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Cnaany Y, Goldstein A, Lavy I, Halpert M, Chowers I, Ben-Eli H. Ophthalmology Residents' Experience in Cataract Surgery: Preoperative Risk Factors, Intraoperative Complications, and Surgical Outcomes. Ophthalmol Ther 2024; 13:1783-1798. [PMID: 38696047 PMCID: PMC11109032 DOI: 10.1007/s40123-024-00947-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 03/26/2024] [Indexed: 05/22/2024] Open
Abstract
INTRODUCTION This retrospective study explores the connection between preoperative patient risk factors, the experience of ophthalmology residents, and the outcomes of cataract surgeries performed at Hadassah Medical Center. It is hypothesized that with increased experience, residents may demonstrate greater proficiency in handling surgeries on higher-risk patients, potentially leading to improved surgical outcomes overall. METHODS Data were examined from 691 consecutive cataract surgeries in 590 patients, conducted by ophthalmology residents at Hadassah Medical Center (January 2018 to February 2022). Demographics, surgeon experience, preoperative cataract risk assessment score, and pre- and postoperative corrected distance visual acuity (CDVA) were analyzed. The risk score was based on cataract density, previous vitrectomy, presence of phacodonesis, small pupil, extreme axial length (> 30 mm or < 21.5 mm) or abnormal axial length (26-30 mm), shallow anterior chamber (< 2.5 mm), poor patient cooperation, oral alpha-1 blocker use, diabetic retinopathy (DR), Fuchs endothelial dystrophy, and having one functioning eye. This study focused on the correlation of risk scores with residents' surgical experience and surgical outcomes. RESULTS As residents gained experience, surgeries on patients with at least one risk factor increased from 54% (first year) to 75% (second year; p < 0.001) and fluctuated between 75%, 82%, and 77% (third, fourth, and fifth years, respectively), with initial preoperative CDVA declining progressively. Despite handling more complex cases over time, the percentage of intraoperative complications per patient decreased with each year of residents' experience (17%, 13%, 11%, 17%, 6%; respectively). Patients without any risk factor had higher postoperative CDVA than those with one or more risk factors (mean ± standard deviation [SD] in logMAR, 0.16 ± 0.26 vs. 0.27 ± 0.35; p < 0.001) and a higher percentage of CDVA improvement (63% vs. 57%, p = 0.016). CONCLUSIONS The use of a preoperative risk assessment scoring system to allocate surgeries to residents at varying experience levels may reduce the risk for surgical complications, thereby ensuring patient safety and providing residents with a gradual learning experience.
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Affiliation(s)
- Yaacov Cnaany
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, POB 12000, 91120, Jerusalem, Israel
| | - Ayelet Goldstein
- Department of Computer Science, Hadassah Academic College, Jerusalem, Israel
| | - Itay Lavy
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, POB 12000, 91120, Jerusalem, Israel
| | - Michael Halpert
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, POB 12000, 91120, Jerusalem, Israel
| | - Itay Chowers
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, POB 12000, 91120, Jerusalem, Israel
| | - Hadas Ben-Eli
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, POB 12000, 91120, Jerusalem, Israel.
- Department of Optometry and Vision Science, Hadassah Academic College, Jerusalem, Israel.
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Arad T, Engel X, Ackermann H, Schmack I, Kohnen T. Association between anterior chamber biometry and posterior capsular defects. J Cataract Refract Surg 2023; 49:1086-1091. [PMID: 37532253 DOI: 10.1097/j.jcrs.0000000000001274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/24/2023] [Indexed: 08/04/2023]
Abstract
PURPOSE To analyze the association between anterior chamber biometric factors and posterior capsular defects (PCDs) that occur during extracapsular cataract extraction. SETTING University Eye Hospital, Goethe University Frankfurt, Germany. DESIGN Population-based study. PATIENTS AND METHODS Extracapsular cataract extractions for inpatient cases within 4 years were retrospectively analyzed. The data on the occurrence of PCDs, age, sex, surgeon, and biometry were obtained. For cases with PCDs, the secondary ocular diseases, number of procedures, lens implant, visual acuity, and course were also recorded. Swept-source optical coherence tomography measurements allowed the measurement of lens thickness (LT) in addition to the usual biometry values. RESULTS A total of 1967 cataract surgeries (patients age: 70.56 ± 8.42, 1005 women; 962 men) were included, and PCDs were documented for 59 (2.54%; 31 women, 28 men) cases (patient age: 70.95 ± 8.52 years). There were no differences ( P = .76) related to the surgeons (n = 9) with minimal effect sizes. The mean LT, axial length, corneal curvature, and anterior chamber depth were 4950.36 ± 466.63 μm, 23.73 ± 1.77 mm, 43.89 ± 1.36 diopters, and 3.02 ± 0.71 mm, respectively. The Wilcoxon-Mann-Whitney test showed significant associations between LT ( P = .01) and PCDs with moderate relevance for the Rosenthal effect size (LT R = 0.34; ACD R = 0.29). CONCLUSIONS In addition to ACD, a tendency for the occurrence of PCD could be proven, especially for LT. Therefore, special attention should be paid to LT preoperatively for comprehensive risk stratification.
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Affiliation(s)
- Tschingis Arad
- From the Department of Ophthalmology, Goethe University, Frankfurt, Germany (Arad, Engel, Schmack, Kohnen); Institute for Biostatistics, Goethe University, Frankfurt, Germany (Ackermann)
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Oustoglou E, Tzamalis A, Banou L, Christou CD, Tsinopoulos I, Samouilidou M, Mataftsi A, Ziakas N. When should cataract surgeons seek assistance from experienced colleagues? Int Ophthalmol 2023; 43:387-395. [PMID: 35864285 DOI: 10.1007/s10792-022-02434-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 07/05/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess which cases should be assorted exclusively to high-volume surgeons and identify when should a cataract surgeon seek assistance from a senior colleague. METHODS The medical records of 2853 patients with age-related cataract were reviewed. Preoperative risk factors were documented for each case, and they were divided into surgeons who had more (> 400 surgeries/year) or less experience (< 400 surgeries/year). Ophthalmology residents were excluded from this review. The cases that involved posterior capsule rupture, dropped nucleus, zonular dehiscence and anterior capsular tear with or without vitreous loss were defined as "complicated". RESULTS From the 3247 cataract extraction surgeries that were reviewed, we were unable to identify any statistically significant difference in the complication rates between the two surgeon groups. In the stepwise regression analysis, both groups supported advanced age (> 85) and mature cataracts with up to fourfold odds ratios (OR). Low-volume surgeons had a fivefold OR in the presence of phacodonesis and a fourfold OR in the case of posterior polar cataract. Finally, the low- and high-volume groups had their highest complication rates in the cumulative four and five risk factors, respectively. CONCLUSION In the presence of advanced age, mature cataracts, phacodonesis and posterior polar cataract, the complication rates appear to be higher for the less experienced surgeons. Meticulous preoperative assessment with detailed documentation of each patient's risk factors can result in fewer complications. The medical complexity of each case can be used as indicator of whether a more experienced surgeon should perform the surgery or not.
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Affiliation(s)
- Eirini Oustoglou
- 2nd Department of Ophthalmology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Argyrios Tzamalis
- 2nd Department of Ophthalmology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lamprini Banou
- 2nd Department of Ophthalmology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Chrysanthos D Christou
- 2nd Department of Ophthalmology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Tsinopoulos
- 2nd Department of Ophthalmology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Samouilidou
- 2nd Department of Ophthalmology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Asimina Mataftsi
- 2nd Department of Ophthalmology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Ziakas
- 2nd Department of Ophthalmology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Chilibeck CM, Brookes NH, Gokul A, Kim BZ, Twohill HC, Moffatt SL, Pendergrast DG, McGhee CNJ. Changing Trends in Corneal Transplantation in Aotearoa/New Zealand, 1991 to 2020: Effects of Population Growth, Cataract Surgery, Endothelial Keratoplasty, and Corneal Cross-Linking for Keratoconus. Cornea 2022; 41:680-687. [PMID: 34267061 DOI: 10.1097/ico.0000000000002812] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/18/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to identify trends in the primary indication for keratoplasty in New Zealand/Aotearoa (NZ) after significant population growth, increase in the number of cataract surgeries per population, widespread adoption of endothelial keratoplasty, and introduction of corneal cross-linking for keratoconus. METHODS Statistical analysis of the New Zealand National Eye Bank's prospective database of all keratoplasties was performed between January 1991 and January 2020. Indications for keratoplasty were isolated for the primary diagnosis. RESULTS In total, 6840 corneas were transplanted with mean 236 ± 57.5 transplants/year, increasing from 2.55 to 6.06 per 100,000 NZ population/year. Over the past decade, the number of transplant recipients aged 60 years or older has increased and recipients aged 20 to 39 years have plateaued. In 2019, for the first time, regraft became the most common indication (30.9%), followed by keratoconus (27.9%) and corneal dystrophy (18.8%), with a steady decline in bullous keratopathy. Proportions of the keratoplasty technique changed dramatically: penetrating keratoplasty fell from 91.4% in 2006 to 55.0% in 2019, Descemet's stripping endothelial keratoplasty increased from 0% to 29.5%, anterior lamellar keratoplasty increased from 2.5% to 5.7%, and Descemet membrane endothelial keratoplasty increased from 0% to 9.1%. CONCLUSIONS Keratoplasty trends in Aotearoa/NZ have changed considerably because of the evolution of phacoemulsification and keratoplasty techniques. Unlike proportions observed overseas, NZ still performs penetrating keratoplasties in over half of all transplants. Corneal cross-linking may be having an early effect of reducing keratoplasty rates for keratoconus.
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Affiliation(s)
- Corina M Chilibeck
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand ; and
| | - Nigel H Brookes
- Department of Ophthalmology, New Zealand National Eye Bank, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Akilesh Gokul
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand ; and
| | - Bia Z Kim
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand ; and
| | - Helen C Twohill
- Department of Ophthalmology, New Zealand National Eye Bank, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - S Louise Moffatt
- Department of Ophthalmology, New Zealand National Eye Bank, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - David G Pendergrast
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand ; and
- Department of Ophthalmology, New Zealand National Eye Bank, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Charles N J McGhee
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand ; and
- Department of Ophthalmology, New Zealand National Eye Bank, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Wang B, Tang L. Analysis of the Effect of Phacoemulsification and Intraocular Lens Implantation Combined With Trabeculectomy on Cataract and Its Influence on Corneal Endothelium. Front Surg 2022; 9:841296. [PMID: 35252341 PMCID: PMC8894437 DOI: 10.3389/fsurg.2022.841296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/14/2022] [Indexed: 11/18/2022] Open
Abstract
Objective This study aimed to discuss the effect of phacoemulsification and intraocular lens implantation (PHACO + IOL) combined with trabeculectomy (TRAB) on cataracts and its influence on the corneal endothelium. Methods We selected 120 cataract patients admitted to our hospital from January 2018 to January 2021. According to different surgical methods, they were divided into the control group and the observation group. The observation group was treated with PHACO + IOL combined with TRAB, the control group only received PHACO. The clinical effect, ophthalmic-related parameters, corneal endothelium, complications, the satisfaction of the two groups were observed. Results The total effective rate and total satisfaction rate of the observation group were significantly higher than the control group (P < 0.05). One month after the operation, the vision and central anterior chamber depth of the observation group were higher than those of the control group, and intraocular pressure (IOP) was lower than that of the control group (P < 0.05). One month after the operation, the corneal endothelial cell area and cell density in the observation group were not significantly different from those before operation (P > 0.05). There was no significant difference in the total incidence of complications between the two groups (P > 0.05). Conclusion This study concluded that PHACO + IOL combined with TRAB has a good curative effect in the treatment of cataracts, which can improve the patients' vision and IOP, keep the functional integrity of corneal endothelial cells, and does not increase the occurrence of complications, the patients' satisfaction is high.
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Lanza M, Koprowski R, Boccia R, Ruggiero A, De Rosa L, Tortori A, Wilczyński S, Melillo P, Sbordone S, Simonelli F. Classification Tree to Analyze Factors Connected with Post Operative Complications of Cataract Surgery in a Teaching Hospital. J Clin Med 2021; 10:jcm10225399. [PMID: 34830681 PMCID: PMC8625404 DOI: 10.3390/jcm10225399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/18/2021] [Accepted: 11/18/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Artificial intelligence (AI) is becoming ever more frequently applied in medicine and, consequently, also in ophthalmology to improve both the quality of work for physicians and the quality of care for patients. The aim of this study is to use AI, in particular classification tree, for the evaluation of both ocular and systemic features involved in the onset of complications due to cataract surgery in a teaching hospital. Methods: The charts of 1392 eyes of 1392 patients, with a mean age of 71.3 ± 8.2 years old, were reviewed to collect the ocular and systemic data before, during and after cataract surgery, including post-operative complications. All these data were processed by a classification tree algorithm, producing more than 260 million simulations, aiming to develop a predictive model. Results: Postoperative complications were observed in 168 patients. According to the AI analysis, the pre-operative characteristics involved in the insurgence of complications were: ocular comorbidities, lower visual acuity, higher astigmatism and intra-operative complications. Conclusions: Artificial intelligence application may be an interesting tool in the physician’s hands to develop customized algorithms that can, in advance, define the post-operative complication risk. This may help in improving both the quality and the outcomes of the surgery as well as in preventing patient dissatisfaction.
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Affiliation(s)
- Michele Lanza
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80100 Napoli, Italy; (R.B.); (A.R.); (L.D.R.); (A.T.); (P.M.); (S.S.); (F.S.)
- Correspondence: ; Tel.: +39-08-1566-6778
| | - Robert Koprowski
- Institute of Biomedical Engineering, Faculty of Science and Technology, University of Silesia in Katowice, Bedzińska 39, 41-200 Sosnowiec, Poland;
| | - Rosa Boccia
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80100 Napoli, Italy; (R.B.); (A.R.); (L.D.R.); (A.T.); (P.M.); (S.S.); (F.S.)
| | - Adriano Ruggiero
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80100 Napoli, Italy; (R.B.); (A.R.); (L.D.R.); (A.T.); (P.M.); (S.S.); (F.S.)
| | - Luigi De Rosa
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80100 Napoli, Italy; (R.B.); (A.R.); (L.D.R.); (A.T.); (P.M.); (S.S.); (F.S.)
| | - Antonia Tortori
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80100 Napoli, Italy; (R.B.); (A.R.); (L.D.R.); (A.T.); (P.M.); (S.S.); (F.S.)
| | - Sławomir Wilczyński
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Będzińska Street 39, 41-200 Sosnowiec, Poland;
| | - Paolo Melillo
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80100 Napoli, Italy; (R.B.); (A.R.); (L.D.R.); (A.T.); (P.M.); (S.S.); (F.S.)
| | - Sandro Sbordone
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80100 Napoli, Italy; (R.B.); (A.R.); (L.D.R.); (A.T.); (P.M.); (S.S.); (F.S.)
| | - Francesca Simonelli
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80100 Napoli, Italy; (R.B.); (A.R.); (L.D.R.); (A.T.); (P.M.); (S.S.); (F.S.)
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Lanza M, Koprowski R, Boccia R, Ruggiero A, De Rosa L, Tortori A, Wilczyński S, Melillo P, Sbordone S, Simonelli F. Classification Tree to Analyze Factors Connected with Post Operative Complications of Cataract Surgery in a Teaching Hospital. J Clin Med 2021; 10:jcm10225399. [PMID: 34830681 DOI: 10.3390/jcm10225399.pmid:34830681;pmcid:pmc8625404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/18/2021] [Accepted: 11/18/2021] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Artificial intelligence (AI) is becoming ever more frequently applied in medicine and, consequently, also in ophthalmology to improve both the quality of work for physicians and the quality of care for patients. The aim of this study is to use AI, in particular classification tree, for the evaluation of both ocular and systemic features involved in the onset of complications due to cataract surgery in a teaching hospital. METHODS The charts of 1392 eyes of 1392 patients, with a mean age of 71.3 ± 8.2 years old, were reviewed to collect the ocular and systemic data before, during and after cataract surgery, including post-operative complications. All these data were processed by a classification tree algorithm, producing more than 260 million simulations, aiming to develop a predictive model. RESULTS Postoperative complications were observed in 168 patients. According to the AI analysis, the pre-operative characteristics involved in the insurgence of complications were: ocular comorbidities, lower visual acuity, higher astigmatism and intra-operative complications. CONCLUSIONS Artificial intelligence application may be an interesting tool in the physician's hands to develop customized algorithms that can, in advance, define the post-operative complication risk. This may help in improving both the quality and the outcomes of the surgery as well as in preventing patient dissatisfaction.
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Affiliation(s)
- Michele Lanza
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80100 Napoli, Italy
| | - Robert Koprowski
- Institute of Biomedical Engineering, Faculty of Science and Technology, University of Silesia in Katowice, Bedzińska 39, 41-200 Sosnowiec, Poland
| | - Rosa Boccia
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80100 Napoli, Italy
| | - Adriano Ruggiero
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80100 Napoli, Italy
| | - Luigi De Rosa
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80100 Napoli, Italy
| | - Antonia Tortori
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80100 Napoli, Italy
| | - Sławomir Wilczyński
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Będzińska Street 39, 41-200 Sosnowiec, Poland
| | - Paolo Melillo
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80100 Napoli, Italy
| | - Sandro Sbordone
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80100 Napoli, Italy
| | - Francesca Simonelli
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80100 Napoli, Italy
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Han JV, McGhee CNJ. New Zealand Cataract Risk Stratification system confirms reduction in intraoperative complication rates in phacoemulsification for all grades of surgeon. Clin Exp Ophthalmol 2021; 49:86-87. [PMID: 33426770 DOI: 10.1111/ceo.13888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Jina V Han
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Ophthalmology, Greenlane Clinical Centre, Auckland District health Board, Auckland, New Zealand
| | - Charles N J McGhee
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Ophthalmology, Greenlane Clinical Centre, Auckland District health Board, Auckland, New Zealand
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Toohey TP, Cheung LM, Agar A, Francis IC. Outcome challenges for cataract surgery employing the New Zealand Cataract Risk Stratification criteria. Clin Exp Ophthalmol 2021; 49:84-85. [PMID: 33438354 DOI: 10.1111/ceo.13882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 10/16/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Thomas P Toohey
- Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Leanne M Cheung
- Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
- Department of Ophthalmology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Ashish Agar
- Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
- Department of Ophthalmology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Ian C Francis
- Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
- Department of Ophthalmology, Prince of Wales Hospital, Sydney, New South Wales, Australia
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Lanza M, Koprowski R, Boccia R, Krysik K, Sbordone S, Tartaglione A, Ruggiero A, Simonelli F. Application of Artificial Intelligence in the Analysis of Features Affecting Cataract Surgery Complications in a Teaching Hospital. Front Med (Lausanne) 2020; 7:607870. [PMID: 33363188 PMCID: PMC7759659 DOI: 10.3389/fmed.2020.607870] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/24/2020] [Indexed: 01/02/2023] Open
Abstract
Aims: To evaluate the ocular and systemic factors involved in cataract surgery complications in a teaching hospital using artificial intelligence. Methods: One eye of 1,229 patients with a mean age of 70.2 ± 10.3 years old that underwent cataract surgery was selected for this study. Ocular and systemic details of the patients were recorded and then analyzed by means of artificial intelligence. A total of 1.25 billion simulations of artificial intelligence learning and testing were conducted on several variables and a customized model of analysis was developed. Results: A total of 73 complications were recorded in this study. According to the analysis performed, the main factors involved in cataract surgery complications were: a surgeon in training, axial length and intraocular lens power. The model predicted how long surgery would last with an error of <6 min compared to the effective time needed. Conclusions: According to the data here obtained, artificial intelligence could be an interesting option to build customized models able to prevent complications and to predict actual surgery time. The customized algorithm option allows the development of better models adaptable to different units as well as the possibility to be calibrated for the same unit along time.
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Affiliation(s)
- Michele Lanza
- Multidisciplinary Department of Medical, Surgical and Dental Specialities, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Robert Koprowski
- Institute of Biomedical Engineering, Faculty of Science and Technology, University of Silesia in Katowice, Sosnowiec, Poland
| | - Rosa Boccia
- Multidisciplinary Department of Medical, Surgical and Dental Specialities, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Katarzyna Krysik
- Department of Ophthalmology with Pediatric Unit, St. Barbara Hospital, Trauma Center, Sosnowiec, Poland
| | - Sandro Sbordone
- Multidisciplinary Department of Medical, Surgical and Dental Specialities, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Antonio Tartaglione
- Multidisciplinary Department of Medical, Surgical and Dental Specialities, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Adriano Ruggiero
- Multidisciplinary Department of Medical, Surgical and Dental Specialities, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Francesca Simonelli
- Multidisciplinary Department of Medical, Surgical and Dental Specialities, University of Campania Luigi Vanvitelli, Naples, Italy
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Zetterberg M, Kugelberg M, Nilsson I, Lundström M, Behndig A, Montan P. A Composite Risk Score for Capsule Complications Based on Data from the Swedish National Cataract Register: Relation to Surgery Volumes. Ophthalmology 2020; 128:364-371. [PMID: 32710994 DOI: 10.1016/j.ophtha.2020.07.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 07/09/2020] [Accepted: 07/16/2020] [Indexed: 02/02/2023] Open
Abstract
PURPOSE To investigate case mix in relation to capsule complication, possible associations between case mix and operation volume, and change in case mix over time. DESIGN Register-based study. PARTICIPANTS Swedish patients who underwent cataract surgery between 2007 and 2016. METHODS Demographics and data on ocular comorbidity, intraoperative difficulties, and capsule complications were registered from 2007 to 2016 and analyzed retrospectively in relation to coded data on individual surgeons' operation volume. Single factor analysis and logistic regression were performed, and a composite risk score was created. MAIN OUTCOME MEASURES Risk of capsule complication, given as adjusted and composite odds ratio in relation to cataract surgery volume. RESULTS Preoperative and intraoperative variables significantly associated with capsule complications were best-corrected visual acuity (BCVA) ≤0.1 (decimal, adjusted odds ratio [aOR], 1.82; P < 0.001); pseudoexfoliation (PEX) (aOR, 1.53; P < 0.001); sight-threatening ocular comorbidity other than age-related macular degeneration (AMD), diabetic retinopathy, glaucoma, or cornea guttata (aOR, 1.35; P = 0.006); use of Trypan blue (aOR, 1.76; P < 0.001); mechanical pupil dilation (aOR, 1.36; P = 0.024); and iris hooks at the rhexis margin (aOR, 6.99; P < 0.001). The composite risk score was 3.09 ± 6.40 (mean ± standard deviation) for patients with capsule complication and 1.28 ± 1.66 for uncomplicated procedures (P < 0.001). High-volume cataract surgeons (≥500 procedures yearly) had a significantly lower composite risk score (mean risk score ≤1.28; range, 1.01-2.02) compared with low- and medium-volume cataract surgeons (1.34 ± 0.56; range, 1.00-4.55 and 1.49 ± 0.58; range, 1.01-5.19), respectively. During the period 2007-2016, the proportion of patients aged >88 years, patients with BCVA ≤0.1, and patients with intraoperative difficulties decreased. CONCLUSIONS Case mix, as calculated from a composite risk score based on preoperative and intraoperative parameters registered in the National Cataract Register (NCR), may contribute to the decrease in capsule complications from 2007 to 2016 and the lower complication rate observed in cases managed by high-volume cataract surgeons.
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Affiliation(s)
- Madeleine Zetterberg
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Department of Ophthalmology, Sahlgrenska University Hospital, Mölndal, Sweden.
| | - Maria Kugelberg
- Department of Clinical Neuroscience, Division of Ophthalmology and Vision, Karolinska Institute, Stockholm, Sweden; St Erik Eye Hospital, Stockholm, Sweden
| | - Ingela Nilsson
- Capio Medocular AB, Malmö, Department of Clinical Sciences/Ophthalmology, Malmö, Sweden
| | - Mats Lundström
- EyeNet Sweden, Blekinge Hospital, Karlskrona, Sweden; Faculty of Medicine, Lund University, Lund, Sweden
| | - Anders Behndig
- EyeNet Sweden, Blekinge Hospital, Karlskrona, Sweden; Department of Clinical Sciences/Ophthalmology, Umeå University, Umeå, Sweden
| | - Per Montan
- Department of Clinical Neuroscience, Division of Ophthalmology and Vision, Karolinska Institute, Stockholm, Sweden; St Erik Eye Hospital, Stockholm, Sweden
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12
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Chilibeck CM, McGhee CNJ. Virtual reality surgical simulators in ophthalmology: Are we nearly there? Clin Exp Ophthalmol 2020; 48:727-729. [PMID: 32488961 DOI: 10.1111/ceo.13784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Corina M Chilibeck
- Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - Charles N J McGhee
- Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
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13
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Michael E. Are topical antibiotics needed following routine phacoemulsification cataract surgery? Clin Exp Ophthalmol 2020; 48:537-539. [PMID: 32083774 DOI: 10.1111/ceo.13737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 12/30/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Eugene Michael
- Department of Ophthalmology, Greenlane Clinical Centre, Auckland, New Zealand
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14
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Han JV, Freundlich S, Patel DV, McGhee CNJ. The role of topical antibiotics in endophthalmitis prophylaxis in routine phacoemulsification cataract surgery? Clin Exp Ophthalmol 2020; 48:539-540. [PMID: 32083803 DOI: 10.1111/ceo.13739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jina V Han
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Simone Freundlich
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Dipika V Patel
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Charles N J McGhee
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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15
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McGhee CNJ, Zhang J, Patel DV. A perspective of contemporary cataract surgery: the most common surgical procedure in the world. J R Soc N Z 2020. [DOI: 10.1080/03036758.2020.1714673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Charles N. J. McGhee
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jie Zhang
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Dipika V. Patel
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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