Abstract
Purpose :
This study determined how a novel cataract surgery grading system might predict intra-operative complications and post-operative results at a U.S. training program.
Methods :
We included 320 resident cases from January to September 2018 performed at a single institution. Risk scores, pre-operative best-corrected visual acuity (BCVA), intra-operative complications, post-operative day 1 (POD1) and month 1 (POM1) BCVA, and POM1 exam findings were tabulated. OLS and logistic regression analysis were used for continuous and binary variables, respectively.
Results :
Mean pre-operative BCVA was 0.40 LogMAR, POD1 BCVA was 0.29, and POM1 BCVA was 0.16. Risk scores ranged from 0 to 8 (mean = 1.28). 4.4% of cases had posterior capsule ruptures, and 3.8% had vitreous loss. Risk scores did not have a significant association with intraocular lens location or the occurrence of intra-operative posterior capsule rupture, vitreous loss, hyphema, or iris prolapse. Risk scores were predictive of POD1 BCVA (β=0.043, p<0.001), POM1 BCVA (β =0.029, p=0.007), and the presence of POM1 Descemet membrane folds (OR=1.27, p=0.032) and corneal edema (OR=1.34, p=0.006). Worse pre-operative visual acuity increased the likelihood of IOL placement in the sulcus (β=4.52, p=0.019) and Descemet membrane folds (β=4.25, p=.004). The presence of a posterior subcapsular cataract (PSC) increased the likelihood of worse POD1 (β=0.039, p=0.008) and POM1 (β=0.033, p=0.002) BCVA, sulcus IOL (OR 1.90, p=.001), and vitreous loss (OR 1.74, p=0.004). Advanced age (>88 years) predicted nuclear sclerosing (OR 1.09, p=0.001) and cortical (OR 1.03, p=0.036) cataracts, but not PSCs, as well as high intraoperative phacoemulsification energy requirement (β=1.18, p=0.025).
Conclusions :
In its current implementation, our institution’s pre-operative cataract surgical risk score was highly correlated with post-operative visual acuity and the presence of POM1 Descemet membrane folds and corneal edema. Furthermore, we have identified particular risk factors (worse pre-operative visual acuity, PSC) that should be given special attention by surgical trainees due to their association with poorer outcomes.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.