Post Cataract Surgery Complications and its Contribution to Visual Impairment/Blindness: The Brazilian Amazon Region Eye Survey (BARES)

Abstract

Purpose : To investigate cataract surgical complications and its contribution to visual outcomes in older adults from rural and urban areas of Parintins City, Brazilian Amazon Region.

Methods : BARES is a population-based study using cluster random sampling to identify individuals ≥ 45 years of age. Eligible individuals were invited to an ophthalmic exam and those who had previous cataract surgery were queried about year and place of surgery. The surgical technique and complications were noted. The contribution of surgical complications on visual impairment (best-corrected visual acuity - BCVA <20/32 to ≥20/200) or blindness (BCVA <20/200) was studied. The association of surgical complications with surgical technique and socio-demographic variables was assessed by multiple logistic regression.

Results : A total of 2384 eligible persons were enumerated, 2041 (85.6%) were examined. Previous cataract surgery was found in 173 (8.5%) participants (270 eyes), 97 subjects with bilateral and 76 with unilateral surgery. The mean age at cataract surgery was 67.8±0.93 years. The most frequent surgical technique was phacoemulsification (63.3%), followed by extra-capsular extraction (32.2%), intra-capsular extraction (2.6%), and others (1.9%). Surgical complications were detected in 142 (52.6%) eyes including posterior capsule opacification (29.6%), posterior capsule rupture (16.3%), intraocular lens (IOL) dislocation (6.7%) and corneal decompensation (6.3%). Surgical complications contributed to visual impairment in 19 (13.4%) eyes and blindness in 17 eyes (12.0%). Posterior capsule rupture (12/19 eyes – 63.2%) and corneal decompensation (10/17 eyes – 58.8%) were the most frequent complication leading, respectively, to visual impairment and blindness. Phacoemulsification technique was found to be significantly less associated to surgical complications [OR=0.35; 95% CI: 0.16-0.76; p=0.011].

Conclusions : Cataract surgical complications were detected in more than half of previously operated eyes in this population. The most common complications contributing to post-operative visual impairment and blindness were posterior capsule rupture and corneal decompensation. These findings reinforce the need to monitor cataract surgery quality in areas with limited access to healthcare to improve visual outcomes.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.