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Matthew D. Geiger, Jennifer Patnaik, D. Claire Miller, Michael Taravella, Richard Davidson, Alan Palestine, Naresh Mandava, Anne Lynch, Karen Christopher, Leonard Keith Seibold; Ocular Comorbidities as Risk Factors for Refractive Surprise Following Cataract Surgery. Invest. Ophthalmol. Vis. Sci. 2019;60(9):2072. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To assess select ocular comorbidities as risk factors for refractive surprise after phacoemulsification cataract surgery among adults.
A retrospective cohort study was conducted on eyes that underwent cataract surgery from January 1st, 2014 to December 31st, 2016 at the University of Colorado Denver. The main outcome of refractive surprise was defined as the difference in spherical equivalent of the refractive target and postoperative refraction in diopters (D). Eyes with ocular comorbidities included traumatic cataract, glaucoma, history of age-related macular degeneration (AMD), history of retinal detachment, prior refractive surgery, high myopia, high hyperopia, high astigmatism, any surgical complication, and combined surgeries (Table). Eyes with each ocular comorbidity of interest were compared to eyes without comorbidities. Univariate logistic regression models with general estimating equations to account for the intra-subject correlation were used to determine associations between refractive surprise and ocular comorbidities. P-values <0.05 were considered statistically significant.
A total of 5683 surgeries were reviewed and 1457 were excluded from analysis due to missing baseline, target or follow-up data. Exactly half (50%) of eyes had at least one of the select comorbidities with the most common being glaucoma (14.1%), AMD (10.4%), high astigmatism (14.6%), high myopia (14.5%), and history of prior refractive surgery (7.1%). 269 (6.4%) eyes had a refractive surprise greater than 1D. Most of the ocular comorbidities had significantly higher rates of greater than 1D refractive surprise compared to eyes without ocular comorbidity (Table), with the exception of AMD, retinal detachments with visual acuities of 20/40 or better at baseline, astigmatism measured as pre-operative cylinder of >2D, and combined surgery with Kahook Dual Blade goniotomy. Significantly increased odds ranged from 1.5 (95% CI: 1.1-2.0) for glaucoma to a high of 8.4 (95% CI: 3.2-22.2) for combined surgery of planned vitrectomy.
In this cohort, traumatic cataract, most combined surgeries, glaucoma, history of retinal detachment with baseline visual acuity of 20/50 or worse, prior refractive surgery, high myopia, high hyperopia, high astigmatism, and complications during phacoemulsification were found to have higher rates of refractive surprise >1D after cataract surgery.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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