Abstract
Purpose :
Approximately 3-10% of cataract surgeries nationally result in refractive surprise greater than one diopter from target refraction. Post-operative refractive surprise has been associated with patient characteristics and clinical factors such as long or short axial length and previous corneal refractive surgery, but the association between refractive outcomes and technical factors such as intra-operative complications and surgical skill is less understood. The purpose of this study is to identify additional factors that may be associated with refractive surprise.
Methods :
We conducted a retrospective chart review of all cataract surgeries at a single academic medical center between July 1, 2013 and June 30, 2014. Refractive outcomes were determined by comparing the postoperative refraction to the preoperative target refraction for each patient; differences greater than one diopter from target refraction were classified as refractive surprise. Logistic regression analysis was used to test the association between refractive surprise and attending surgeon, intra-operative complications, and concomitant surgical procedure, while controlling for age, gender, race, co-morbid glaucoma or diabetic retinopathy, and pre-operative cataract grade.
Results :
1131 cataract surgeries were performed during the study period. Of these, 668 patients had no missing entries for the variables of interest and were used as the study population. Refractive surprise occurred in 6.19% of cases. Patients who experienced operative complications were 5.6 times more likely to have refractive surprise than who did not (p<0.05); patients with poor pre-operative visual acuity were more likely to experience refractive surprise as well (p<0.05). Other variables were not associated with refractive surprise.
Conclusions :
Surgical complications are associated with higher rates of refractive surprise. Quality improvement initiatives that focus on reducing surgical complications may help improve surgical refractive outcomes.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.