The Influence of Lunar Phases on Complications in Cataract Surgery: An Analysis of 16,965 Patients.
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ABSTRACT:
SUBMITTER: Faschinger EM
PROVIDER: S-EPMC5534307 | biostudies-other | 2017
REPOSITORIES: biostudies-other
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Project description:BackgroundTo compare the intraoperative challenges, complications, and operation time of illuminated chopper-assisted cataract surgery between cataract surgery only and phacovitrectomy in eyes with diabetic retinopathy.MethodsOne university hospital, retrospective case series. Two hundred ninety-five eyes of 295 consecutive patients with diabetic retinopathy who underwent cataract surgery only or phacovitrectomy were retrospectively reviewed. Intraoperative challenges and complications of cataract surgery were thoroughly analyzed by 3D viewing of digitally recorded videos. The pupil diameter, operation time, and improved efficacy (100/operation time × pupil diameter) were compared between the cataract surgery only and phacovitrectomy groups.ResultsOf the 295 eyes, 211 underwent cataract surgery only, and 84 underwent phacovitrectomy. Intraoperative challenges such as small pupil, miosis, or poor red reflex occurred more frequently (46 [21.8%] vs. 28 [33.3%], p = 0.029); pupil diameter was smaller (7.34 ± 0.94 vs. 6.89 ± 0.88 mm, p < 0.001) in the phacovitrectomy group than in the cataract surgery only group; however, rates of posterior capsule rupture and operation time were not different between the two groups (0 [0%] vs. 1 [1.2%], p = 0.285; 16.54 ± 2.65 vs. 16.31 ± 4.30 min, p = 0.434). Improved efficacy was higher in the phacovitrectomy group (0.85 ± 0.18 vs. 0.97 ± 0.28, p = 0.002).ConclusionsThe use of an illuminated chopper is a potential solution for diabetic cataract surgery, particularly in phacovitrectomy, by decreasing the use of supplemental devices, operation time, and posterior capsule rupture.Trial registrationRetrospectively registered.
| S-EPMC10214589 | biostudies-literature
Project description:PurposeTo evaluate the outcome of phacoemulsification in patients with chronic ocular Graft-versus-host disease (oGVHD) after allogeneic hematopoietic stem cell transplantation (aHSCT).MethodsRetrospective, observational multicenter study from 1507 oGVHD patients. From the patient files, data were collected including best-corrected visual acuity (BCVA), intraocular pressure (IOP), Schirmer's test I, tear film break-up time (TFBUT), corneal fluorescein staining score, postoperative complications, and pre- and post-operative topical therapy.ResultsSeventy-three patients underwent cataract surgery in 104 eyes. In n = 84 eyes, the oGVHD NIH grade was documented; 12% (n = 12) of analyzed eyes were staged oGVHD NIH grade 1, 31% (n = 32) NIH 2 and 39% (n = 41) NIH 3. The mean BCVA improved in 82% of the eyes (n = 86 eyes). BCVA significantly increased from 0.7 ± 0.5 to 0.4 ± 0.4 LogMAR after surgery independent from oGVHD severity. The mean IOP decreased from 14 ± 4 to 13 ± 4 mmHg after surgery. Visual acuity was moderately correlated to the pre-operative degree of corneal staining (Pearson p = 0.26, p = 0.002, Cohen's effect size f = 0.29). The visual acuity decreased by 0.078 LogMar units (95% CI = 0.027-0.141) with each increase of corneal staining by one grade (p = 0.05). After surgery, corneal epitheliopathy increased significantly in 42% (n = 44) of the eyes. Postoperative complications included corneal perforation (n = 6, 6%), cystoid macular edema (n = 4, 4%), and endophthalmitis (n = 1, 1%).ConclusionPhacoemulsification in patients with chronic oGVHD significantly improves visual acuity, but is associated with an increased risk of complications in particular corneal epitheliopathy and corneal perforations.
| S-EPMC9325851 | biostudies-literature
Project description:Cataract surgery is generally safe; however, severe complications exist. Preexisting conditions are known to predispose patients to intraoperative and postoperative complications. This study quantifies the relationship between aggregated preoperative risk factors and cataract surgery complications, and builds a model predicting outcomes on an individual level, given a constellation of patient characteristics.This study utilized a retrospective cohort of patients age 40 years or older who received cataract surgery. Risk factors, complications, and demographic information were extracted from the Electronic Health Record based on International Classification of Diseases, 9th edition codes, Current Procedural Terminology codes, drug prescription information, and text data mining. We used a bootstrapped least absolute shrinkage and selection operator model to identify highly associated variables. We built random forest classifiers for each complication to create predictive models.Our data corroborated existing literature, including the association of intraoperative complications, complex cataract surgery, black race, and/or prior eye surgery with increased risk of any postoperative complications. We also found other, less well-described risk factors, including diabetes mellitus, young age (<60 years), and hyperopia, as risk factors for complex cataract surgery and intraoperative and postoperative complications. Our predictive models outperformed existing published models.The aggregated risk factors and complications described here can guide new avenues of research and provide specific, personalized risk assessment for a patient considering cataract surgery. Furthermore, the predictive capacity of our models can enable risk stratification of patients, which has utility as a teaching tool as well as informing quality/value-based reimbursements.
| S-EPMC4930873 | biostudies-literature
Project description:Diabetes mellitus is one of the most prevalent chronic diseases worldwide. Diabetic patients are at risk of developing cataract and present for surgery at an earlier age than non-diabetics. The aim of this study was to review the problems associated with cataract surgery in a diabetic patient. Corneal complications in diabetic patients include delayed wound healing, risk of developing epithelial defects or recurrent erosions due to the impairment of epithelial basement membranes and epithelial-stromal interactions. Diabetic patients present lower endothelial cell density and their endothelium is more susceptible to trauma associated with cataract surgery. A small pupil is common in diabetic patients making cataract surgery technically challenging. Finally diabetic patients have an increased risk for developing postoperative pseudophakic cystoid macular edema, posterior capsule opacification or endophthalmitis. In patients with pre-proliferative or proliferative diabetic retinopathy, diabetic macular edema or iris neovascularization adjunctive therapy such as an intravitreal anti-vascular endothelial growth factor injection, can inhibit exacerbation related to cataract surgery.
| S-EPMC6572121 | biostudies-literature
Project description:ObjectivesTo describe the relationships between axial length and intraoperative complications in patients undergoing cataract surgery.DesignCohort analysis of the Royal College of Ophthalmologists' National Ophthalmology Database (RCOphth NOD).Setting110 National Health Service Trusts in England, Health Boards in Wales, Independent Sector Treatment Centres and Guernsey.Participants820 354 patients, aged 18 years or older, undergoing cataract surgery. Eligible operations were those from centres with at least 50 operations with a recorded axial length measurement and age at surgery between 1 April 2010 and 31 August 2019.InterventionsPhacoemulsification where the primary intention was cataract surgery alone.Outcome measuresPosterior capsule rupture (PCR) and other recorded intraoperative complications.Results1 211 520 eligible operations were performed by 3210 surgeons. The baseline axial length was <21 mm (short eyes) for 17 170 (1.4%) eyes, 21-28 mm (medium eyes) for 1 182 513 (97.6%) eyes and >28 mm (long eyes) for 11 837 (1.0%) eyes. The median age at surgery was younger for patients with long eyes than those with short or medium eyes. The rate of any intraoperative complication was higher for short eyes than medium or long with complication rates of 4.5%, 2.9% and 3.3%, respectively (p<0.001). PCR occurred in 1.40% surgeries overall, and in 1.53%, 1.40% and 1.61% of short, medium and long eyes, respectively (p=0.043, not significant at the 1% level).ConclusionsOverall PCR rates for cataract surgery in RCOphth NOD contributing centres are lower than previously reported and there is little change in PCR rates by axial length. Short eyes were more likely to have an intraoperative complication than medium or long eyes.
| S-EPMC9396167 | biostudies-literature
Project description:Topical antibiotic and steroid ointments are sometimes used topically at the conclusion of intraocular surgery, and inadvertent entry into the eye has been reported. Dispersed ointment droplets or consolidated globules in the anterior chamber (AC) can sometimes be visualized on exam. Occasionally, intraocular ointment is found incidentally without apparent toxic effect, but retained ointment usually presents with early or delayed intraocular inflammation, pressure rise, macular edema, or corneal edema. The usual treatment for toxicity from retained ointment is removal of the ointment. While the complication of ointment-induced cystoid macular edema has been reported, there is paucity of literature on the anatomical response and eventual visual outcome of patients who have been treated for long-standing edema from retained ointment. We present a case of a patient who presented with history of poor vision since the time of cataract surgery 33 months prior, who had cystoid macular edema, reduced endothelial cell count, and apparent Maxitrol ointment (neomycin, polymyxin B sulfate, and dexamethasone in paraffin vehicle; Novartis Pharmaceuticals UK) floating in the AC. The patient was treated with AC washout and sub-Tenon injection of triamcinolone. His vision, retinal architecture by optical coherence tomography, endothelial cell count, and pachymetry has been followed for 9 months following this treatment.
| S-EPMC6341354 | biostudies-literature
Project description:This study assessed the performance of automated machine learning (AutoML) in classifying cataract surgery phases from surgical videos. Two ophthalmology trainees without coding experience designed a deep learning model in Google Cloud AutoML Video Classification for the classification of 10 different cataract surgery phases. We used two open-access publicly available datasets (total of 122 surgeries) for model training, validation and testing. External validation was performed on 10 surgeries issued from another dataset. The AutoML model demonstrated excellent discriminating performance, even outperforming bespoke deep learning models handcrafter by experts. The area under the precision-recall curve was 0.855. At the 0.5 confidence threshold cut-off, the overall performance metrics were as follows: sensitivity (81.0%), recall (77.1%), accuracy (96.0%) and F1 score (0.79). The per-segment metrics varied across the surgical phases: precision 66.7-100%, recall 46.2-100% and specificity 94.1-100%. Hydrodissection and phacoemulsification were the most accurately predicted phases (100 and 92.31% correct predictions, respectively). During external validation, the average precision was 54.2% (0.00-90.0%), the recall was 61.1% (0.00-100%) and specificity was 96.2% (91.0-99.0%). In conclusion, a code-free AutoML model can accurately classify cataract surgery phases from videos with an accuracy comparable or better than models developed by experts.
| S-EPMC8844421 | biostudies-literature
Project description:PurposeTo compare rates and severity of complications between infants undergoing cataract surgery with and without intraocular lens (IOL) implantation.DesignProspective, randomized clinical trial.ParticipantsThe Infant Aphakia Treatment Study (IATS) is a randomized, multicenter (n = 12) clinical trial comparing treatment of aphakia with a primary IOL or contact lens in 114 infants with unilateral congenital cataract.InterventionInfants underwent cataract surgery with or without placement of an IOL.Main outcome measuresThe rate, character, and severity of intraoperative complications (ICs), adverse events (AEs), and additional intraocular surgeries (AISs) during the first postoperative year in the 2 groups were analyzed.ResultsThere were more patients with ICs (28% vs. 11%; P = 0.031), AEs (77% vs. 25%; P<0.0001), and AISs (63% vs. 12%; P<0.0001) in the IOL group than the contact lens group. Iris prolapse was the most common IC. The most common AE was visual axis opacification, and the most common additional intraocular reoperation was a clearing of visual axis opacification.ConclusionsThe rates of ICs, AEs, and AISs 1 year after surgery were numerically higher in the IOL group, but their functional impact does not clearly favor either treatment group.Financial disclosure(s)The author(s) have no proprietary or commercial interest in any materials discussed in this article.
| S-EPMC3230731 | biostudies-literature
Project description:The aim of the present study was to evaluate macular vascular density (MVD) variation after uneventful cataract surgery using optical coherence tomography angiography (OCTA) in patients with high myopia. Patients with cataracts scheduled for cataract surgery were divided into a high-myopia group [spherical equivalent (SE)≤-6.0 diopter (D) and axial length (AL)≥25 mm] and a low-myopia group (SE>-6.0 D and AL<25 mm). All patients were examined for MVD and retinal thickness (RT) with OCTA pre-operatively and post-operatively (1 day, 1 week, and 1 and 3 months after surgery). A total of 55 eyes from 44 patients were included. MVD and RT both changed after cataract surgery. The mean change in superficial vascular density (SVD) in patients with high myopia was significantly lower than that in the low-myopia group at the four post-operative time-points (all P<0.05). In addition, the RT of eyes with high myopia exhibited a different variation compared with that of the low-myopia group. Significant correlations were identified between AL, RT, intraocular pressure and SVD after surgery. In conclusion, superficial retinal perfusion in patients with high myopia was significantly lower than that in low myopia patients, which may lead to complications caused by poor perfusion.
| S-EPMC7664619 | biostudies-literature
Project description:Low-risk elective surgical procedures are common, but there are no clear guidelines for when preoperative consultations are required. Such consultations may therefore represent a substantial discretionary service.To assess temporal trends, explanatory factors, and geographic variation for preoperative consultation in Medicare beneficiaries undergoing cataract surgery, a common low-risk elective procedure.Cohort study using a 5% national random sample of Medicare part B claims data including a cohort of 556,637 patients 66 years or older who underwent cataract surgery from 1995 to 2006. Temporal trends in consultations were evaluated within this entire cohort, whereas explanatory factors and geographic variation were evaluated within the 89,817 individuals who underwent surgery from 2005 to 2006.Separately billed preoperative consultations (performed by family practitioners, general internists, pulmonologists, endocrinologists, cardiologists, nurse practitioners, or anesthesiologists) within 42 days before index surgery.The frequency of preoperative consultations increased from 11.3% in 1998 to 18.4% in 2006. Among individuals who underwent surgery in 2005 to 2006, hierarchical logistic regression modeling found several factors to be associated with preoperative consultation, including increased age (75-84 years vs 66-74 years: adjusted odds ratio [AOR], 1.09 [95% CI, 1.04-1.13]), race (African American race vs other: AOR, 0.71 [95% CI, 0.65-0.78]), urban residence (urban residence vs isolated rural town: AOR, 1.64 [95% CI, 1.49-1.81]), facility type (outpatient hospital vs ambulatory surgical facility: AOR, 1.10 [95% CI, 1.05-1.15]), anesthesia provider (anesthesiologist vs non-medically directed nurse anesthetist: AOR, 1.16 [95% CI, 1.10-1.24), and geographic region (Northeast vs South: AOR, 3.09 [95% CI, 2.33-4.10]). The burden of comorbidity was associated with consultation, but the effect size was small (<10%). Variation in frequency of consultation across hospital referral regions was substantial (median [range], 12% [0-69%]), even after accounting for differences in patient-level, anesthesia provider-level, and facility-level characteristics.Between 1995 and 2006, the frequency of preoperative consultation for cataract surgery increased substantially. Referrals for consultation seem to be primarily driven by nonmedical factors, with substantial geographic variation.
| S-EPMC4167873 | biostudies-literature