Intraoperative difficulties, complications and self-assessed visual function in cataract surgery

Should Multifocal Intraocular Lenses Become a Standard in Phacoemulsification Cataract Surgery?

Cataracts impair daily activities such as reading, outdoor sports, and driving, which may not match best-corrected visual acuity at optimal room light conditions, but can be just as important to patients [...].

Self-assessed visual function outcome in cataract surgery: minimum important difference of the Catquest-9SF questionnaire

BACKGROUND

The purpose of this study was to study the minimum important difference (MID) of the Catquest-9SF questionnaire in cataract surgery.

METHODS

A nationwide multi-center prospective randomized study was conducted using the Swedish National Cataract Register and the Catquest-9SF questionnaire. Randomized patients (n = 400) who had completed the Catquest-9SF before surgery and three months after surgery were sent an anchor question on self-assessed change in visual function after cataract surgery 14 days after the postoperative Catquest-9SF. Rasch analysis was performed on the preoperative and postoperative Catquest-9SF questionnaires, and the patients were dichotomized with regard to their preoperative Rasch score. The MID range of the two groups was calculated based on the anchor question, and the anchor question based MID was then estimated in a scatter plot. The MID was also estimated based on distribution by calculating Cohen's effect size.

RESULTS

The analyses included 231 patients who had completed the Catquest-9SF on both occasions as well as the questionnaire with the anchor question. The group with better preoperative visual function had an anchor question based MID of - 0.5 and a Cohen's effect size based MID of - 1.07. The group with worse preoperative visual function had an anchor question based MID of - 1.80 and a Cohen's effect size based MID of - 1.46.

CONCLUSION

This article contributes detailed knowledge of the MID of Catquest-9SF, enabling even more accurate high-quality evaluation of the outcome and benefit of cataract surgery worldwide.

Cataract standard set for outcome measures: An Italian tertiary referral centre experience

PURPOSE

Implementation of the International Consortium for Health Outcomes Measurements (ICHOM) standard for cataract surgery into clinical practice at an Italian tertiary referral centre.

METHODS

Prospective, observational, descriptive study consisting of the registry and analysis of cataract surgeries performed during a 6-month enrolment period at the University Eye Clinic of Trieste, Trieste, Italy. Outcomes were recorded and analysed according to the ICHOM Cataract Standard Set version 2.0.1. Records included clinician-reported outcome measures (CROMs) - visual outcome and complications - and patient-reported outcome measures (PROMs) - self-assessed vision with the Catquest-9SF questionnaire. Correlations between PROMs and CROMs were evaluated. A multiple linear regression was used for predicting the change in PROMs with surgery.

RESULTS

A total of 218 eyes (of 218 patients) were analysed. Postoperative corrected distance visual acuity (CDVA) was ⩾0.3 in 89.0% (194/218) of eyes. There was a statistically significant improvement of the post-operative Catquest-9SF global average score. (p < 0.001). The change in the Catquest-9SF score significantly correlated with the change in Item 2 score (related to intermediate vision) (r = 0.634, p < 0.001). A predictive model of the change in the Catquest-9SF score was found (p < 0.001, R2: 0.527) based on preoperative Catquest-9SF total score, presence or not of macular degeneration, presence or not of intraoperative complications, age >75 years old, and preoperative CDVA.

CONCLUSIONS

Cataract surgery improves the functional vision, with some factors limiting the outcomes such as comorbidities. Self-perceived improvement in intermediate vision significantly influenced the improvement in self-assessed vision.

Visual Acuity Outcomes after Phacoemulsification in Eyes with Good Visual Acuity before Cataract Surgery

OBJECTIVE

to analyse cataract surgery outcomes and related factors in eyes presenting with good visual acuity.

SUBJECT AND METHODS

A retrospective longitudinal study of patients undergoing phacoemulsification between 2014 and 2018 in Moorfields Eye Hospital was conducted. Pre- and post-operative visual acuities were analysed. Inclusion criteria were age ≥40 years and pinhole visual acuity ≥6/9 pre-operatively. Exclusion criteria were no post-operative visual acuity data. The visual acuity change variable was also defined according to post-operative visual acuity being above or below the Snellen 6/9 threshold.

RESULTS

2,720 eyes were included. The unaided logMAR visual acuity improved from 0.54 to 0.20 (p < 0.001), the logMAR visual acuity with glasses improved from 0.35 to 0.05 (p < 0.001), and the logMAR pinhole visual acuity improved from 0.17 to 0.13 (p < 0.001); 8.1% of patients had Snellen visual acuity <6/9 post-operatively. Mean follow-up period was 23.6 ± 9.9 days. In multivariate analysis, factors associated with visual acuity <6/9 post-operatively were age (OR = 0.96, 95% confidence interval [CI] [0.95, 0.98], p < 0.001), vitreous loss (OR = 0.21, 95% CI [0.08, 0.56], p = 0.002), and iris trauma (OR = 0.28, 95% CI [0.10, 0.82] p = 0.02).

CONCLUSIONS

Visual acuity improved significantly, although at least 8.1% of them did not reach their pinhole preoperative visual acuity. Worse visual acuity outcomes were associated with increasing age, vitreous loss, and iris trauma. The 6/9 vision threshold may not be able to accurately differentiate those who may benefit from cataract surgery and those who may not.

Catquest-9SF functioning over a decade - a study from the Swedish National Cataract Register

Background

The Swedish National Cataract Register (NCR) collects data on cataract surgery outcomes during March, including patient-reported outcomes using the Catquest-9SF questionnaire for over 11 years. Previous studies from NCR have shown that the preoperative visual acuity has improved over time. The main purpose of this study was to evaluate the Catquest-9SF Rasch scoring performance in this changing environment. A second purpose was to describe clinical data over the same period for those who completed the questionnaire.

Methods

The performance of the Catquest-9SF was analysed by a separate Rasch analysis for each year, resulting in a preoperative and postoperative score for each participating patient in the annual cohorts. The clinical data and questionnaire scoring were analysed for each year in the period 2008–2018 inclusive.

Results

Data were available for 42,023 eyes for 11 annual cohorts (2008–2018). The psychometric properties of the questionnaire were stable during the study period. Person separation (precision) for the whole period was 2.58 and varied between 2.45 and 2.72. The person reliability was 0.87 and varied between 0.86 and 0.88. The targeting of question difficulty to person ability became less accurate over time meaning that the item activities became easier to carry out without difficulty. The average targeting for the whole period was −2.06 and changed from −1.92 in 2008 to −2.31 in 2018. The person score improved both before surgery and after surgery, indicating that patients are undergoing surgery at a more able level and getting better outcomes. The average improvement by surgery decreased from 3.41 logits in 2008 to 3.21 logits in 2018 (p = 0.003).

Over time, patient age decreased from 75 to 74 years (p < 0.001) and the proportion of women decreased from 63.9 to 57.9% (p < 0.001). The mean preoperative visual acuity in both the operated eye and the better eye improved over time (0.47 to 0.40 logMAR, p < 0.001 and 0.22 to 0.19 logMAR, p < 0.001, respectively), as did the mean postoperative visual acuity in the operated eye (0.14 to 0.09 logMAR, p < 0.001).

Conclusions

The Catquest-9SF retained stable psychometric properties over this 11-year period although more recent cohorts included slightly younger patients with somewhat better vision.

Visual and Refractive Outcomes of Cataract Surgeries Performed in One Year in a Private Practice Setting: Review of 2714 Procedures

Methods

Our center's database was used to identify all isolated cataract procedures performed during 2017. The electronic records were reviewed to collect the preoperative information, presence of intra- or postsurgical complications, and visual and refractive outcomes one month after surgery.

Results

In 2017, 2714 eyes of 1543 patients underwent cataract surgery in our center. Mean patient age was 70.42 years. 775 eyes (28.55%) had prior ophthalmic pathologies, and 113 eyes (4.16%) had undergone previous surgical procedures. Surgical complications developed in 35 eyes (1.29%), including 9 posterior capsule tears (0.33%) and 3 cases of dropped lens fragments (0.11%). A toric or multifocal intraocular lens was implanted in 45.6% of eyes. As regards postoperative complications, 59 eyes (2.17%) required a return to the operating theater, including 29 eyes (1.07%) requiring reinterventions due to an unexpected refractive result. There were no cases of endophthalmitis. Mean LogMAR-corrected distance visual acuity (CDVA) improved from 0.25 (SD 0.34) preoperatively to 0.04 (SD 0.17) postoperatively; 86.5% of eyes achieved a CDVA ≤0.0, with 97.5% achieving ≤0.3. In 86.4% of eyes, the difference between target and residual spherical equivalent difference was of 0.50 D or lower; 88% of eyes had a spherical equivalent ±0.50 D.

Conclusions

The visual and refractive outcomes of cataract surgery in a private practice setting were excellent, well over the benchmarks set by the ESCRS. The safety profile was also within expected standards. This study provides information for ophthalmologists in private practice on expected outcomes.

Visual acuity and intraocular pressure after surgical management of late in-the-bag dislocation of intraocular lenses. A single-centre prospective study

OBJECTIVES

To describe logarithm of the minimum angle of resolution (logMAR) best corrected visual acuity (BCVA) and intraocular pressure (IOP) after surgical management of late in-the-bag dislocation of the intraocular lens.

SUBJECTS/METHODS

In a single-centre prospective study, 165 consecutive cases having surgical correction for late in-the-bag-dislocation of intraocular lenses were analysed. One-year follow-up data of BCVA, IOP and a specially created composite variable designated "IOP issue" which considered IOP ≥ 23 mmHg, ongoing pressure reducing treatment and previous pressure reducing surgery were compared with baseline values. Logistic regression was used to investigate factors with a possible influence on the results.

RESULTS

The vast majority, 80% of patients, were operated with an anterior approach with repositioning of the present IOL. Remaining patients were managed with lens exchange via a posterior approach combined with a pars plana vitrectomy (PPV). Baseline BCVA values improved from 0.65 ± 0.48 to 0.32 ± 0.41 (p < 0.001), IOP decreased from 20.12 ± 8.4 to 18.44 ± 5.96 mmHg (p = 0.02) whereas the proportion of cases with a pressure issue remained unchanged, 47.3%, at the 1-year follow-up. Determinants for having a pressure issue at the 1-year follow-up were present a pressure issue at baseline and IOL repositioning with the anterior approach.

CONCLUSIONS

Both surgical methods provided similar visual rehabilitation to other techniques described in the literature. However, subjects whose IOL was exchanged in combination with a PPV were at lower risk for an IOP issue at the follow-up.