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P. H. Blomquist, H. H. Winslow, J. W. Sargent; Validation of Najjar-Awwad Cataract Risk Score for Residents. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5456.
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To validate the Najjar-Awwad cataract risk score for residents and the recommendation that beginning surgeons start with cases with risk scores <5.
Phacoemulsification cataract surgeries performed by 33 residents between April 2005 and December 2008 at 2 urban public county hospitals, Parkland Memorial Hospital (Dallas county) and John Peter Smith Hospital (Tarrant county), were retrospectively reviewed. Traumatic, congenital, and polar cataracts as well as lenses with dislocation or phacodonesis were excluded. Cases with incomplete documentation of risk factors were also excluded. The cataract risk score, which can range from 2-25, was calculated retrospectively for 1833 eligible cases. Intraoperative complications included posterior and anterior capsular tears, vitreous prolapse, dropped nucleus, and conversion to manual extracapsular cataract extraction. In addition to odds ratios, P values were calculated using chi square.
There were 119 complications (6.5%), though the rate of complications involving vitreous prolapse or loss (including dropped nucleus) was only 3.2%. The significant risk factors included in the risk score associated with intraoperative complications were poor red reflex (odds ratio 2.1; 95% CI 1.4-3.1; P=0.00007) and dense nuclear sclerosis (OR 2.1; 95% CI 1.3-3.3; P=0.004). Cataract risk scores ranged from 3-16. Only 85 cases (4.6%) had a score <5, while 359 (19.6%) had a score <6 and 885 (48.2%) had a score <7. The odds ratio was 1.1 (95% CI 0.45-2.8; P=0.80) for complications for score <5, 1.2 (95% CI 0.7-1.9; P=0.55) for score <6, and 2.1 (95% CI 1.4-3.1; P=0.0002) for score <7.
While the Najjar-Awwad cataract surgery risk score can be used to predict intraoperative complications at the time of cataract surgery, the complication rate did not significantly increase until the score reached 7. There was a paucity of cases with scores <5 in our county hospital populations. We recommend that beginning surgeons be given cases with risk scores at least <7.
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