Cataract surgery refractive outcomes: representative standards in a National Health Service setting

Brogan, Kerr; Diaper, Charles; Rotchford, Alan P

doi:10.1136/bjophthalmol-2018-312209

Cited by 31 publications

(33 citation statements)

References 19 publications

(16 reference statements)

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“…Between 1 and 3 months, 46% of patients had SEs within 0.25 D, 80% within 0.50 D, and 95% within 1.00 D of the target. These values exceed the benchmark standards set by the UK National Health Service of 55% within 0.50 D and 85% within 1.00 D 28,29. Additionally, these results meet the new benchmark of 94% within 1.00 D of the target proposed by Massachusetts Eye and Ear 30.…”

Section: Discussionmentioning

confidence: 45%

Refractive outcomes after trabecular microbypass stent with cataract extraction in open-angle glaucoma

Scott

Ferguson

Stephens

et al. 2019

OPTH

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Purpose To evaluate the impact of trabecular microbypass stents combined with cataract surgery on refractive outcomes in patients with open-angle glaucoma (OAG). Setting Private practice, Sioux Falls, South Dakota, USA. Design Retrospective, comparative case series. Methods Eyes with OAG had implantation of trabecular microbypass stents with concomitant cataract surgery. The unmatched control group comprised eyes that underwent only cataract extraction. Data were collected preoperatively and postoperatively for 6 months. Data included spherical equivalent (SE), astigmatic error, intraocular pressure (IOP), and number of glaucoma medications. Results The series included 76 consecutive OAG eyes with combined cataract plus trabecular microbypass stent and 50 consecutive non-OAG eyes with cataract surgery only. SE outcomes were equivalent between the groups ( P <0.001). For the combined and cataract-only groups respectively, 46% vs 52% had SEs within 0.25 D of the target, 80% vs 80% within 0.50 D, and 95% vs 94% within 1.00 D. Astigmatism outcomes did not significantly differ between the groups ( P >0.05). As for magnitude of astigmatism in the combined and cataract only groups respectively, 51% vs 32% were within 0.5 D, 75% vs 66% within 1.0 D, 87% vs 82% within 1.5 D, and 89% vs 94% within 2.0 D. In the OAG combined–surgery group, mean intraocular pressure reduction was 3.4 mmHg ( P <0.0001) at 1 month postoperatively, 4.0 mmHg ( P <0.0001) at 3 months, and 3.4 mmHg ( P <0.01) at 6 months. Mean decrease in number of glaucoma medications was 0.4 ( P <0.05) at 1 month, 0.7 ( p <0.0001) at 3 months, and 0.9 ( P <0.001) at 6 months. Conclusion The results of this study suggest the trabecular microbypass stent is a refractively neutral device.

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Section: Discussionmentioning

confidence: 45%

Refractive outcomes after trabecular microbypass stent with cataract extraction in open-angle glaucoma

Scott

Ferguson

Stephens

et al. 2019

OPTH

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“…National Health Service data suggested that 62.3% of patients within 0.5D of the refractive target should represent a minimum level of efficiency following cataract surgery. 23 Although this possibly represents the lower end of achievable accuracy, we compare favourably despite the higher potential risk profile of cataract surgery in cases with long-standing glaucoma. Vector astigmatic analysis suggested minor improvements although this may have been ameliorated by the relatively low preoperative refractive astigmatic values of our cohort (mean −0.91 ± 0.76D).…”

Section: Discussionmentioning

confidence: 91%

Refractive Outcomes After Trabecular Micro-Bypass Stents (iStent Inject) with Cataract Extraction in Open-Angle Glaucoma

Ioannidis

Töteberg‐Harms

Hamann

et al. 2020

OPTH

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Purpose: Simultaneous cataract and glaucoma surgery has traditionally been challenging for the anterior segment surgeon. The introduction of minimally invasive glaucoma surgery (MIGS) in conjunction with cataract surgery appears safe and effective in lowering intraocular pressure. Although a significant visual impact leading from the combined procedure is unexpected, we aim to describe the refractive outcomes in a cohort of patients undergoing simultaneous cataract removal and iStent inject and discuss the potential implications of combined surgery in patients with co-existent glaucoma. Patients and Methods: This is a retrospective consecutive case series inclusive of patients undergoing combined femtosecond laser-assisted cataract surgery and the insertion of two trabecular micro-bypass stents (iStent inject). Visual acuity, refraction and astigmatic vector analysis were collated and analysed from the preoperative and 4 weeks postoperative visits. Results: One hundred and six eyes of 89 patients from 2 surgeons were included in the original cohort. The mean absolute difference from target refraction was 0.36 ± 0.25D. 73.9% of eyes were within ± 0.5D of the refractive target and 98.9% of eyes were within ± 1.00D. 73.8% of eyes had 0.5D or less residual refractive astigmatism following the procedure. Conclusion: We present a novel cohort of glaucoma patients undergoing combined trabecular micro-bypass stents (iStent inject) and cataract surgery achieving excellent refractive outcomes. The results of this study indicate that this second-generation device is refractively neutral.

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“…As regards refractive outcomes, our results also compare favorably with the recent reports. Mean absolute error between target and postoperative spherical equivalent was [21], and the EUROQUO report on refractive outcomes including surgeries performed in 2014 and 2015 found a mean absolute biometry prediction error of 0.42 D (SD 0.52) and 72.7% of eyes within 0.5 D of target [7]. Patients implanted with multifocal IOLs expect to be spectacle independent, and in order to achieve this and to optimize IOL performance, postoperative refraction should be close to emmetropia.…”

Section: Discussionmentioning

confidence: 99%

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

Rementería-Capelo

García-Pérez

Gros-Otero

et al. 2020

Journal of Ophthalmology

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Introduction. Currently available outcome data for cataract surgery include mostly patients from public health systems. The purpose of this study was to report the visual and refractive outcomes of cataract procedures performed during one year in a private practice center, which may include a different spectrum of patients. 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.

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Cataract surgery refractive outcomes: representative standards in a National Health Service setting

Cited by 31 publications

References 19 publications

<p>Refractive outcomes after trabecular microbypass stent with cataract extraction in open-angle glaucoma</p>

<p>Refractive outcomes after trabecular microbypass stent with cataract extraction in open-angle glaucoma</p>

<p>Refractive Outcomes After Trabecular Micro-Bypass Stents (iStent <em>Inject</em>) with Cataract Extraction in Open-Angle Glaucoma</p>

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

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