National cataract surgery survey 1997-8: a report of the results of the clinical outcomes

Abstract

Aims-A national survey of over 100 hospitals in the UK was carried out to collect routine clinical information on the outcomes of cataract surgery. The clinical outcomes of interest were: visual acuity at time of discharge from postoperative hospital follow up, visual acuity at time of final refraction; complications related to surgery occurring during the operation, within 48 hours of surgery, and within 3 months of surgery. In addition, information on age and comorbidity was obtained. This article reports on the findings of the experience of approximately 18 000 patients who had cataract surgery in the hospital eye service of the NHS. Results-Of those with no ocular comorbidity, 85% achieved a visual acuity of 6/12 or better on discharge from postoperative hospital follow up, while 65% of patients with a serious co-existing eye disease achieved this level of acuity at this time. At final refraction, 92% of patients without ocular comorbidity and 77% of patients with ocular comorbidity achieved 6/12 or better visual acuity. The following main risk indicators were associated with visual outcomes and complications related to surgery: age, other eye diseases, diabetes and stroke, type of surgical procedure, and grade of surgeon. Conclusions-The acceptability of these findings could fruitfully be the subject of discussion within the ophthalmic community and hopefully issues arising out of the study can lead to research, especially in-depth studies of the outcomes of cataract surgery in those patients with coexisting serious eye conditions. (Br J Ophthalmol 1999;83:1336-1340

The Cataract National Dataset electronic multicentre audit of 55 567 operations: risk stratification for posterior capsule rupture and vitreous loss

“…The first National Cataract Surgery Survey (1993) reported rates of PCR without VL of 4% and PCR with VL 1%, 7 and the second National Cataract Surgery Survey 1997-1998 (1999) had an overall PCR with or without VL of 4.4%. 1 However, the proportion of phacoemulsification procedures performed in these studies was lower than the current figure of 99.9%, and since then, also there have been some advances in technology and technique, improving the quality of surgery. The First Pilot National Electronic Cataract Surgery Survey (2005) found an overall posterior capsular/zonular rupture rate of 2.7% (published only in Royal College Cataract Guidelines 8 ) and two more recent studies in 2006 reported a rate of 1.7% for PCR with or without VL 9 and 1.1% for PCR with VL and 0.4% for PCR alone, 2 similar figures to those described in this paper.…”

“…The analyses have confirmed about which preoperative features are associated with the cataract surgery 'index complication' PCR and/or VL, which is widely accepted as an indicator of quality of surgery. 1,2,7 From the ORs (Table 1), we have illustrated a method for estimating a composite risk for any combination of risk indicators. Our data show that the accumulated risk of PCR or VL or both for individual patients with multiple risk indicators stack up such that the predicted probabilities for 'high-risk cases' are substantial.…”

“…1,2 It is important as it is associated with the need for additional surgical procedures, a greater number of follow-up visits and increased frequency of postoperative complications, which may adversely affect the final visual outcome. 3 It is widely regarded as the benchmark complication to judge the quality of cataract surgery.…”

Residual debris as a potential cause of postphacoemulsification endophthalmitis

“…, it is quite clear that 'sterile endophthalmitis' could be due to these residual debris, but it is not clear that the high incidence of postsurgical endophthalmitis (PE) in 1999 is only due to residual debris. If the sterilising procedures were correct and the rate of phacoemulsification surgeries were similar in 1998 and 1999 (although having different PE annual incidence), the proven infectious PE of 1999 could be due, for instance, to an insufficient surgical prophylaxis (data about the hospitals' prophylaxis protocols are not provided), or to an accumulation of patients with a higher risk of a bad outcome 1 , or/and to some specific factor associated with the end of 1999.…”

“…We read with great interest the article by Leslie et al, 1 since we have also been dealing with a cluster of endophthalmitis at our tertiary care centre in South India. In all, 10 patients (0.18% of 5706 procedures) developed culture-proven postphacoemulsification endophthalmitis between January and August 2003, following surgery by seven surgeons, at three dedicated eye operation theatre complexes.…”