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Jeang LJ, Liechty JJ, Powell A, Schwartz C, DiSclafani M, Drucker MD, McDowell WM. Rate of Posterior Capsule Rupture in Phacoemulsification Cataract Surgery by Residents with Institution of a Wet Laboratory Course. JOURNAL OF ACADEMIC OPHTHALMOLOGY 2022. [DOI: 10.1055/s-0042-1744270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Abstract
Purpose To determine if a structured surgical wet laboratory curriculum for ophthalmology residents reduced the rate of posterior capsule rupture (PCR) in phacoemulsification cataract surgery.
Setting James A. Haley Veterans' Hospital, Tampa, FL.
Design Retrospective cohort study.
Methods The study assessed resident-performed phacoemulsification cataract cases from 2011 to 2017, after the creation of a wet laboratory course. Primary outcome measure was PCR. If present, timing of complication, dropped lens fragments, and the need for anterior vitrectomies were noted. Self-reported rates of PCR prior to institution of a wet laboratory course (2010–2011) were compared with cases done by residents who completed the course (2011–2017).
Results A total of 3,445 cases were reviewed of which 2.44% (84 cases) noted PCR. Of these, 19% (16) had dropped lens fragments, and 60.7% (51) required anterior vitrectomy. Sixty-nine cases documented timing of PCR with the majority, 58%, occurring during phacoemulsification. When comparing rates of PCR in cases done prior to the presence of a wet laboratory course versus after, there was a significant reduction observed (5.20% before vs. 2.44% after).
Conclusion In the presence of a wet laboratory curriculum, the rate of PCR decreased dramatically. The average rate was lower than those reported at other training programs (2.6–9.9%). Most PCR occurred during phacoemulsification, suggesting need for further focused instruction in this step.
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Affiliation(s)
- Lauren J. Jeang
- University of South Florida Department of Ophthalmology, Tampa, Florida
| | - Jacob J. Liechty
- University of South Florida Department of Ophthalmology, Tampa, Florida
| | - Asyvia Powell
- University of South Florida School of Medicine, Tampa, Florida
| | | | - Mark DiSclafani
- University of South Florida Department of Ophthalmology, Tampa, Florida
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Changing practice patterns in European cataract surgery as reflected in the European Registry of Quality Outcomes for Cataract and Refractive Surgery 2008 to 2017. J Cataract Refract Surg 2021; 47:373-378. [PMID: 33086294 DOI: 10.1097/j.jcrs.0000000000000457] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/17/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To study practice patterns in European cataract surgery over a 10-year period. SETTING European clinics affiliated to the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO). DESIGN Registry cohort study. METHODS The EUREQUO contains preoperative, intraoperative, and postoperative parameters reported by surgeons in many European clinics. All data reported to the registry are anonymized. Preoperative parameters included age, sex, visual acuity, target refraction, ocular comorbidity, and surgical difficulties. Surgical data included anesthesia, surgical technique, intraocular lens optic biomaterial, and complications. Postoperative parameters included visual acuity, refraction, and short-term complications. RESULTS During the study period (January 1, 2008, to December 31, 2017), a total of 2 714 108 cataract extractions were reported to the EUREQUO. Preoperative data changed over time, with decreases in mean age (74.5-73.0 years), proportion of women from 60.6% (100 373/165 628) to 57.2% (174 908/305 845), and proportion of coexisting eye diseases from 30.0% (49 638/165 650) to 27.0% (82 704/305 846) and with improvements in preoperative visual acuity (mean logarithm of minimum angle of resolution [logMAR] 0.46 to 0.37). The use of topical anesthesia increased over time from 28.1% (26 238/93 320) to 71.7% (130 525/182 083). Surgical complications showed a significant decrease from 2.5% (4107/165 650) to 1.2% (3573/305 846). The visual outcome improved over time (mean logMAR 0.08 to 0.05), as did the absolute median prediction error (0.38 diopter [D] to 0.28 D). CONCLUSIONS Trends in European cataract surgery practice patterns from 2008 to 2017 have moved toward younger patients with better preoperative visual acuity, fewer surgical complications, and better predicted refractions and visual outcomes.
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Scott WJ, Tauber S, Gessler JA, Ohly JG, Owsiak RR, Eck CD. Comparison of vitreous loss rates between manual phacoemulsification and femtosecond laser-assisted cataract surgery. J Cataract Refract Surg 2018; 42:1003-8. [PMID: 27492098 DOI: 10.1016/j.jcrs.2016.04.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 04/13/2016] [Accepted: 04/14/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To compare the vitreous loss complication rate of manual phacoemulsification cataract surgery with that of femtosecond laser-assisted cataract surgery. SETTING Mercy Eye Specialists, Springfield, Missouri, USA. DESIGN Retrospective single-center case series. METHODS Cataract surgeries from 2010 to 2014 performed by 4 surgeons were audited for rates of vitreous loss. Vitreous loss data were statistically analyzed with and without exclusions. RESULTS Of the total 7155 cases from 2010 to 2014, 3784 were consecutively performed using manual phacoemulsification from 2010 to 2012 and 3371 were performed using femtosecond laser-assisted cataract surgery from 2013 to 2014. The rate of vitreous loss with exclusions was 1.17% in the manual phacoemulsification group and versus 0.65% femtosecond laser-assisted group; without exclusions, the rate was 1.40% versus 0.77%. In absolute terms, the rate decreased for every surgeon in the study. The chi-square test showed a statistically significant association between the date of surgery, and thus technique, and vitrectomy cases (P < .05). Odds ratio analysis with exclusions versus without exclusions indicated that surgeries performed from 2010 to 2012 using manual phacoemulsification were 1.6 times and 1.8 times, respectively, more likely to have vitreous loss than surgeries performed from 2013 to 2014 using the femtosecond laser-assisted cataract surgery technique. CONCLUSIONS Conversion from manual phacoemulsification to femtosecond laser-assisted cataract surgery resulted in a statistically significant decrease in vitreous loss. Because vitreous loss increases the risk for other serious complications of cataract surgery, this new finding has important implications for the safety of cataract surgery. FINANCIAL DISCLOSURE Proprietary or commercial disclosures are listed after the references.
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Affiliation(s)
- Wendell J Scott
- From Mercy Eye Specialists (Scott, Tauber, Gessler, Ohly, Owsiak), Springfield, and Mercy Hospital (Eck), St. Louis, Missouri, USA.
| | - Shachar Tauber
- From Mercy Eye Specialists (Scott, Tauber, Gessler, Ohly, Owsiak), Springfield, and Mercy Hospital (Eck), St. Louis, Missouri, USA
| | - James A Gessler
- From Mercy Eye Specialists (Scott, Tauber, Gessler, Ohly, Owsiak), Springfield, and Mercy Hospital (Eck), St. Louis, Missouri, USA
| | - Johann G Ohly
- From Mercy Eye Specialists (Scott, Tauber, Gessler, Ohly, Owsiak), Springfield, and Mercy Hospital (Eck), St. Louis, Missouri, USA
| | - Rachel R Owsiak
- From Mercy Eye Specialists (Scott, Tauber, Gessler, Ohly, Owsiak), Springfield, and Mercy Hospital (Eck), St. Louis, Missouri, USA
| | - Craig D Eck
- From Mercy Eye Specialists (Scott, Tauber, Gessler, Ohly, Owsiak), Springfield, and Mercy Hospital (Eck), St. Louis, Missouri, USA
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Davey K, Chang B, Purslow C, Clay E, Vataire AL. Budget impact model of Mydrane®, a new intracameral injectable used for intra-operative mydriasis, from a UK hospital perspective. BMC Ophthalmol 2018; 18:104. [PMID: 29673317 PMCID: PMC5907706 DOI: 10.1186/s12886-018-0746-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 03/16/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND During cataract surgery, maintaining an adequate degree of mydriasis throughout the entire operation is critical to allow for visualisation of the capsulorhexis and the crystalline lens. Good anaesthesia is also essential for safe intraocular surgery. Mydrane® is a new injectable intracameral solution containing two mydriatics (tropicamide 0.02% and phenylephrine 0.31%) and one anaesthetic (lidocaine 1%) that was developed as an alternative to the conventional topical pre-operative mydriatics used in cataract surgery. This study aimed to estimate the budget impact across a one year time frame using Mydrane® instead of topical dilating eye drops, for a UK hospital performing 3,000 cataract operations a year. METHODS A budget impact model (BIM) was developed to compare the economic outcomes associated with the use of Mydrane® versus topical drops (tropicamide 0.5% and phenylephrine 10%) in patients undergoing cataract surgery in a UK hospital. The outcomes of interest included costs and resource use (e.g. clinician time, mydriasis failures, operating room time, number of patients per vial of therapy etc.) associated with management of mydriasis in patients undergoing cataract surgery. All model inputs considered the UK hospital perspective without social or geographical variables. Deterministic sensitivity analyses were also performed to assess the model uncertainty. RESULTS Introduction of Mydrane® is associated with a cost saving of £6,251 over 3,000 cataract surgeries in one year. The acquisition costs of the Mydrane® (£18,000 by year vs. £3,330 for eye drops) were balanced by substantial reductions in mainly nurses' costs and time, plus a smaller contribution from savings in surgeons' costs (£20,511) and lower costs associated with auxiliary dilation (£410 due to avoidance of additional dilation methods). Results of the sensitivity analyses confirmed the robustness of the model to the variation of inputs. Except for the duration of one session of eye drop instillation and the cost of Mydrane®, Mydrane® achieved an incremental cost gain compared to tropicamide/phenylephrine eye drops. CONCLUSIONS Despite a higher acquisition cost of Mydrane®, the budget impact of Mydrane® on hospital budgets is neutral. Mydrane® offers a promising alternative to traditional regimes using eye drops, allowing for a better patient flow and optimisation of the surgery schedule with neutral budget impact.
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Affiliation(s)
- Keith Davey
- Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK.
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Risk factors for refractive error after cataract surgery: Analysis of 282 811 cataract extractions reported to the European Registry of Quality Outcomes for cataract and refractive surgery. J Cataract Refract Surg 2018; 44:447-452. [DOI: 10.1016/j.jcrs.2018.01.031] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 01/26/2018] [Accepted: 01/30/2018] [Indexed: 11/23/2022]
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Thome C, Chambers DB, Hooker AM, Thompson JW, Boreham DR. Deterministic Effects to the Lens of the Eye Following Ionizing Radiation Exposure: is There Evidence to Support a Reduction in Threshold Dose? HEALTH PHYSICS 2018; 114:328-343. [PMID: 29360710 DOI: 10.1097/hp.0000000000000810] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Ionizing radiation exposure to the lens of the eye is a known cause of cataractogenesis. Historically, it was believed that the acute threshold dose for cataract formation was 5 Sv, and annual dose limits to the lens were set at 150 mSv. Recently, however, the International Commission on Radiological Protection has reduced their threshold dose estimate for deterministic effects to 0.5 Gy and is now recommending an occupational limit of 20 mSv per year on average. A number of organizations have questioned whether this new threshold and dose limit are justified based on the limited reliable data concerning radiation-induced cataracts. This review summarizes all of the published human epidemiological data on ionizing radiation exposure to the lens of the eye in order to evaluate the proposed threshold. Data from a variety of exposure cohorts are reviewed, including atomic bomb survivors, Chernobyl liquidators, medical workers, and radiotherapy patients. Overall, there is not conclusive evidence that the threshold dose for cataract formation should be reduced to 0.5 Gy. Many of the studies reviewed here are challenging to incorporate into an overall risk model due to inconsistencies with dosimetry, sample size, and scoring metrics. Additionally, risk levels in the studied cohorts may not relate to occupational scenarios due to differences in dose rate, radiation quality, age at exposure and latency period. New studies should be designed specifically focused on occupational exposures, with reliable dosimetry and grading methods for lens opacities, to determine an appropriate level for dose threshold and exposure limit.
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Abstract
This review article deals with a potentially sight threatening complication – rupture of the posterior capsule – during cataract surgery. Cataract surgery is the most commonly performed surgical procedure in ophthalmology and despite tremendous technical and technological advancements, posterior capsular rent (PCR) still occurs. PCR occurs both in the hands of experienced senior surgeons and the neophyte surgeons, although with a higher frequency in the latter group. Additionally, certain types of cataracts are prone to this development. If managed properly in a timely manner the eventual outcome may be no different from that of an uncomplicated case. However, improper management may lead to serious complications with a higher incidence of permanent visual disability. The article covers the management of posterior capsular rent from two perspectives: 1. Identifying patients at higher risk and measures to manage such patients by surgical discipline, and 2. Intraoperative management of posterior capsular rent and various case scenarios to minimize long-term complications. This review is written for experienced and not-so-experienced eye surgeons alike to understand and manage PCR.
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Affiliation(s)
- Arup Chakrabarti
- Chief, Cataract and Glaucoma Services, Chakrabarti Eye Care Centre, Kochulloor, Trivandrum, Kerala, India
| | - Nazneen Nazm
- Assistant Professor, Ophthalmology ESI-PGIMSR, ESIC Medical College and ESIC Hospital, The West Bengal University of Health Sciences, Kolkata, West Bengal, India
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Kessel L, Andresen J, Erngaard D, Flesner P, Tendal B, Hjortdal J. Indication for cataract surgery. Do we have evidence of who will benefit from surgery? A systematic review and meta-analysis. Acta Ophthalmol 2016; 94:10-20. [PMID: 26036605 PMCID: PMC4744664 DOI: 10.1111/aos.12758] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 04/06/2015] [Indexed: 12/16/2022]
Abstract
The need for cataract surgery is expected to rise dramatically in the future due to the increasing proportion of elderly citizens and increasing demands for optimum visual function. The aim of this study was to provide an evidence-based recommendation for the indication of cataract surgery based on which group of patients are most likely to benefit from surgery. A systematic literature search was performed in the MEDLINE, CINAHL, EMBASE and COCHRANE LIBRARY databases. Studies evaluating the outcome after cataract surgery according to preoperative visual acuity and visual complaints were included in a meta-analysis. We identified eight observational studies comparing outcome after cataract surgery in patients with poor (<20/40) and fair (>20/40) preoperative visual acuity. We could not find any studies that compared outcome after cataract surgery in patients with few or many preoperative visual complaints. A meta-analysis showed that the outcome of cataract surgery, evaluated as objective and subjective visual improvement, was independent on preoperative visual acuity. There is a lack of scientific evidence to guide the clinician in deciding which patients are most likely to benefit from surgery. To overcome this shortage of evidence, many systems have been developed internationally to prioritize patients on waiting lists for cataract surgery, but the Swedish NIKE (Nationell Indikationsmodell för Katarakt Ekstraktion) is the only system where an association to the preoperative scoring of a patient has been related to outcome of cataract surgery. We advise that clinicians are inspired by the NIKE system when they decide which patients to operate to ensure that surgery is only offered to patients who are expected to benefit from cataract surgery.
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Affiliation(s)
- Line Kessel
- Department of Ophthalmology Rigshospitalet ‐ Glostrup Glostrup Denmark
- Danish Health and Medicines Authorities Copenhagen Denmark
| | | | - Ditte Erngaard
- Department of Ophthalmology Næstved Hospital Næstved Denmark
| | | | - Britta Tendal
- Danish Health and Medicines Authorities Copenhagen Denmark
| | - Jesper Hjortdal
- Department of Ophthalmology Aarhus University Hospital NBG Aarhus Denmark
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Indications and clinical outcomes of capsular tension ring implantation in phacoemulsification surgery at a tertiary teaching hospital: A review of 4316 cataract surgeries. J Fr Ophtalmol 2015; 38:955-9. [DOI: 10.1016/j.jfo.2015.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 03/31/2015] [Accepted: 05/15/2015] [Indexed: 11/18/2022]
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[Clinical practice variation in cataract surgery]. ACTA ACUST UNITED AC 2014; 90:220-32. [PMID: 25475557 DOI: 10.1016/j.oftal.2014.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 07/14/2014] [Accepted: 07/16/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Cataract surgery rates have dramatically increased in the last two decades. However, clinical practice variation in cataract surgery has not been thoroughly studied. The aim of this review is to analyze clinical practice variation, including the causes and consequences of this phenomenon. Then, its role in health care planning and health care quality is focused, emphasizing the importance of reducing it and providing several practical strategies to accomplish it. RECENT FINDINGS The latest researches are presented in this article. They identify the development and implementation of clinical practice guidelines as the best tool to standardize care processes. CONCLUSION Managing unwarranted or unwanted variation would improve quality of care and may lead to a significant saving in health care spending.
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Lee MY, Goh PP, Salowi MA, Adnan TH, Ismail M. The Malaysian Cataract Surgery Registry: Cataract Surgery Practice Pattern. Asia Pac J Ophthalmol (Phila) 2014; 3:343-7. [PMID: 26107976 DOI: 10.1097/apo.0000000000000030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To present the cataract surgery practice pattern among the ophthalmic surgeons in hospitals managed by the Ministry of Health (MOH) in Malaysia. DESIGN Secondary data analysis on Malaysian Cataract Surgery Registry (CSR). METHODS The Malaysian CSR collected data on cataract surgeries done at all the ophthalmology departments in MOH from year 2002 to 2004 (paper-based) and 2007 to 2011 (web-based). Data collected include type of admission, surgical techniques, type of anesthesia, and intraocular lens (IOL). Descriptive and inferential analysis was performed. RESULTS Of the 185,388 cataract surgeries done over 8 years, 171,482 (91.5%) were captured in CSR. There was a steep rise in phacoemulsification cataract surgery from 39.7% in 2002 to 78.0% in 2011 with a corresponding fall in extracapsular cataract extraction from 54.0% to 17.3% in the respective years. This explained the surge in the use of foldable IOL from 26.5% in 2002 to 88.3% in 2011. The proportion of cataract surgery with IOL implantation was 97.5% in 2012 and 98.2% in 2011. The proportion of day-care cataract surgery was low, with 39.3% in 2002 to 52.3% in 2011. Vitreoretinal surgery was the commonest type of combined surgery performed. CONCLUSIONS Although phacoemulsification was performed in two thirds of the patients who presented to MOH hospitals in Malaysia, extracapsular cataract extraction was still being performed because of a significant proportion of cataract that were brunescent and limited access to phacoemulsification machines and consumables. There is a need to increase day-care cataract surgery as it will eventually save cost.
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Affiliation(s)
- Ming-Yueh Lee
- From the *Department of Ophthalmology and †Clinical Research Centre, Kuala Lumpur Hospital, Kuala Lumpur; ‡Department of Ophthalmology,Sarawak General Hospital, Sarawak; and §Department of Ophthalmology,Selayang Hospital, Selangor, Malaysia
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Mitsuhiro MH, Berezovsky A, Belfort R, Ellwein LB, Salomao SR. Uptake, Barriers and Outcomes in the Follow-up of Patients Referred for Free-of-Cost Cataract Surgery in the Sao Paulo Eye Study. Ophthalmic Epidemiol 2014; 22:253-9. [PMID: 25310584 DOI: 10.3109/09286586.2014.966849] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE To determine uptake, barriers and outcomes in the follow-up of patients referred for free-of-charge, expedited cataract surgery in the Sao Paulo Eye Study (SPES). METHODS SPES was a population-based study of urban, low-middle income residents aged ≥50 years. Presenting visual acuity (PVA), best-corrected visual acuity, refraction, and slit-lamp examination were performed in 3677 participants. For subjects with cataract as a principal cause of best-corrected visual acuity ≤20/40, surgery was offered free of charge. Two years after the baseline study, surgery uptake, barriers to surgery, and visual outcomes were analyzed. RESULTS Among 210 (5.71%) participants who had a cataract surgery indication at baseline, 164 (78.1%) were successfully contacted and 55 (33.5%) reported being operated on for cataract, with 51 agreeing to be re-examined. In a multiple logistic regression model, age, sex, schooling, previous cataract surgery, and PVA at baseline were not significantly associated with surgery uptake. Co-existing health conditions (20.4%), fear of surgery (12.2%) and fear of losing eyesight (11.6%) were the most frequent barriers to cataract surgery adherence. Among the 69 eyes operated on in the interval between baseline and follow-up, PVA ≥20/63 was observed in 50 (72.6%, 95% confidence interval, CI, 62.2-82.3%), PVA <20/63-20/200 in 11 (15.8%, 95% CI 8.9-22.9%) and PVA <20/200 in 8 (11.6%, 95% CI 5.3-17.9%). CONCLUSIONS Quality of surgery is an increasing determinant of uptake rates. Although free-of-charge and expedited cataract surgery was offered, surgical outcomes might have influenced the low uptake. Aside from cataract surgery campaigns, improvement of surgeon skills, accurate biometry, treatment of ocular comorbidities, postoperative follow-up and eye-care education are needed.
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Affiliation(s)
- Marcia H Mitsuhiro
- Departamento de Oftalmologia, Escola Paulista de Medicina, Universidade Federal de Sao Paulo , Sao Paulo, SP , Brasil and
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Lundström M, Goh PP, Henry Y, Salowi MA, Barry P, Manning S, Rosen P, Stenevi U. The changing pattern of cataract surgery indications: a 5-year study of 2 cataract surgery databases. Ophthalmology 2014; 122:31-8. [PMID: 25234011 DOI: 10.1016/j.ophtha.2014.07.047] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 06/24/2014] [Accepted: 07/26/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE The aim of this study was to describe changes over time in the indications and outcomes of cataract surgery and to discuss optimal timing for the surgery. DESIGN Database study. PARTICIPANTS Patients who had undergone cataract extraction in the Netherlands, Sweden, or Malaysia from 2008 through 2012. METHODS We analyzed preoperative, surgical, and postoperative data from 2 databases: the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO) and the Malaysian National Cataract Registry. The EUREQUO contains complete data from the national cataract registries in the Netherlands and Sweden. MAIN OUTCOME MEASURES Preoperative and postoperative corrected distance visual acuity, preoperative ocular comorbidity in the surgery eye, and capsule complications during surgery. RESULTS There were substantial differences in indication for surgery between the 3 national data sets. The percentage of eyes with a preoperative best-corrected visual acuity of 20/200 or worse varied from 7.1% to 72%. In all 3 data sets, the visual thresholds for cataract surgery decreased over time by 6% to 28% of the baseline values. The frequency of capsule complications varied between the 3 data sets, from 1.1% to 3.7% in 2008 and from 0.6% to 2.7% in 2012. An increasing postoperative visual acuity was also seen for all 3 data sets. A high frequency of capsule complication was related significantly to poor preoperative visual acuity, and a high frequency of decreased visual acuity after surgery was related significantly to excellent preoperative visual acuity. CONCLUSIONS The 5-year trend in all 3 national data sets showed decreasing visual thresholds for surgery, decreasing surgical complication rates, and increasing visual outcomes regardless of the initial preoperative visual level. Cataract surgery on eyes with poor preoperative visual acuity was related to surgical complications, and cataract surgery on eyes with excellent preoperative visual acuity was related to adverse visual results.
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Affiliation(s)
- Mats Lundström
- Department of Clinical Sciences, Ophthalmology, Faculty of Medicine, Lund University, Lund, Sweden.
| | - Pik-Pin Goh
- National Cataract Registry, Clinical Research Centre, Ministry of Health, Kuala Lumpur, Malaysia
| | - Ype Henry
- Department of Ophthalmology, VUmc, Amsterdam, The Netherlands
| | - Mohamad A Salowi
- Department of Ophthalmology, Sarawak General Hospital, Ministry of Health, Malaysia
| | - Peter Barry
- Royal Victoria Eye and Ear and St. Vincent's University Hospital, Dublin, Ireland
| | - Sonia Manning
- Ophthalmology Department, Cork University Hospital, Cork, Ireland
| | - Paul Rosen
- Oxford Eye Hospital, Oxford, United Kingdom
| | - Ulf Stenevi
- Department of Ophthalmology, Sahlgren's University Hospital, Mölndal, Sweden
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Olawoye OO, Ashaye AO, Bekibele CO, Ajayi BGK. Visual outcome after cataract surgery at the university college hospital, ibadan. Ann Ib Postgrad Med 2014; 9:8-13. [PMID: 25161481 PMCID: PMC4111036 DOI: 10.4314/aipm.v9i1.72428] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Aim: The aim of this study was to determine the visual outcome
of patients who had cataract surgery in the University College
Hospital Ibadan. Methodology: This is an observational descriptive, longitudinal
study of consecutive patients undergoing cataract surgery at
the University College Hospital conducted between May and
October 2007. A total of 184 patients who presented to the
hospital and met the inclusion criteria were recruited into the
study. Patients were examined preoperatively, 1st day
postoperatively and 8th week postoperatively. Results: The mean age was 66.5 years; and the male to female
ratio was 1.2:1. Preoperatively, 137 patients (74.5%) were blind
in the operated eye, while 39 patients (23.6%) were blind in
both eyes at presentation. At 1st day postoperatively, 87 patients
(47.3%) had pinhole visual acuity of 6/6-6/18. Best corrected
vision after refraction eight weeks postoperatively showed that
127 patients out of 161 patients (78.8%) had good vision while
28 patients (17.4%) had borderline vision, and six patients (3.8%)
had severe visual impairment after refraction. The number of
bilaterally blind patients also reduced from 39 (23.6%) to one
(0.6%). Uncorrected refractive error was the commonest cause
of poor vision prior to refraction. Glaucoma was the commonest
ocular co-morbidity accounting for poor vision in 9.1% of
patients eight weeks after cataract surgery. Conclusion: This study demonstrates that good results can be
obtained with cataract surgery and intraocular lens implantation
in the developing world. More attention should be directed
towards ensuring that successful outcomes are indeed being
realized by continued monitoring of postoperative visual
outcomes and prompt refraction for all patients.
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Affiliation(s)
- O O Olawoye
- Department of Ophthalmology, University College Hospital Ibadan, Nigeria
| | - A O Ashaye
- Department of Ophthalmology, University College Hospital Ibadan, Nigeria
| | - C O Bekibele
- Department of Ophthalmology, University College Hospital Ibadan, Nigeria
| | - B G K Ajayi
- Ojulowo Specialist Eye Centre, Mokola Ibadan
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Hahn U, Neuhann I, Schmickler S, Krummenauer F. A methodological approach to identify external factors for indicator-based risk adjustment illustrated by a cataract surgery register. BMC Health Serv Res 2014; 14:279. [PMID: 24965949 PMCID: PMC4082622 DOI: 10.1186/1472-6963-14-279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 06/18/2014] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Risk adjustment is crucial for comparison of outcome in medical care. Knowledge of the external factors that impact measured outcome but that cannot be influenced by the physician is a prerequisite for this adjustment. To date, a universal and reproducible method for identification of the relevant external factors has not been published. The selection of external factors in current quality assurance programmes is mainly based on expert opinion. We propose and demonstrate a methodology for identification of external factors requiring risk adjustment of outcome indicators and we apply it to a cataract surgery register. METHODS Defined test criteria to determine the relevance for risk adjustment are "clinical relevance" and "statistical significance". Clinical relevance of the association is presumed when observed success rates of the indicator in the presence and absence of the external factor exceed a pre-specified range of 10%. Statistical significance of the association between the external factor and outcome indicators is assessed by univariate stratification and multivariate logistic regression adjustment.The cataract surgery register was set up as part of a German multi-centre register trial for out-patient cataract surgery in three high-volume surgical sites. A total of 14,924 patient follow-ups have been documented since 2005. Eight external factors potentially relevant for risk adjustment were related to the outcome indicators "refractive accuracy" and "visual rehabilitation" 2-5 weeks after surgery. RESULTS The clinical relevance criterion confirmed 2 ("refractive accuracy") and 5 ("visual rehabilitation") external factors. The significance criterion was verified in two ways. Univariate and multivariate analyses revealed almost identical external factors: 4 were related to "refractive accuracy" and 7 (6) to "visual rehabilitation". Two ("refractive accuracy") and 5 ("visual rehabilitation") factors conformed to both criteria and were therefore relevant for risk adjustment. CONCLUSION In a practical application, the proposed method to identify relevant external factors for risk adjustment for comparison of outcome in healthcare proved to be feasible and comprehensive. The method can also be adapted to other quality assurance programmes. However, the cut-off score for clinical relevance needs to be individually assessed when applying the proposed method to other indications or indicators.
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Affiliation(s)
- Ursula Hahn
- Institut für Medizinische Biometrie und Epidemiologie, Fakultät für Gesundheit der Universität Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany.
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Lundström M, Barry P, Brocato L, Fitzpatrick C, Henry Y, Rosen P, Stenevi U. European registry for quality improvement in cataract surgery. Int J Health Care Qual Assur 2014; 27:140-51. [PMID: 24745139 DOI: 10.1108/ijhcqa-10-2012-0101] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE A project aimed at creating a multi-national database for cataract and refractive surgery was initiated in 2008. The database was intended for learning and clinical improvement, not supervision. The project was co-funded by the European Union, under the Executive Agency for Health and Consumers and the European Society of Cataract and Refractive Surgeons (ESCRS) and supported by 11 national societies for cataract and refractive surgery. The purpose of this article is to describe the setup of the database and the ensuing achievements within cataract surgery after four years. DESIGN/METHODOLOGY/APPROACH A web-based system was created for input and output of data, with a software interface to two databases, one for cataract surgery and one for refractive surgery. Data can be put in either manually through web forms or by transfer of data from existing national registries or large electronic medical record systems. Output of reports from the system or export of one's own data is available on the web. The data are anonymous to all users, with the sole exception that reporting surgeons and clinics have access to their own data. The system does not include any patient identification. FINDINGS After four years, data from 16 countries have been entered into the system, including reports of more than 900,000 cataract extractions. The database has been used by individual clinics for benchmarking and clinical improvement work, and has also served as the basis for new clinical guidelines for cataract surgery. The ESCRS has guaranteed the sustainability of the database after the project period. ORIGINALITY/VALUE A European quality registry with data input from surgeons and clinics in 16 European countries has been established. Close to one million surgeries have been entered into the system during the first four years. Evidence-based guidelines have been published based on data in the registry. The system is used for benchmarking by both experienced surgeons and trainees.
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[Potentials and limitations of the planned compulsory quality assurance program for cataract surgery (Qesü)]. Ophthalmologe 2013; 110:370-6. [PMID: 23539300 DOI: 10.1007/s00347-013-2811-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Cataract surgery is scheduled for a federal program for quality improvement across the different sectors of care (outpatient care and hospitals). In case of implementation not only ophthalmic surgeons but all ophthalmologists would have to contribute to the documentation. Urgency, potential benefits and limitations of a compulsory compared to a voluntary quality assessment system are analyzed.
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Westborg I, Mönestam E. Intracameral anesthesia for cataract surgery: a population-based study on patient satisfaction and outcome. Clin Ophthalmol 2013; 7:2063-8. [PMID: 24204107 PMCID: PMC3804568 DOI: 10.2147/opth.s51409] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate if the standard anesthetic regimen – topical combined with intracameral anesthesia without sedation – in a population-based cohort of unselected cataract surgery cases is adequate, optimal, and good practice, or if improvements are necessary. Methods We conducted a prospective, observational study on all cases of cataract surgery during a 1-year period at one institution (n=1249). Data were collected from the patients’ records. Outcome measures were use of preoperative sedation, type of anesthesia, complications, and adverse events. In a subgroup of patients (n=124) satisfaction with the anesthetic regimen was evaluated using a short questionnaire. Results Most cases (90%, 1125/1249) had combined topical and intracameral anesthesia without sedation. Patients who chose preoperative sedation (midazolam hydrochloride sublingually) were significantly younger and more often female (P=0.0001 and P=0.011, respectively). In the questionnaire subgroup, the median pain score after surgery was 0.7 (visual analog scale, 0–10). A pain score of 1.9 or less was reported by 76% of the patients. Patients reporting a pain score of 2 or more had sedation and additional anesthetics more often. No significant difference was found regarding age, sex, pulse rate, oxygen saturation, first or second eye surgery, or adverse intraoperative events for patients with pain scores of 1.9 or less and 2 or more. Conclusion This large population-based series of small-incision phacoemulsification surgery shows that combined topical and intracameral anesthesia without sedatives is well tolerated for most phacoemulsification patients. It is also effective in cases when complications or adverse events occur. It is important to be responsive to the individual patient’s needs and adjust operating procedures if necessary, as there were a few patients who experienced insufficient anesthesia.
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Affiliation(s)
- Inger Westborg
- Department of Clinical Sciences/Ophthalmology, Umeå University, Umeå, Sweden ; Eye Clinic, Sunderby Hospital, Luleå, Sweden
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de Sanctis U, Damiani F, Brusasco L, Grignolo F. Refractive error after cataract surgery combined with descemet stripping automated endothelial keratoplasty. Am J Ophthalmol 2013; 156:254-259.e1. [PMID: 23870359 DOI: 10.1016/j.ajo.2013.04.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Revised: 04/02/2013] [Accepted: 04/02/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess refractive error after cataract surgery combined with Descemet stripping automated endothelial keratoplasty using adjusted keratometric (K) readings to calculate intraocular lens (IOL) power. DESIGN Prospective, interventional case series. METHODS One eye of 39 consecutive patients with Fuchs endothelial dystrophy and cataract were included. To calculate IOL power before surgery, the Javal steep and flat K readings (Haag-Streeit) were adjusted by reducing their value by -1.19 diopters (D); the axial length was measured by immersion biometry, and the standard A-constant was used. Surgery included phacoemulsification, IOL (Acrysof SN60AT; Alcon) implantation within the capsular bag, and Descemet stripping automated endothelial keratoplasty using posterior lamella prepared with a 300-μm head microkeratome (Moria). The absolute prediction error (absolute difference between predicted and achieved refraction) was assessed 6 months after surgery. RESULTS The mean power of the implanted IOL was 23.22 ± 2.90 D. The mean predicted and achieved refractions were -0.27 ± 0.26 D and -0.23 ± 0.73 D, respectively. The mean absolute prediction error was 0.59 ± 0.42 D (range, 0.05 to -1.52 D). The postoperative spherical equivalent fell within ±0.50 D, ±1.00 D, and ±2.00 D of the predicted refraction in 55.5%, 83.3%, and 100% of cases, respectively. Had the IOL power been calculated without adjusting the K readings, the mean absolute prediction error would have been significantly higher (0.86 ± 0.62 D; P = .04). CONCLUSIONS In this study, in which posterior lamellae were prepared using a 300-μm head microkeratome, adjusting preoperative K readings by -1.19 D led to accurate IOL power calculation and highly predictable refractive error after cataract surgery combined with Descemet stripping automated endothelial keratoplasty.
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Lundström M, Barry P, Henry Y, Rosen P, Stenevi U. Visual outcome of cataract surgery; Study from the European Registry of Quality Outcomes for Cataract and Refractive Surgery. J Cataract Refract Surg 2013; 39:673-9. [DOI: 10.1016/j.jcrs.2012.11.026] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 11/20/2012] [Accepted: 11/21/2012] [Indexed: 11/25/2022]
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Wang BZ, Chan E, Vajpayee RB. A retrospective study of the indications and outcomes of capsular tension ring insertion during cataract surgery at a tertiary teaching hospital. Clin Ophthalmol 2013; 7:567-72. [PMID: 23671385 PMCID: PMC3650888 DOI: 10.2147/opth.s38543] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The purpose was to determine preoperative indications, intraoperative procedures, and outcomes of capsular tension ring (CTR) insertion during cataract surgery. METHODS A review of all patients undergoing cataract surgery with insertion of a CTR between July 2000 and June 2010 was conducted at The Royal Victorian Eye and Ear Hospital, a large tertiary teaching hospital in Victoria, Australia. Information relating to each patient's demographic details, preoperative assessment, surgical procedure, and postoperative assessment were obtained. RESULTS Eighty-four eyes of 82 patients were included in this study. The main indications for CTR insertion were previous trauma, pseudoexfoliation syndrome, and mature cataracts. Twenty-one eyes (25.0%) did not have any obvious preoperative indication. A posterior capsule tear was the most common intraoperative complication (3.6%). An intraocular lens was successfully implanted in the bag in 72 eyes (85.7%). Postoperatively, the most common complications were a decentered intraocular lens (8.3%) and persistent corneal edema (6.0%). Overall, 61 eyes (72.6%) had better postoperative visual acuity compared with preoperative acuity, with 67 patients (79.8%) achieving vision of 20/40 or better. CONCLUSION For the majority of cases, CTR use in complex cataract surgeries is associated with improved postoperative outcomes. CTR implantation is most commonly required in patients with known risk factors for zonular instability.
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Affiliation(s)
- Bob Z Wang
- The Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia; Centre for Eye Research Australia, University of Melbourne, East Melbourne, Victoria, Australia
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Abell RG, Kerr NM, Vote BJ. Toward zero effective phacoemulsification time using femtosecond laser pretreatment. Ophthalmology 2013; 120:942-8. [PMID: 23465860 DOI: 10.1016/j.ophtha.2012.11.045] [Citation(s) in RCA: 171] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 11/08/2012] [Accepted: 11/08/2012] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To compare effective phacoemulsification time after femtosecond laser pretreatment with conventional phacoemulsification and the associated effect on visual outcomes and endothelial cell loss. DESIGN Prospective, consecutive, single-surgeon case-control study. CONTROLS Controls underwent phacoemulsification cataract extraction plus insertion of an intraocular lens (IOL). Cases underwent pretreatment with the femtosecond laser followed by phacoemulsification cataract extraction and IOL insertion. METHODS Two hundred one eyes underwent cataract surgery between April 2012 and July 2012. Data collected included patient demographics, preoperative characteristics, femtosecond lens fragmentation method, effective phacoemulsification time (EPT), intraoperative complications, and postoperative outcomes. MAIN OUTCOME MEASURES Effective phacoemulsification time, intraoperative complications, corneal endothelial cell loss, as well as postoperative best-corrected visual acuity, intraocular pressure, and refractive outcomes. RESULTS Patient demographics were similar between groups. There was no difference between baseline cataract grades (2.59 ± 0.71 vs. 2.52 ± 0.72, not significant). One hundred percent of cases pretreated with the femtosecond laser had complete capsulotomy. Mean EPT was reduced by 83.6% in the femtosecond pretreatment group (P<0.0001) when compared with controls, with 30% having 0 EPT (P<0.0001). Effective phacoemulsification time was reduced 28.6% within the femtosecond group using improved lens fragmentation algorithms, and a further 72.8% reduction was achieved with a 20-gauge phacoemulsification tip. Overall, there was a 96.2% reduction in EPT between controls and the optimized femtosecond pretreatment group. This was associated with a 36.1% reduction in endothelial cell loss in the femtosecond group. Visual and refractive outcomes were similar to those of conventional cataract surgery. CONCLUSIONS Femtosecond laser pretreatment results in a significant reduction in effective phacoemulsification time, including the possibility of 0 EPT. Further reductions may be achieved using optimization of lens fragmentation patterns and surgical technique. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Robin G Abell
- Tasmanian Eye Institute, Launceston, Tasmania, Australia
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Khan MI, Syed S, Subash M, Mearza A, Muhtaseb M. Sutureless large incision cataract extraction: Indications and results from two teaching hospital eye departments in the United Kingdom. Oman J Ophthalmol 2013; 5:157-60. [PMID: 23439745 PMCID: PMC3574510 DOI: 10.4103/0974-620x.106095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective: To highlight the role of Sutureless Large Incision Cataract Extraction (SLICE) in the United Kingdom for the treatment of cataracts at high risk for intra- or postoperative complications. Setting: Two University Hospitals in the United Kingdom Materials and Methods: Retrospective case note review of planned SLICE performed over a 12-month period. Results: SLICE was performed on 11 eyes of 11 patients (mean age, 79 years) having preoperative vision of hand motions (10 eyes) with very dense or mobile cataracts and high risk for phacoemulsification. Mean follow up was 12 weeks, with no operative or postoperative complications. Nine patients (without ocular or systemic comorbidity) achieved best corrected vision of 0.3 LogMAR (20/40) or better. Conclusions: SLICE is safe and effective for dense or mobile cataracts and can play a role in patients where conventional phacoemulsification carries higher risks of complications.
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Affiliation(s)
- Mohammad I Khan
- Singleton Hospital, Abertawe Bro Morgannwg University, NHS Trust, Swansea, United Kingdom
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[Result-related success rates of cataract operations. Results of a systematic literature review]. Ophthalmologe 2012; 109:575-82. [PMID: 22534745 DOI: 10.1007/s00347-012-2577-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This systematic literature review, including 7 publications released since 2000, provides references for outcome indicators of cataract surgery for quality management initiatives. The reported relative numbers of cases achieving visual rehabilitation and refractive accuracy were determined and compared. With one exception the success rates did not represent benchmarks defined as best possible outcome but describe the results of data collected in a population during routine clinical practice. A best corrected visual acuity (BCVA) of ≥ 0.5 was achieved in 84-93% of all patients and in 95-99% of patients without preoperative visually impairing comorbidities. A refractive accuracy (absolute deviation of target refraction from spherical equivalent) of ≤ 1 D was reported in 72-97% of the patients. The success rates of these well established outcome indicator levels were high. Differences between operators were more distinguishable and the clinical relevance higher with less liberal indicator levels. A BCVA ≥ 1 was realized in 30-47% of all patients and in 52-62% of patients without visually impairing comorbidities. A total of 45-80% of the patients showed a refractive accuracy of ≤ 0.5 D. Exogenous factors not influencable by the surgeon have a relevant impact on the success rates. The literature review confirms the strong association of visually impairing comorbidities and BCVA outcome. Based on literature methodological problems of quality management systems for cataract surgery are discussed. While voluntary initiatives have the ability to solve these difficulties appropriate concepts for mandatory procedures are currently lacking.
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Chee SP. Pseudo anterior capsule barrier for the management of posterior capsule rupture. J Cataract Refract Surg 2012; 38:1309-15. [PMID: 22814036 DOI: 10.1016/j.jcrs.2012.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 02/15/2012] [Accepted: 02/18/2012] [Indexed: 10/28/2022]
Abstract
UNLABELLED A technique that uses an implanted intraocular lens (IOL) to create a barrier for the management of posterior capsule rupture is described. When a rupture occurs, surgery is halted and a dispersive ophthalmic viscosurgical device (OVD) injected into the anterior chamber to prevent vitreous prolapse. The remaining nucleus is maneuvered into the anterior chamber away from the pupillary space. The posterior capsule tear is converted into a continuous curvilinear capsulorhexis where possible. Dissociated anterior vitrectomy is performed as indicated, keeping the large nuclear fragments trapped in the OVD-filled anterior chamber. An IOL is implanted in the capsular bag or sulcus with optic capture through the anterior capsulorhexis. Using reduced parameters, phacoemulsification of the remaining fragments is completed over the IOL, which functions as a barrier to seal off the vitreous cavity. Residual nuclear fragments and vitreous are cleared from beneath the optic by placing the vitreous cutter under the optic, recapturing the optic before the instruments are removed from the eye. FINANCIAL DISCLOSURE The author has no financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Soon-Phaik Chee
- Singapore National Eye Centre, Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, and Singapore Eye Research Institute, Singapore.
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Lundström M, Barry P, Henry Y, Rosen P, Stenevi U. Evidence-based guidelines for cataract surgery: Guidelines based on data in the European Registry of Quality Outcomes for Cataract and Refractive Surgery database. J Cataract Refract Surg 2012; 38:1086-93. [DOI: 10.1016/j.jcrs.2012.03.006] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 12/20/2011] [Indexed: 10/28/2022]
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Zudans VJ, Desai NR, Trattler WB. Comparison of prediction error: Labeled versus unlabeled intraocular lens manufacturing tolerance. J Cataract Refract Surg 2012; 38:394-402. [DOI: 10.1016/j.jcrs.2011.08.044] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Revised: 08/25/2011] [Accepted: 08/31/2011] [Indexed: 11/29/2022]
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Decreasing rate of capsule complications in cataract surgery. J Cataract Refract Surg 2011; 37:1762-7. [DOI: 10.1016/j.jcrs.2011.05.022] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 03/14/2011] [Accepted: 05/11/2011] [Indexed: 11/20/2022]
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Hahn U, Krummenauer F, Kölbl B, Neuhann T, Schayan-Araghi K, Schmickler S, von Wolff K, Weindler J, Will T, Neuhann I. Determination of valid benchmarks for outcome indicators in cataract surgery: a multicenter, prospective cohort trial. Ophthalmology 2011; 118:2105-12. [PMID: 21856011 DOI: 10.1016/j.ophtha.2011.05.011] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Revised: 04/14/2011] [Accepted: 05/06/2011] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To evaluate a systematic approach to derive valid benchmarks for 2 outcome indicators intended to ascertain quality in cataract surgery and to propose benchmark levels drawn from the study results. DESIGN Prospective, multicenter cohort trial. PARTICIPANTS A total of 1685 patients (206-239 eyes per trial site) were recruited consecutively at 7 study sites. The patients featured age-related cataracts and were undergoing unilateral cataract surgery in the period between January 2007 and August 2008. METHODS Only patients with uncomplicated age-related cataracts were included. Cataract surgery was performed by phacoemulsification. The SN60AT (Alcon, Inc., Fort Worth, TX) intraocular lens (IOL) was used as a study lens. The IOL power was calculated using the SRK-T formula with a standardized A constant. Biometry was performed with the IOL Master (Carl Zeiss Meditex, Jena, Germany). Only highly experienced senior surgeons were involved. MAIN OUTCOME MEASURES The outcome indicators 1 month and 3 months after surgery were the respective achievement of: (1) maximum absolute deviation of 0.5 diopter (D) between target refraction and postoperative spherical equivalent (primary end point, refractive accuracy); (2) best-corrected visual acuity of at least 0.8 (secondary end point, visual acuity outcome). RESULTS In the pooled data, maximum absolute deviation of ± 0.5 D from target refraction was achieved in 80% (95% confidence interval, 78%-82%) of cases. Visual acuity of 0.8 or more was reached in 87% (95% confidence interval, 80%-93%) of cases. The results from the trial centers differed significantly in the outcomes of the primary and secondary end points (P<0.001). CONCLUSIONS The study quantified benchmark levels for 2 outcome indicators in a standardized cataract surgery procedure. External confounding factors such as the comorbidity of patients, which cannot be influenced by the surgeon, were excluded. The derived benchmarks selectively illustrate the quality of the surgery and are superior to success rates published in the literature from unspecific data collections. This method is more suited for improving outcome quality by benchmarking. General methodologic problems are discussed, leading to recommendations for future study designs. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Ursula Hahn
- The OcuNet Cataract Benchmark Trial Group, Duesseldorf, Germany.
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Casuccio A, Cillino G, Pavone C, Spitale E, Cillino S. Pharmacologic pupil dilation as a predictive test for the risk for intraoperative floppy-iris syndrome. J Cataract Refract Surg 2011; 37:1447-54. [DOI: 10.1016/j.jcrs.2011.02.030] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 02/22/2011] [Accepted: 02/24/2011] [Indexed: 11/27/2022]
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Prospective multicenter trial assessing effectiveness, refractive predictability and safety of a new aberration free, bi-aspheric intraocular lens. Cont Lens Anterior Eye 2011; 34:188-92. [PMID: 21616703 DOI: 10.1016/j.clae.2011.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 04/14/2011] [Accepted: 04/14/2011] [Indexed: 11/22/2022]
Abstract
PURPOSE To determine the effectiveness and safety of the Softec HD IOL; and to present refractive outcomes for lenses manufactured at an IOL power tolerance of 0.11 D. METHODS Three-hundred and ninety adult patients requiring removal of a cataractous lens with implantation of a monofocal IOL in at least one eye were eligible for study participation across eight US investigative sites. Patients were enrolled unilaterally. After routine surgery, subjects were examined for adverse events (AEs), best corrected visual acuity (BCVA) and manifest refraction correction at 12 months postoperatively. RESULTS Three-hundred and sixty-six (95%) of patients completed the 12-month postoperative visit. The percent of patients achieving best corrected Snellen acuity 20/40 or better was 98.9%, and 81.1% of patients achieved best corrected Snellen acuity 20/25 or better. Of those patients (80%) implanted with a lens available in 0.25 D increments (manufactured at a tolerance of 0.11 D) 40.9%, 69.8% and 93.8% of patients were within ±0.25 D, ±0.50 D and ±1.0 D of predicted target refraction respectively. Overall incidence of cumulative and persistent IOL Grid AEs was 2.2% with no AE meeting or exceeding the FDA Grid of Historical Controls. CONCLUSIONS The Softec HD IOL is a safe and effective lens. The high manufacturing tolerance of the lens appears to enhance refractive outcomes.
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Questionnaires for measuring cataract surgery outcomes. J Cataract Refract Surg 2011; 37:945-59. [DOI: 10.1016/j.jcrs.2011.03.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Accepted: 11/21/2010] [Indexed: 11/17/2022]
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Quintana JM, Escobar A, Bilbao A, Navarro G, Begiristain JM, Fernandez de Larrea N, Perea E, Alberdi T. Effect of hospital on variation in visual acuity and vision-specific quality of life after cataract surgery. J Eval Clin Pract 2010; 16:665-72. [PMID: 20545811 DOI: 10.1111/j.1365-2753.2009.01157.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the contribution of hospital-to-hospital variability in changes in clinical and health-related quality of life outcomes among patients undergoing cataract extraction by phacoemulsification. METHODS Prospective observational study of 14 public hospitals. We recruited consecutive patients on waiting lists for cataract extraction. Clinical data were collected prior to the intervention and 6 weeks afterward. Subjects completed the visual function index (VF-14) prior to the procedure and 3 months afterward. Univariate and multivariate analysis were performed for visual acuity and VF-14 scores. RESULTS Substantial differences were observed across the 14 hospitals. At baseline, mean visual acuity ranged from 0.16 to 0.34, and mean VF-14 scores ranged from 48.06 to 75.89. Following cataract extraction, the mean improvement in visual acuity ranged from 0.35 to 0.57 and in VF-14 scores from 10.94 to 41.70. The ranges were even more pronounced among patients with low visual acuity or low VF-14 scores prior to the intervention. Significant differences remained in multivariate analysis. Within the multivariate analysis, the variable 'hospitals' had an R(2) of 0.069 for the visual acuity model and of 0.073 for the VF-14 model, 20% and 13%, respectively, of the total variability explained. Variation was also observed within geographic regions. CONCLUSIONS Outcomes of patients undergoing cataract extractions vary widely from hospital to hospital, even within the same geographic region, explaining an important part of the results. Quality improvement efforts should concentrate on patients with low pre-intervention visual acuity or vision-related disability to reduce this variability in outcomes.
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Affiliation(s)
- Jose M Quintana
- Unidad de Investigación, Hospital Galdakao-Usansolo-CIBER Epidemiología y Salud Pública (CIBERESP), Galdakao, Vizcaya, Spain.
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Chen AA, Kelly JP, Bhandari A, Wu MC. Pharmacologic prophylaxis and risk factors for intraoperative floppy-iris syndrome in phacoemulsification performed by resident physicians. J Cataract Refract Surg 2010; 36:898-905. [DOI: 10.1016/j.jcrs.2009.12.039] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Revised: 12/15/2009] [Accepted: 12/15/2009] [Indexed: 10/19/2022]
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Charalampidou S, Dooley I, Molloy L, Beatty S. Value of dual biometry in the detection and investigation of error in the preoperative prediction of refractive status following cataract surgery. Clin Exp Ophthalmol 2010; 38:255-65. [PMID: 20447121 DOI: 10.1111/j.1442-9071.2010.02211.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE To report the value of dual biometry in the detection of biometry errors. METHODS Study 1: retrospective study of 224 consecutive cataract operations. The intraocular lens power calculation was based on immersion biometry. Study 2: immersion biometry was compared with optical coherence biometry (OCB) in terms of axial length, anterior chamber depth, keratometry readings and the recommended lens power to achieve emmetropia. Study 3: prospective study of 61 consecutive cataract operations. Both immersion and OCB were performed, but lens power calculation was based on the latter. RESULTS Study 1: 115 (86%), 101 (75.4%), 90 (67.2%) and 50 (37.3%) of postoperative spherical equivalents were within +/-1.5 dioptres (D), +/-1.25 D, +/-1 D and +/-0.5 D of the target, respectively. Study 2: excellent agreement between axial length readings, anterior chamber depth readings and keratometry readings by immersion biometry and OCB was observed (reflected in a mean bias of -0.065 mm, -0.048 mm and +0.1803 D, respectively, in association with OCB). Agreement between the lens power recommended by each technique to achieve emmetropia was poor (mean bias of +1.16 D in association with OCB), but improved following appropriate modification of lens constants in the Accutome A-scan software (mean bias with OCB = -0.4 D). Study 3: 37 (92.5%) and 23 (57.5%) of operated eyes achieved a postoperative refraction within +/-1 D and +/-0.5 D of target, respectively. CONCLUSION Systematic errors in biometry can exist, in the presence of acceptable postoperative refractive results. Dual biometry allows each biometric parameter to be scrutinized in isolation, and identify sources of error that may otherwise go undetected.
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Affiliation(s)
- Sofia Charalampidou
- Department of Ophthalmology, Waterford Regional Hospital, Waterford, Ireland.
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Lundström M, Behndig A, Montan P, Artzén D, Jakobsson G, Johansson B, Thorburn W, Stenevi U. Capsule complication during cataract surgery: Background, study design, and required additional care. J Cataract Refract Surg 2009; 35:1679-87.e1. [DOI: 10.1016/j.jcrs.2009.05.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Revised: 05/12/2009] [Accepted: 05/12/2009] [Indexed: 10/20/2022]
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Artzén D, Lundström M, Behndig A, Stenevi U, Lydahl E, Montan P. Capsule complication during cataract surgery: Case-control study of preoperative and intraoperative risk factors. J Cataract Refract Surg 2009; 35:1688-93. [DOI: 10.1016/j.jcrs.2009.05.026] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Revised: 05/12/2009] [Accepted: 05/12/2009] [Indexed: 11/25/2022]
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Validity of Newly Developed Appropriateness Criteria for Cataract Surgery. Ophthalmology 2009; 116:409-417.e3. [DOI: 10.1016/j.ophtha.2008.07.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2008] [Revised: 07/02/2008] [Accepted: 07/31/2008] [Indexed: 11/18/2022] Open
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Chung JK, Park SH, Lee WJ, Lee SJ. Bilateral cataract surgery: A controlled clinical trial. Jpn J Ophthalmol 2009; 53:107-113. [DOI: 10.1007/s10384-008-0627-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Accepted: 10/27/2008] [Indexed: 10/21/2022]
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Manual small incision cataract surgery in a United Kingdom university teaching hospital setting. Int Ophthalmol 2009; 30:23-9. [PMID: 19129974 DOI: 10.1007/s10792-008-9286-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2008] [Accepted: 12/18/2008] [Indexed: 10/21/2022]
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Kugelberg M, Lundström M. Factors related to the degree of success in achieving target refraction in cataract surgery. J Cataract Refract Surg 2008; 34:1935-9. [DOI: 10.1016/j.jcrs.2008.06.036] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2008] [Accepted: 06/26/2008] [Indexed: 11/25/2022]
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Fattore G, Torbica A. Cost and reimbursement of cataract surgery in Europe: a cross-country comparison. HEALTH ECONOMICS 2008; 17:S71-S82. [PMID: 18186033 DOI: 10.1002/hec.1324] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The number of cataract extractions has increased substantially over time. At present, cataract surgery is estimated to be the most common single procedure performed in the developed world. The present study compares the costs of a cataract intervention across nine European countries. To enhance comparability, data were collected using a common template based on a case vignette. Adequate data for analysis were collected from 41 providers and were used to evaluate variation across countries and providers. Ordinary least squares and a multilevel model were used to investigate cost variation. Mean total costs per cataract intervention varied considerably from country to country, ranging from 318 euros in Hungary to 1087 euros in Italy. Variations of a similar magnitude were detected for personnel costs and overheads. However, variations in the cost of the lens were more modest. Overall, our results confirm expectations about the causes of cost variations across EU member states, indicating that these variations may be attributable to the quantity of resources used in performing the operation, the price of resources, and the type of setting in which the operation is performed. The study highlights how accounting practices and available cost data differ across Europe. It also shows the feasibility of collecting data on the basis of vignettes using common cost templates. Studies following this approach will gain importance if cross-country comparisons are to be used to promote European benchmarking exercises.
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Affiliation(s)
- Giovanni Fattore
- CERGAS and Institute of Public Administration and Health Care, Bocconi University, Milan, Italy.
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Chang DF, Osher RH, Wang L, Koch DD. Prospective Multicenter Evaluation of Cataract Surgery in Patients Taking Tamsulosin (Flomax). Ophthalmology 2007; 114:957-64. [PMID: 17467530 DOI: 10.1016/j.ophtha.2007.01.011] [Citation(s) in RCA: 128] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Revised: 01/10/2007] [Accepted: 01/10/2007] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Intraoperative floppy iris syndrome (IFIS) caused by systemic alpha-blockers has been associated with an increased risk of cataract surgical complications when the surgeon was unaware of the medication history and did not anticipate its occurrence. This study was undertaken to evaluate the surgical outcomes and rate of complications when the ophthalmologist knew the patient was taking tamsulosin (Flomax, Boehringer-Ingelheim Pharmaceuticals, Ridgefield, CT) and used 1 of several strategies to manage IFIS. DESIGN Prospective multicenter nonrandomized observational series. PARTICIPANTS A total of 167 consecutive eyes in 135 patients taking tamsulosin and undergoing cataract surgery. METHODS Phacoemulsification was performed in conjunction with at least 1 of 4 different IFIS management strategies, namely, topical atropine preoperatively, iris retractors, pupil expansion ring, or use of viscoadaptive ophthalmic viscosurgical device with reduced fluidic parameters. MAIN OUTCOME MEASURES Severity of IFIS, incidence of operative or postoperative complications, and final visual acuity. RESULTS The IFIS severity was rated as mild in 17%, moderate in 30%, and severe in 43% of the study eyes. No IFIS was noted in 10% of the eyes. The rate of posterior capsule rupture and vitreous loss was 0.6% (1/167; 95% confidence interval, 0%-1.8%). Ninety-five percent of eyes achieved a best-corrected visual acuity of at least 20/40. CONCLUSION When experienced surgeons could anticipate IFIS and employ compensatory surgical techniques, the complication rate from cataract surgery was low and the visual outcomes were excellent in eyes of patients with a history of tamsulosin use.
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Latinovic S, Canadanovic V, Babic N, Ljesevic L, Grkovic D, Zikic Z, Babovic S, Davidovic S, Barisic S, Karadzic J, Malesevic M. Vision related quality of life: A cataract study. ACTA ACUST UNITED AC 2007; 60:653-6. [DOI: 10.2298/mpns0712653l] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Introduction. Since 1996, advanced methods and new instruments for the assessment of vision quality of life (VisQoL) index (37 and 15) have been developed and applied at the University Eye Clinic in Novi Sad. Many researches assume that postoperative results should not be evaluated only by postoperative visual acuity, but also by subjective perception of visual function and the patients ability to perform everyday activities, i.e. by quality of life. Therefore, our clinical results were based on both parameters of visual function, as the most objective attributes for assessing outcomes of certain types of cataract surgery. Material and Methods. Based on the results of the Cataract Study in Vojvodina in 2004, 5.7% of patients waiting for cataract surgery were already blind, 16.5% had low vision with cataract on both eyes, and 57% of patients had monocular blindness. Results and Discussion. With improvement of visual acuity to 0.5 or higher, after cataract surgery in 96.5% of patients, the cumulative VisQoL 15-index changed from 59.3 to 95.5. Intraocular lens implantation contributed most to the significant improvement in the vision related quality of life. Our study showed that pseudophakic patients had better quality of life than aphakic patients, who had the same visual acuity and refractive correction. Difficulties in performing everyday activities, such as shopping, using the telephone and reading, were found in 12.7% of aphakic, but only in 3% of pseudophakic patients. Conclusion. Advanced phacoemulsification techniques enable operated cataract patients immediate vision recovery, better quality of life, and personal satisfaction with visual function in everyday activities.
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Affiliation(s)
| | | | - Nikola Babic
- Klinički centar Vojvodine, Klinika za očne bolesti, Novi Sad
| | | | - Desanka Grkovic
- Klinički centar Vojvodine, Klinika za očne bolesti, Novi Sad
| | - Zoran Zikic
- Klinički centar Vojvodine, Klinika za očne bolesti, Novi Sad
| | - Sinisa Babovic
- Klinički centar Vojvodine, Klinika za očne bolesti, Novi Sad
| | | | - Sava Barisic
- Klinički centar Vojvodine, Klinika za očne bolesti, Novi Sad
| | - Jelena Karadzic
- Klinički centar Vojvodine, Klinika za očne bolesti, Novi Sad
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Bartels MC, Saxena R, van den Berg TJTP, van Rij G, Mulder PGH, Luyten GPM. The Influence of Incision-Induced Astigmatism and Axial Lens Position on the Correction of Myopic Astigmatism with the Artisan Toric Phakic Intraocular Lens. Ophthalmology 2006; 113:1110-7. [PMID: 16713627 DOI: 10.1016/j.ophtha.2006.02.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2005] [Revised: 02/07/2006] [Accepted: 02/07/2006] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To evaluate postoperative astigmatism with regard to incision-induced astigmatism and deviation in axial alignment with the use of preoperative limbal marking with the Javal keratometer (Haag Streit, Bern, Switzerland) in eyes implanted with the Artisan toric phakic intraocular lens (IOL) (Ophtec, Groningen, The Netherlands). DESIGN Prospective nonrandomized trial. PARTICIPANTS Fifty-four eyes of 33 patients with myopia (mean, -9.67 diopters [D]) and astigmatism (mean, -3.44 D). INTERVENTION The enclavation site was marked on the limbus using the Javal keratometer. The Artisan toric phakic IOL was implanted according to the axis marked on the limbus. Follow-up was a minimum of 6 months. MAIN OUTCOME MEASURES Safety index, efficacy index, predictability, safety, and vector analysis of total refractive correction were determined. The effects of axis misalignment and incision-induced astigmatism on the final refractive error were evaluated. RESULTS At 6 months after surgery, the safety index was 1.29+/-0.29 and the efficacy index was 1.04+/-0.35. Mean spherical equivalent subjective refraction reduced from -11.39+/-4.86 D before surgery to -0.38+/-0.57 D at 6 months. Sixty-seven percent of eyes were within 0.50 D of attempted refraction and 89% were within 1.00 D. Mean preoperative cylinder was 2.92+/-1.60 D at 91.4 degrees . At 6 months, the mean cylinder was 0.28+/-0.54 D at 174.3 degrees . No eyes lost 2 or more lines of best-corrected visual acuity at 6 months. Eighty-three percent of eyes achieved uncorrected visual acuity of 20/40 and 28% achieved 20/20. Vector analysis of total surgically induced astigmatism revealed a mean cylindrical change of 3.21+/-1.71 D. Average axis misalignment was 0.37+/-5.34 degrees . The mean incision-induced astigmatism was 0.74+/-0.61 D at 0.2 degrees . CONCLUSIONS Implantation of the myopic toric IOL leads to safe, efficacious, and predictable results. The level of unpredictability caused by minor axis IOL misalignment has minimal effects on the residual refractive error. The procedure of axis alignment with the Javal keratometer seems to be an accurate method of marking the eye for toric IOL implantation. Incision-induced astigmatism can result in an overcorrection of the cylinder. A systematic undercorrection of -0.50 D for attempted cylindrical outcome could result in an achieved correction closer to emmetropia.
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Ang GS, Whyte IF. Effect and outcomes of posterior capsule rupture in a district general hospital setting. J Cataract Refract Surg 2006; 32:623-7. [PMID: 16698484 DOI: 10.1016/j.jcrs.2006.01.047] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2005] [Accepted: 10/12/2005] [Indexed: 11/24/2022]
Abstract
PURPOSE To assess how patients from a district general hospital population were affected on a short-term basis after posterior capsule (PC) rupture during phacoemulsification cataract surgery. SETTING Department of Ophthalmology, Raigmore Hospital, Inverness, United Kingdom. METHODS This retrospective audit encompassing a 2-year period evaluated the incidence of PC rupture and its outcomes. Details of the patients' age, preoperative and final postoperative best corrected visual acuity (BCVA), ocular comorbidity, surgeon grade, number and duration of follow-up reviews, and postoperative complications were collected. RESULTS Over the 2-year period, the PC rupture rate was 1.7% (45 PC ruptures in 2727 phacoemulsification cataract procedures). Thirty-eight eyes (84.4%) achieved a final BCVA of 6/12 or better. In 39 eyes (86.7%), final BCVA improved compared with BCVA at presentation. Mean duration of follow-up was 11.7 weeks. The most common extra procedure was anterior vitrectomy (64.4%). The most common postoperative complication was raised intraocular pressure (IOP) (exceeding 30 mm Hg) on the first postoperative day (20.0%) despite additional acetazolamide as prophylaxis. None developed infective endophthalmitis. Apart from 1 retinal detachment (2.2%) at week 27, all complications resolved by 19 weeks. No patient required additional long-term medication at the final visit. CONCLUSION Posterior capsule rupture impacted on the patient in the short-term in terms of additional surgical procedures, additional topical and oral medications, and number and duration of follow-up reviews. Most patients recovered an acuity of 6/12 or better. However, it is important to be vigilant of postoperative complications, especially raised IOP on the first postoperative day.
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Affiliation(s)
- Ghee Soon Ang
- Department of Ophthalmology, Raigmore Hospital, Inverness, United Kingdom
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Ma Quintana J, Escobar A, Aróstegui I. Development of appropriateness explicit criteria for cataract extraction by phacoemulsification. BMC Health Serv Res 2006; 6:23. [PMID: 16512906 PMCID: PMC1409777 DOI: 10.1186/1472-6963-6-23] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2005] [Accepted: 03/02/2006] [Indexed: 11/24/2022] Open
Abstract
Background Consensus development techniques were used in the late 1980s to create explicit criteria for the appropriateness of cataract extraction. We developed a new appropriateness of indications tool for cataract following the RAND method. We tested the validity of our panel results. Methods Criteria were developed using a modified Delphi panel judgment process. A panel of 12 ophthalmologists was assembled. Ratings were analyzed regarding the level of agreement among panelists. We studied the influence of all variables on the final panel score using linear and logistic regression models. The explicit criteria developed were summarized by classification and regression tree analysis. Results Of the 765 indications evaluated by the main panel in the second round, 32.9% were found appropriate, 30.1% uncertain, and 37% inappropriate. Agreement was found in 53% of the indications and disagreement in 0.9%. Seven variables were considered to create the indications and divided into three groups: simple cataract, with diabetic retinopathy, or with other ocular pathologies. The preoperative visual acuity in the cataractous eye and visual function were the variables that best explained the panel scoring. The panel results were synthesized and presented in three decision trees. Misclassification error in the decision trees, as compared with the panel original criteria, was 5.3%. Conclusion The parameters tested showed acceptable validity for an evaluation tool. These results support the use of this indication algorithm as a screening tool for assessing the appropriateness of cataract extraction in field studies and for the development of practice guidelines.
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Affiliation(s)
- José Ma Quintana
- Unidad de Investigación, Hospital de Galdakao, Galdakao, Vizcaya, Spain
| | - Antonio Escobar
- Unidad de Investigación, Hospital de Basurto, Bilbao, Vizcaya, Spain
| | - Inmaculada Aróstegui
- Departamento de Matemática Aplicada, Estadística e Investigación Operativa, Universidad del País Vasco, Lejona, Vizcaya, Spain
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