Dataset Information

Torsional phacoemulsification: A pilot study to revise the "harm scale" evaluating the endothelial damage and the visual acuity after cataract surgery.

ABSTRACT: To study the effect of torsional phacoemulsification energy on corneal endothelium evaluating the relationship between changes of endothelial cells and postoperative visual acuity.This prospective clinical observational cohort study included 50 patients with cataract who underwent torsional phacoemulsification. Sequential quantitative and qualitative morphometric endothelial cell analyses of the cornea were performed four weeks preoperatively and six weeks postoperatively using noncontact specular microscopy.This work confirmed the strong relationship, described by a linear model (one-way ANOVA, R2 = 77.9%, P < 0.0001), between the percentage of endothelial cell loss (ECL%) and the 5-score harm scale. According to the Tukey post-hoc pairwise comparison test, distinct values of ECL% are grouped in 3 subsets. The value of ECL = 10% has been identified as cut-off to discriminate patients with excellent postoperative best-corrected visual acuity (BCVA > 85 letters) from those with just a good/satisfied visual outcome (BCVA ? 85 letters). Within the 5-score harm scale, there was a significant correlation among phaco energy intraoperatively delivered and the average endothelial cell loss.This study confirms the validity of the 5-score harm scale first proposed by Sorrentino and colleagues in 2016. This time, the method categorizes cataracts taking into account nucleus hardness and phaco cumulative dissipated energy. Predicting the harm on corneal endothelium, we can discriminate patients with excellent BCVA and with just good/satisfied BCVA. With torsional phacoemulsification with respect to longitudinal, the percentage of patients who can reach excellent BCVA is remarkably increased.

SUBMITTER: Sorrentino FS

PROVIDER: S-EPMC5658130 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Torsional phacoemulsification: A pilot study to revise the "harm scale" evaluating the endothelial damage and the visual acuity after cataract surgery.

Sorrentino Francesco Saverio FS Matteini Silvia S Imburgia Aurelio A Bonifazzi Claudio C Sebastiani Adolfo A Parmeggiani Francesco F

PloS one 20171026 10

<h4>Purpose</h4>To study the effect of torsional phacoemulsification energy on corneal endothelium evaluating the relationship between changes of endothelial cells and postoperative visual acuity.<h4>Methods</h4>This prospective clinical observational cohort study included 50 patients with cataract who underwent torsional phacoemulsification. Sequential quantitative and qualitative morphometric endothelial cell analyses of the cornea were performed four weeks preoperatively and six weeks postope ...[more]

PMID: 29073200

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Project description:PurposeThe impact of cataract surgery on low luminance visual acuity deficit (LLVAD) measurements was investigated by measuring the LLVAD before and after cataract surgery.DesignProspective, longitudinal study.ParticipantsPatients undergoing cataract surgery.MethodsPhotopic luminance (PL)-best-corrected visual acuity (BCVA) and low luminance (LL)-BCVA were obtained using the ETDRS chart. Low luminance visual acuity deficit scores were calculated by subtracting the LL-BCVA letter score from the PL-BCVA letter score. To demonstrate the reproducibility of these visual acuity measurements, we used data from drusen-only eyes previously published in the Complement Inhibition with Eculizumab for the Treatment of Nonexudative Age-Related Macular Degeneration (COMPLETE) study. The PL-BCVA, LL-BCVA, and LLVAD measurements obtained at an interval of 3 months in this cohort were used for comparison. In the current study, the impact of cataract surgery on LLVAD measurements was analyzed by comparing the PL-BCVA, LL-BCVA, and LLVAD measurements before and after cataract surgery.Main outcome measuresThe reproducibility of the visual acuity measurements and the changes in LLVAD measurement after cataract surgery.ResultsIn the COMPLETE study, no clinically significant differences were found in the PL-BCVA, LL-BCVA, or LLVAD measurements between baseline and the 3-month follow-up visits with a change of -1.1 letters, -1.3 letters, and 0.1 letters, respectively (P = 0.02, P = 0.11, and P = 0.88, respectively). In the current study, significant increases were found in the PL-BCVA and LL-BCVA measurements, with a change of 7.3 letters and 10.2 letters after cataract surgery (P < 0.001 for both), and a statistically significant decrease in LLVAD measurements was found, with a change of -3.0 letters after cataract surgery (P = 0.002).ConclusionsBecause of the variable effect of cataracts on LL-BCVA measurements and the significant change in LLVAD measurements after cataract surgery, investigators should be aware that cataract surgery during a trial will have an unpredictable impact on LLVAD measurements, and pseudophakic and phakic patients should be analyzed separately.

Project description:PurposeTo determine factors impacting cumulative dissipated energy (CDE) and postoperative best-corrected visual acuity (BCVA) in phacoemulsification.DesignReview of 1102 cases at University of California, San Francisco (UCSF) and at Zhongshan Ophthalmic Center (ZOC), China.SubjectsPatients who underwent cataract surgery at UCSF 03/2014-03/2019 and at ZOC 10/2018-05/2019.MethodsPatient demographics, medical history, routine ocular examination, and surgical information, including disassembly method, complications, and surgeon training level were recorded. Univariable and multivariable regression models were used to determine factors associated with CDE and good postoperative BCVA (20/40 or better) at 1 month.Outcome measuresCDE, postoperative BCVA.ResultsIn multivariable analysis, patient age at time of surgery, diabetes, degree of nuclear sclerosis (NS), white-to-white corneal diameter, disassembly method, preoperative BCVA, surgeon training level, and surgical center were significantly associated with CDE. Log10CDE increased by 0.20-0.31 for patient age ≥ 70 years, by 0.07 if the patient had diabetes, by 0.12-0.41 for NS grade ≥ 2, by 0.48 per 10 mm increase in white-to-white corneal diameter, by 0.34-0.47 for disassembly method other than non-stop chop, by 0.16 per unit increase in preoperative logMAR BCVA, and by > 0.09 when phacoemulsification was performed by residents early in their training. Log10CDE was 0.33 higher at UCSF than ZOC. In multivariable analysis, worse baseline visual acuity and age above 90 years at time of surgery decreased the odds of good BCVA (OR = 0.26 per unit increase in preoperative logMAR BCVA; OR = 0.12 for age > 90); comorbid retinal issues decreased the odds of good postoperative BCVA (OR = 0.13-0.39); greater anterior chamber depth (ACD) or shorter axial length (AL), increased the odds of good postoperative outcome (OR = 2.64 per 1 mm increase ACD, OR = 0.84 per 1 mm increase AL).ConclusionsCataract grade determined by slit lamp exam and, for the first time, older patient age, were noted to be important predictors of high CDE. CDE was not a risk factor for postoperative BCVA measured at postoperative 1 month. When surgery was performed by trainees under supervision, lower training level was associated with higher CDE, but not with worse postoperative BCVA.

Project description:ObjectiveTo describe visual acuity data representation in the American Academy of Ophthalmology Intelligent Research in Sight (IRIS) Registry and present a data-cleaning strategy.DesignReliability and validity study.ParticipantsPatients with visual acuity records from 2018 in the IRIS Registry.MethodsVisual acuity measurements and metadata were identified and characterized from 2018 IRIS Registry records. Metadata, including laterality, assessment method (distance, near, and unspecified), correction (corrected, uncorrected, and unspecified), and flags for refraction or pinhole assessment were compared between Rome (frozen April 20, 2020) and Chicago (frozen December 24, 2021) versions. We developed a data-cleaning strategy to infer patients' corrected distance visual acuity in their better-seeing eye.Main outcome measuresVisual acuity data characteristics in the IRIS Registry.ResultsThe IRIS Registry Chicago data set contains 168 920 049 visual acuity records among 23 001 531 unique patients and 49 968 974 unique patient visit dates in 2018. Visual acuity records were associated with refraction in 5.3% of cases, and with pinhole in 11.0%. Mean (standard deviation) of all measurements was 0.26 (0.41) logarithm of the minimum angle of resolution (logMAR), with a range of - 0.3 to 4.0 A plurality of visual acuity records were labeled corrected (corrected visual acuity [CVA], 39.1%), followed by unspecified (37.6%) and uncorrected (uncorrected visual acuity [UCVA], 23.4%). Corrected visual acuity measurements were paradoxically worse than same day UCVA 15% of the time. In aggregate, mean and median values were similar for CVA and unspecified visual acuity. Most visual acuity measurements were at distance (59.8%, vs. 32.1% unspecified and 8.2% near). Rome contained more duplicate visual acuity records than Chicago (10.8% vs. 1.4%). Near visual acuity was classified with Jaeger notation and (in Chicago only) also assigned logMAR values by Verana Health. LogMAR values for hand motion and light perception visual acuity were lower in Chicago than in Rome. The impact of data entry errors or outliers on analyses may be reduced by filtering and averaging visual acuity per eye over time.ConclusionsThe IRIS Registry includes similar visual acuity metadata in Rome and Chicago. Although fewer duplicate records were found in Chicago, both versions include duplicate and atypical measurements (i.e., CVA worse than UCVA on the same day). Analyses may benefit from using algorithms to filter outliers and average visual acuity measurements over time.Financial disclosuresProprietary or commercial disclosure may be found found in the Footnotes and Disclosures at the end of this article.

Dataset Information

Torsional phacoemulsification: A pilot study to revise the "harm scale" evaluating the endothelial damage and the visual acuity after cataract surgery.

Publications

Torsional phacoemulsification: A pilot study to revise the "harm scale" evaluating the endothelial damage and the visual acuity after cataract surgery.

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