Abstract
Purpose :
Public safety-net hospital patients have high rates of ocular comorbidities, which can occur in the setting of chronic disease and may affect cataract surgery outcomes. In a retrospective case series, we aimed to characterize the outcomes and complications, as well as identify risk factors for poor outcomes and complications, of resident-performed cataract surgeries at an urban public safety-net hospital.
Methods :
The study population included all patients undergoing cataract surgery at LAC+USC with a resident as the primary surgeon from July 2015 to June 2016. Exclusion criteria included cases performed by a fellow; cataract cases combined with retina, glaucoma or corneal surgeries; and cases with inadequate documentation. Pre-operative, surgical, and post-operative characteristics were recorded. Primary outcomes were major intraoperative complication rate, risk factors for major intraoperative complications, rates of visual improvement, and risk factors for poor visual outcome. A multivariable Firth’s logistic regression tested risk factors for statistical significance.
Results :
811 eyes were analyzed. 599 (73.9%) cases resulted with post-op best corrected visual acuity (BCVA) 20/40 or better, with 641 (80.9%) cases showing at least two lines of visual improvement. 119 (14.7%) cases had at least one intraoperative complication, most commonly posterior capsule tear (8.6%) and vitreous loss (7.2%). Ocular risk factors significantly associated with lower odds of post-op BCVA of 20/40 or better included history of proliferative diabetic retinopathy (PDR) (OR=0.25; 95% CI=0.14-0.44; p<0.001), intravitreal therapy (IVT) (OR=0.40; 95% CI=0.16-0.99; p=0.047), and vitreous hemorrhage (VH) (OR=0.33; 95% CI=0.15-0.70; p=0.004). Patients with history of VH (OR=0.33; 95% CI=0.15-0.72; p=0.005) were also significantly less likely to improve vision by two lines. History of panretinal photocoagulation (PRP) was associated with significantly increased odds of intraoperative complication (OR=5.22; 95% CI=1.42-19.27; p=0.013).
Conclusions :
Several ocular comorbidities and ocular therapies—including PDR, VH, IVT—were significantly associated with poor visual outcomes, while PRP was associated with intraoperative complication, in resident-performed cataract surgery at a public safety-net hospital. These results can better inform both resident education and pre-surgical counseling for this underserved patient population.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.