraoperative complication was 5.0%. Where NZCRS scoring recommendations were observed (n = 448) the intraoperative complication rate was 4.5% but in "nonadherence" cases (n = 52 residents operating on higher-risk cases) this nearly doubled (9.6%). Postoperative complications occurred in 5.2%, primarily cystoid macular edema (3.7%). Postoperatively, mean unaided visual acuity was 6/12 (20/40) and best-corrected visual acuity improved from 6/20 (20/63) preoperatively to 6/10 (20/32) postoperatively (P < .05). CONCLUSIONS The NZCRS system aids identification of higher-risk cataract cases and appropriate case-to-surgeon allocation and may increase surgeon awareness of risk factors. Compared to 2 previous studies under similar conditions in the same institution, the NZCRS system was associated with a 40% reduction in intraoperative complications (8.4% to 5%). The rate of posterior capsular tear was 0.6% (P = .035) compared to 2.6% in baseline phase and 1.4% in a prior risk stratification phase. Risk stratification seems to reduce intraoperative phacoemulsification complications in public teaching hospital settings.
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Moustafa GA, Borkar DS, McKay KM, Eton EA, Koulisis N, Lorch AC, Kloek CE. Outcomes in resident-performed cataract surgeries with iris challenges: Results from the Perioperative Care for Intraocular Lens study. J Cataract Refract Surg 2018; 44:1469-1477. [PMID: 30391157 DOI: 10.1016/j.jcrs.2018.08.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/16/2018] [Accepted: 08/05/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To assess the outcomes of resident-performed cataract surgeries with iris challenges and to compare these outcomes with similar surgeries performed by attending surgeons. SETTING Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA. DESIGN Retrospective chart review. METHODS All cases of cataract extraction by phacoemulsification with intraocular lens implantation, performed by comprehensive ophthalmologists between January 1 and December 31, 2014, were reviewed. Cases with preoperative or intraoperative miosis, iris prolapse, and intraoperative floppy iris syndrome, were included for analysis. Visual outcomes and the rate of perioperative adverse events were compared between resident and attending surgeon cases. Factors predicting adverse events were also assessed. RESULTS In total, 1931 eye cases of 1434 patients were reviewed, and 65 resident cases and 168 attending surgeon cases were included. The mean logarithm of the minimum angle of resolution corrected distance visual acuity was better in the resident group 1 month after surgery (0.051 ± 0.10 [SD] versus 0.132 ± 0.30, P = .03); however, the difference was eliminated when controlling for macular disease. The mean operative time was 43.8 ± 26.5 minutes and 30.9 ± 12.6 minutes for cases performed by resident surgeons and attending surgeons, respectively (P .0001). Residents utilized supplemental pharmacologic dilation or retraction more frequently than attending surgeons (98% versus 87% of cases, P = .008). The overall rate of adverse events was no different between residents and attending surgeons (P = 0.16). Dense nuclear sclerosis predicted adverse events in cataract cases with iris challenges (adjusted odds ratio, 1.86; 95% confidence interval, 1.17-2.94; P = .001). CONCLUSION Although requiring longer operative times and more surgical manipulation, residents who performed cataract surgeries with iris challenges achieved outcomes comparable to those performed by attending surgeons, and residents should be given the opportunity to operate on these eyes.
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Affiliation(s)
- Giannis A Moustafa
- From the Department of Ophthalmology (Moustafa, Borkar, McKay, Lorch, Kloek), Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, Retina Service (Borkar), Wills Eye Hospital, Philadelphia, Pennsylvania, Harvard Medical School (Eton), Boston, Massachusetts, and University of Southern California Roski Eye Institute (Koulisis), Keck School of Medicine, Los Angeles, California, USA
| | - Durga S Borkar
- From the Department of Ophthalmology (Moustafa, Borkar, McKay, Lorch, Kloek), Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, Retina Service (Borkar), Wills Eye Hospital, Philadelphia, Pennsylvania, Harvard Medical School (Eton), Boston, Massachusetts, and University of Southern California Roski Eye Institute (Koulisis), Keck School of Medicine, Los Angeles, California, USA
| | - K Matthew McKay
- From the Department of Ophthalmology (Moustafa, Borkar, McKay, Lorch, Kloek), Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, Retina Service (Borkar), Wills Eye Hospital, Philadelphia, Pennsylvania, Harvard Medical School (Eton), Boston, Massachusetts, and University of Southern California Roski Eye Institute (Koulisis), Keck School of Medicine, Los Angeles, California, USA
| | - Emily A Eton
- From the Department of Ophthalmology (Moustafa, Borkar, McKay, Lorch, Kloek), Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, Retina Service (Borkar), Wills Eye Hospital, Philadelphia, Pennsylvania, Harvard Medical School (Eton), Boston, Massachusetts, and University of Southern California Roski Eye Institute (Koulisis), Keck School of Medicine, Los Angeles, California, USA
| | - Nicole Koulisis
- From the Department of Ophthalmology (Moustafa, Borkar, McKay, Lorch, Kloek), Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, Retina Service (Borkar), Wills Eye Hospital, Philadelphia, Pennsylvania, Harvard Medical School (Eton), Boston, Massachusetts, and University of Southern California Roski Eye Institute (Koulisis), Keck School of Medicine, Los Angeles, California, USA
| | - Alice C Lorch
- From the Department of Ophthalmology (Moustafa, Borkar, McKay, Lorch, Kloek), Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, Retina Service (Borkar), Wills Eye Hospital, Philadelphia, Pennsylvania, Harvard Medical School (Eton), Boston, Massachusetts, and University of Southern California Roski Eye Institute (Koulisis), Keck School of Medicine, Los Angeles, California, USA
| | - Carolyn E Kloek
- From the Department of Ophthalmology (Moustafa, Borkar, McKay, Lorch, Kloek), Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, Retina Service (Borkar), Wills Eye Hospital, Philadelphia, Pennsylvania, Harvard Medical School (Eton), Boston, Massachusetts, and University of Southern California Roski Eye Institute (Koulisis), Keck School of Medicine, Los Angeles, California, USA.
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- From the Department of Ophthalmology (Moustafa, Borkar, McKay, Lorch, Kloek), Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, Retina Service (Borkar), Wills Eye Hospital, Philadelphia, Pennsylvania, Harvard Medical School (Eton), Boston, Massachusetts, and University of Southern California Roski Eye Institute (Koulisis), Keck School of Medicine, Los Angeles, California, USA
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Low SAW, Braga-Mele R, Yan DB, El-Defrawy S. Intraoperative complication rates in cataract surgery performed by ophthalmology resident trainees compared to staff surgeons in a Canadian academic center. J Cataract Refract Surg 2018; 44:1344-1349. [PMID: 30201127 DOI: 10.1016/j.jcrs.2018.07.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 06/07/2018] [Accepted: 07/04/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To compare the intraoperative complication rates in cataract surgery performed by resident trainees and staff ophthalmologists. SETTING Kensington Eye Institute, University of Toronto, Toronto, Canada. DESIGN Prospective case series. METHODS This study included 8738 consecutive cases of primary phacoemulsification cataract surgery performed by staff surgeons and resident trainees from January to December 2016. There were no exclusion criteria. Data collected included the level of resident training, case complexity, degree of resident involvement, and intraoperative complications. Primary outcome measures included intraoperative complication rates and level of complexity of cataract surgeries performed by resident trainees and staff surgeons. RESULTS Resident trainees were involved in 44% of surgeries. Of those, 82% were completed in their entirety by a resident and 18% were performed by both the staff surgeon and resident. Staff surgeons performed 56% of all surgeries without resident involvement. Sixty-seven percent of surgeries were simple and 33% were complex, with small pupil or intraoperative floppy-iris syndrome being the most common reason for complex cases. For simple cases, there was no difference in the overall complication rates (1.7% and 2.0%; P = .52), posterior capsule rupture rates (0.9% and 0.8%; P = .76), or vitreous loss rates (0.4% and 0.2%; P = .08) between staff and residents, respectively. CONCLUSION There were no differences in complication rates between the two groups.
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Affiliation(s)
- Stephanie A W Low
- From the Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.
| | - Rosa Braga-Mele
- From the Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - David B Yan
- From the Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Sherif El-Defrawy
- From the Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
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Ellis EM, Lee JE, Saunders L, Haw WW, Granet DB, Heichel CW. Complication rates of resident-performed cataract surgery: Impact of early introduction of cataract surgery training. J Cataract Refract Surg 2018; 44:1109-1115. [PMID: 30078539 DOI: 10.1016/j.jcrs.2018.06.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 06/05/2018] [Accepted: 06/09/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE To determine the effect of the early introduction of cataract surgery training on the complication rates of resident-performed cataract surgery. SETTING University of California San Diego, San Diego, California, USA. DESIGN Retrospective case series. METHODS Two classes of ophthalmology residents were examined, one class with a late introduction of cataract surgery and one with an early introduction of cataract surgery. All cataract cases in which residents acted as primary surgeon were included. Patient charts were reviewed to collect data on patient characteristics, surgical details, and intraoperative and postoperative complications. RESULTS The late-introduction cohort comprised 3 residents who performed 540 cataract cases, all during their final year of residency. The early-introduction cohort comprised 4 residents who performed 780 cataract cases beginning in the first year of residency. The late-introduction cohort had higher rates of major intraoperative complications than the early-introduction cohort (8.5% versus 3.1%) and of anterior vitrectomy (7.6% versus 2.1%) (both P < .001). Examination of the anterior vitrectomy rate as a function of experience showed the early-introduction cohort had a stable anterior vitrectomy rate of 1% to 2% throughout training, while the late-introduction cohort had a peak anterior vitrectomy rate of 12% at approximately case 20. Multivariable regression analysis showed the early-introduction cohort was independently associated with a lower rate of anterior vitrectomy (hazard ratio, 0.49; 95% confidence interval, 0.36-0.66) after adjusting for differences in patient characteristics and surgical complexity. CONCLUSIONS Early introduction of cataract surgery training significantly decreased the rate of major intraoperative complications, specifically anterior vitrectomy, in resident-performed cataract surgeries.
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Affiliation(s)
- Erika M Ellis
- From the Bascom Palmer Eye Institute (Ellis), Miller School of Medicine, University of Miami, Miami, Florida, and Shiley Eye Institute (Saunders, Lee, Haw, Heichel) and Ratner Children's Eye Center of the Shiley Eye Institute (Granet), University of California San Diego, San Diego, California, USA
| | - Jeffrey E Lee
- From the Bascom Palmer Eye Institute (Ellis), Miller School of Medicine, University of Miami, Miami, Florida, and Shiley Eye Institute (Saunders, Lee, Haw, Heichel) and Ratner Children's Eye Center of the Shiley Eye Institute (Granet), University of California San Diego, San Diego, California, USA
| | - Luke Saunders
- From the Bascom Palmer Eye Institute (Ellis), Miller School of Medicine, University of Miami, Miami, Florida, and Shiley Eye Institute (Saunders, Lee, Haw, Heichel) and Ratner Children's Eye Center of the Shiley Eye Institute (Granet), University of California San Diego, San Diego, California, USA
| | - Weldon W Haw
- From the Bascom Palmer Eye Institute (Ellis), Miller School of Medicine, University of Miami, Miami, Florida, and Shiley Eye Institute (Saunders, Lee, Haw, Heichel) and Ratner Children's Eye Center of the Shiley Eye Institute (Granet), University of California San Diego, San Diego, California, USA
| | - David B Granet
- From the Bascom Palmer Eye Institute (Ellis), Miller School of Medicine, University of Miami, Miami, Florida, and Shiley Eye Institute (Saunders, Lee, Haw, Heichel) and Ratner Children's Eye Center of the Shiley Eye Institute (Granet), University of California San Diego, San Diego, California, USA
| | - Chris W Heichel
- From the Bascom Palmer Eye Institute (Ellis), Miller School of Medicine, University of Miami, Miami, Florida, and Shiley Eye Institute (Saunders, Lee, Haw, Heichel) and Ratner Children's Eye Center of the Shiley Eye Institute (Granet), University of California San Diego, San Diego, California, USA.
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Kaplowitz K, Yazdanie M, Abazari A. A review of teaching methods and outcomes of resident phacoemulsification. Surv Ophthalmol 2018; 63:257-267. [DOI: 10.1016/j.survophthal.2017.09.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 09/11/2017] [Accepted: 09/12/2017] [Indexed: 10/18/2022]
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Aykut A, Kukner AS, Karasu B, Palancıglu Y, Atmaca F, Aydogan T. Everything is ok on YouTube! Quality assessment of YouTube videos on the topic of phacoemulsification in eyes with small pupil. Int Ophthalmol 2018; 39:385-391. [DOI: 10.1007/s10792-018-0823-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 01/09/2018] [Indexed: 11/24/2022]
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Kim BZ, Patel DV, McKelvie J, Sherwin T, McGhee CN. The Auckland Cataract Study II: Reducing Complications by Preoperative Risk Stratification and Case Allocation in a Teaching Hospital. Am J Ophthalmol 2017; 181:20-25. [PMID: 28666731 DOI: 10.1016/j.ajo.2017.06.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 06/14/2017] [Accepted: 06/19/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the effect of preoperative risk stratification for phacoemulsification surgery on intraoperative complications in a teaching hospital. DESIGN Prospective cohort study. METHODS Prospective assessment of consecutive phacoemulsification cases (N = 500) enabled calculation of a risk score (M-score of 0-8) using a risk stratification system. M-scores of >3 were allocated to senior surgeons. All surgeries were performed in a public teaching hospital setting, Auckland, New Zealand, in early 2016. Postoperatively, data were reviewed for complications and corrected distance visual acuity (CDVA). Results were compared to a prospective study (N = 500, phase 1) performed prior to formal introduction of risk stratification. RESULTS Intraoperative complications increased with increasing M-scores (P = .044). Median M-score for complicated cases was higher (P = .022). Odds ratio (OR) for a complication increased 1.269 per unit increase in M-score (95% confidence interval [CI] 1.007-1.599, P = .043). Overall rate of any intraoperative complication was 5.0%. Intraoperative complication rates decreased from 8.4% to 5.0% (OR = 0.576, P = .043) comparing phase 1 and phase 2 (formal introduction of risk stratification). The severity of complications also reduced. A significant decrease in complications for M = 0 (ie, minimal risk cases) was also identified comparing the current study (3.1%) to phase 1 (7.2%), P = .034. There was no change in postoperative complication risks (OR 0.812, P = .434) or in mean postoperative CDVA (20/30, P = .484) comparing current with phase 1 outcomes. CONCLUSION A simple preoperative risk stratification system, based on standard patient information gathered at preoperative consultation, appears to reduce intraoperative complications and support safer surgical training by appropriate allocation of higher-risk cases.
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Ergun ŞB, Kocamış Sİ, Çakmak HB, Çağıl N. The evaluation of the risk factors for capsular complications in phacoemulsification. Int Ophthalmol 2017; 38:1851-1861. [PMID: 28852905 DOI: 10.1007/s10792-017-0667-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 07/26/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE To determine and quantify the risk factors for disruption of lens capsule integrity during phacoemulsification. METHODS The medical records of the patients who had undergone phacoemulsification cataract surgery and had a complication associated with lens capsule were reviewed. Consecutive cases were also reviewed in reverse chronological order as a control group. The exclusion criteria were pediatric cataracts, traumatic cataracts and lens dislocation. As a result, 403 uncomplicated and 83 complicated eyes were analyzed. The differences between the complication group and the group without complications regarding the risk factors were shown by employing the Chi-square test and Fischer's exact test. The variables having the level of significance (p < 0.25) after the Chi-square test and Fischer's exact test were enrolled into the multiple stepwise logistic regression analysis. RESULTS Age (60-69/≤80) (p = 0.017), male gender (p = 0.006), pupil size ≤3 mm (p = <0.001), mature-brunescent cataract (p = <0.001), anterior chamber depth <2.5 mm (p = 0.001), posterior polar cataract (p = 0.006), diabetic retinopathy(p = <0.001), coronary artery disease (p = 0.098) and surgeon factor (junior resident/senior resident, p = 0.015; senior resident/specialist in ophthalmology, p = 0.026; junior resident/specialist in ophthalmology, p = 0.020) were among the factors significantly related to a capsule complication. An Excel program has been developed according to these results to predict the probability of capsule complication. CONCLUSIONS Higher-risk cases can be predicted preoperatively, thus allowing surgeons to take appropriate precautions, better informing the patient and better selecting the cases especially for trainee surgeons.
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Affiliation(s)
- Şule Berk Ergun
- Department of Ophthalmology, Numune Training and Research Hospital, Ankara, Turkey
| | - Sücattin İlker Kocamış
- Department of Ophthalmology, Faculty of Medicine, Hitit University, Çorum, Turkey. .,Bahçelievler Mah. Melikgazi Cad, Şanal Apt No:2/4, Çorum, Turkey.
| | - Hasan Basri Çakmak
- Department of Ophthalmology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Nurullah Çağıl
- Department of Ophthalmology, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
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Salowi MA, Chew FLM, Adnan TH, King C, Ismail M, Goh PP. The Malaysian Cataract Surgery Registry: risk Indicators for posterior capsular rupture. Br J Ophthalmol 2017; 101:1466-1470. [PMID: 28292773 DOI: 10.1136/bjophthalmol-2016-309902] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 02/08/2017] [Accepted: 02/18/2017] [Indexed: 12/16/2022]
Abstract
AIM To identify the risk indicators for posterior capsular rupture (PCR) in the Malaysian Cataract Surgery Registry (CSR). METHODS Data from the web-based CSR were collected for cataract surgery performed from 2008 to 2013. Data was contributed by 36 Malaysian Ministry of Health public hospitals. Information on patient's age, ethnicity, cause of cataract, ocular and systemic comorbidity, type of cataract surgery performed, local anaesthesia and surgeon's status was noted. Combined procedures and type of hospital admission were recorded. PCR risk indicators were identified using logistic regression analysis to produce adjusted OR for the variables of interest. RESULTS A total of 150 213 cataract operations were registered with an overall PCR rate of 3.2%. Risk indicators for PCR from multiple logistic regression were advancing age, male gender (95% CI 1.04 to 1.17; OR 1.11), pseudoexfoliation (95% CI 1.02 to 1.82; OR 1.36), phacomorphic lens (95% CI 1.25 to 3.06; OR 1.96), diabetes mellitus (95% CI 1.13 to 1.29; OR 1.20) and renal failure (95% CI 1.09 to 1.55; OR 1.30). Surgical PCR risk factors were combined vitreoretinal surgery (95% CI 2.29 to 3.63; OR 2.88) and less experienced cataract surgeons. Extracapsular cataract extraction (95% CI 0.76 to 0.91; OR 0.83) and kinetic anaesthesia were associated with lower PCR rates. CONCLUSIONS This study was agreed with other studies for the risk factors of PCR with the exception of local anaesthesia given and type of cataract surgery. Better identification of high-risk patients for PCR decreases intraoperative complications and improves cataract surgical outcomes.
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Affiliation(s)
- Mohamad Aziz Salowi
- Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, Malaysia.,Department of Ophthalmology, Hospital Selayang, Batu Caves, Malaysia
| | - Fiona L M Chew
- Department of Ophthalmology, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - Tassha Hilda Adnan
- Biostatistics Unit, National Clinical Research Centre, Kuala Lumpur, Malaysia
| | | | - Mariam Ismail
- Department of Ophthalmology, Sultan Abdul Halim Hospital, Sungai Petani, Kedah, Malaysia
| | - Pik-Pin Goh
- Clinical Research Centre, National Clinical Research Centre, Kuala Lumpur, Malaysia
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Halkiadakis I, Chatziralli I, Drakos E, Katzakis M, Skouriotis S, Patsea E, Mitropoulos P, Kandarakis A. Causes and management of small pupil in patients with cataract. Oman J Ophthalmol 2017; 10:220-224. [PMID: 29118499 PMCID: PMC5657166 DOI: 10.4103/ojo.ojo_102_2016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The purpose of the study was to present the causes and management of small pupil (<6 mm) in Greek patients with cataract. METHODS About 1144 consecutive patients with cataract comprised the study group. The pupil size was measured after maximal dilation by means of Rosenbaum cards and Colvard pupillometer. Dilation regimen included phenylephrine 10%, tropicamide 1%, cyclopentolate 1%, and ketorolac trometamol 0.5% administered 3 times at 5 min intervals starting 1 h before surgery. The presence of possible risk factors for small pupil was recorded. The need of additional maneuvers and devices to dilate the pupil during cataract surgery was examined, and the complication rate in cases with small pupils was recorded. RESULTS Small pupil was observed in 78 out of 1144 eyes (6.8%, 95% confidence interval = 5.2%-8.8%). Nine eyes had pupil size <4 mm (0.78%) preoperatively. Six cases (0.52%) developed intraoperative pupillary miosis. The major cause of small pupil was pseudoexfoliation (PEX) in 47.4% (37/78) of patients. No significant associations were observed regarding age, gender, history of diabetes mellitus, the maturity of cataract, and phacodonesis. Techniques for small pupil management included pupil stretching in 14 cases (17.9%), use of iris hooks in 6 cases (7.7%), iris sphincter cuts in 2 cases (2.6%), and placement of a Malyugin Ring in 4 cases (5.1%). Seven eyes (9%) with small pupil had capsular rupture versus 16 eyes (1.5%) with normal dilation (P < 0.001). CONCLUSIONS Small pupil is not very common in Greek population, is mostly caused by PEX, and it is associated with increased complication rate.
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Affiliation(s)
| | - Irini Chatziralli
- Department of Ophthalmology, Ophthalmiatrion Athinon, Athens, Greece
| | - Evangelos Drakos
- Department of Ophthalmology, Ophthalmiatrion Athinon, Athens, Greece
| | - Michail Katzakis
- Department of Ophthalmology, Ophthalmiatrion Athinon, Athens, Greece
| | | | - Eleni Patsea
- Department of Ophthalmology, Ophthalmiatrion Athinon, Athens, Greece
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Kim BZ, Patel DV, Sherwin T, McGhee CN. The Auckland Cataract Study: Assessing Preoperative Risk Stratification Systems for Phacoemulsification Surgery in a Teaching Hospital. Am J Ophthalmol 2016; 171:145-150. [PMID: 27637785 DOI: 10.1016/j.ajo.2016.09.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 08/31/2016] [Accepted: 09/04/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate 2 preoperative risk stratification systems for assessing the risk of complications in phacoemulsification cataract surgery, performed by residents, fellows, and attending physicians in a public teaching hospital. DESIGN Cohort study. METHODS One observer assessed the clinical data of 500 consecutive cases, prior to phacoemulsification cataract surgery performed between April and June 2015 at Greenlane Clinical Centre, Auckland, New Zealand. Preoperatively 2 risk scores were calculated for each case using the Muhtaseb and Buckinghamshire risk stratification systems. Complications, intraoperative and postoperative, and visual outcomes were analyzed in relation to these risk scores. RESULTS Intraoperative complication rates increased with higher risk scores using the Muhtaseb or Buckinghamshire stratification system (P = .001 and P = .003, respectively, n = 500). The odds ratios for residents and fellows were not significantly different from attending physicians after case-mix adjustment according to risk scores (P > .05). Postoperative complication rates increased with higher Buckinghamshire risk scores but not with Muhtaseb scores (P = .014 and P = .094, respectively, n = 476). Postoperative corrected-distance visual acuity was poorer with higher risk scores (P < .001 for both, n = 476). CONCLUSION This study confirms that the risk of intraoperative complications increases with higher preoperative risk scores. Furthermore, higher risk scores correlate with poorer postoperative visual acuity and the Buckinghamshire risk score also correlates with postoperative complications. Therefore, preoperative assessment using such risk stratification systems could assist individual informed consent, preoperative surgical planning, safe allocation of cases to trainees, and more meaningful analyses of outcomes for individual surgeons and institutions.
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