Cataract complications study: an analysis of adverse effects among 14,520 eyes in relation to surgical experience

Aaronson, Alexander; Kanclerz, Piotr; Grzybowski, Andrzej; Tuuminen, Raimo

doi:10.21037/atm-20-845

Cited by 24 publications

(16 citation statements)

References 37 publications

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“…Since this difference was not significant, it is therefore not possible to conclude that the non-fasting regimen results in a lower incidence of complications. This result deserves to be confirmed by studies with a very high number of patients included as it is known that when surgery is performed by experienced surgeons the complication rate is relatively low, in particular, < 1% ( 19 ).…”

Section: Discussionmentioning

confidence: 78%

The StarvAnx Study-Comparison Between the Effects of Non-fasting Vs. Fasting Strategy on Surgical Outcomes, Anxiety and Pain in Patients Undergoing Cataract Surgery Under Topical Anesthesia: A Randomized, Crossover, Controlled Trial

et al. 2022

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BackgroundFasting is usually recommended in patients undergoing cataract surgery under topical anesthesia. However, starving before surgery may increase preoperative anxiety and affect surgical outcomes. It is not known which fasting or non-fasting strategy is best for cataract surgery. The aim of this study was to compare non-fasting and fasting strategy in patients undergoing cataract surgery under topical anesthesia with regard to surgical outcomes, anxiety and pain.MethodsThis randomized, crossover, controlled trial enrolled patients undergoing surgery for bilateral cataract under topical anesthesia at Cochin Hospital (Paris, France), from February to May 2021. Patients were randomly assigned to the non-fasting or fasting group for the first eye surgery and were switched to the other group for the second eye surgery. The primary endpoint was to compare the rate of anesthetist's interventions during surgery. The secondary endpoints included intra-operative complications, duration of surgery, surgeon perception of surgical difficulty, anesthesia-related complications and anxiety and pain level.Resultsone hundred and nine consecutive patients were included, with 60 of them being fasted first and non-fasted for the second eye surgery, while the other 59 were non-fasted first and fasted for the next surgery. The number of patients requiring sedation was significantly lower in the non-fasting group compared with the fasting group [1%; 95%IC (0-3.2) vs. 6%; 95%IC (2.9-8.9), P = 0.04]. No anesthesia-related complications were observed. There was no difference in the number of intra-operative complications between the non-fasting and the fasting groups (,respectively, 0 and 1; P = 1). Anxiety level and surgical pain were significantly lower in the non-fasting group compared to the fasting group (,respectively, 2.3 ± 2.0 vs. 4.1 ± 2.4, P = 0.01 and 0.6 ± 0.6 vs. 2.6 ± 3.4, P = 0.003). The mean duration of surgery was significantly shorter in the non-fasting group compared with the fasting group (,respectively, 16.0 ± 5.9 vs. 22.3 ± 6.1 min; P = 0.03).ConclusionIn conclusion pre-operatory non-fasting strategy provides a better patient experience with regards to preoperative anxiety and surgical pain. It allows to reduce operating times and is safe and well-tolerated as regards the anesthetic intervention.

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Section: Discussionmentioning

confidence: 78%

The StarvAnx Study-Comparison Between the Effects of Non-fasting Vs. Fasting Strategy on Surgical Outcomes, Anxiety and Pain in Patients Undergoing Cataract Surgery Under Topical Anesthesia: A Randomized, Crossover, Controlled Trial

et al. 2022

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“…Senior grade surgeons are generally better placed to perform more efficient ISBCS surgery and reduce the risk of complications [73]. In fact in a recent study by Aaronson et al [74] paper, the authors clearly show that even with improvements in surgical teaching complication rates are consistently lower with senior surgeons. This is, of course, not to say that with proper supervision and training that complication rates in trainee surgeons cannot be minimized but this is not the subject of the current review.…”

Section: Case Selectionmentioning

confidence: 98%

Recurring themes during cataract assessment and surgery

Chandra

Sivaprasad

Ursell

et al. 2021

Eye

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The aim of this review was to discuss frequently encountered themes such as cataract surgery in presence of age-related macular degeneration (AMD), dementia, Immediate Sequential Bilateral Cataract Surgery (ISBCS), discussing non-standard intraocular lens (IOL) options during consultation in the National Health Services (NHS) and the choice of the biometric formulae based on axial length. Individual groups of authors worked independently on each topic. We found that cataract surgery does improve visual acuity in AMD patients but the need for cataract surgery should be individualised. In patients with dementia, cataract surgery should be considered 'sooner rather than later' as progression may prevent individuals presenting for surgery. This should be planned after discussion of patients' best interests with any carers; multifocal IOLs are not proven to be the best option in these patients. ISBCS gives comparable outcomes to delayed sequential surgeries with a low risk of bilateral endophthalmitis and it can be cost-saving and efficient. Patients are entitled to know all suitable IOL options that can improve their quality of life. Deliberately withholding this information or pressuring patients to choose a non-standard IOL is inappropriate. However, one should be mindful of the not spending inappropriate amounts of time discussing these in the NHS setting which may affect care of other NHS patients. Evidence suggests Hoffer Q, Haigis, Hill-RBF and Kane formulae for shorter eyes; Barrett Universal II (BU II), Holladay II, Haigis and Kane formulae for longer eyes and BU II, Hill-RBF and Kane formulae for medium axial length eyes.

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“…Phacoemulsification and intraocular artificial lens implantation are well-known standard procedures to treat cataract, with a very low complication rate [1]. Most common complications such as posterior capsular bag rupture or corneal edema are well described [2]. Postoperative complications such as increased intraocular pressure and secondary cataract are also well known.…”

Section: Introductionmentioning

confidence: 99%

Rare Foreign Body in Anterior Chamber following Cataract Surgery: About an Eyelash

Sabaratnam

Tran

2022

Klin Monbl Augenheilkd

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Cataract complications study: an analysis of adverse effects among 14,520 eyes in relation to surgical experience

Cited by 24 publications

References 37 publications

The StarvAnx Study-Comparison Between the Effects of Non-fasting Vs. Fasting Strategy on Surgical Outcomes, Anxiety and Pain in Patients Undergoing Cataract Surgery Under Topical Anesthesia: A Randomized, Crossover, Controlled Trial

The StarvAnx Study-Comparison Between the Effects of Non-fasting Vs. Fasting Strategy on Surgical Outcomes, Anxiety and Pain in Patients Undergoing Cataract Surgery Under Topical Anesthesia: A Randomized, Crossover, Controlled Trial

Recurring themes during cataract assessment and surgery

Rare Foreign Body in Anterior Chamber following Cataract Surgery: About an Eyelash

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