September 2018

ASCRS•ASOA UPDATE

In the Journal of Cataract & Refractive Surgery September 2018


Cataract surgery outcomes in the very elderly

Emily Li, MD, Curtis Margo, MD, Paul Greenberg, MD
One group of U.S. patients with visually significant cataracts continues to rise—those older than age 85. To determine how old age impacted cataract outcomes, investigators conducted a review of the literature. They determined that after adjusting for higher rates of systemic and ocular comorbidities that can afflict this population, such elderly patients had similar complication rates to younger individuals undergoing the procedure. In most cases visual acuity as well as quality of life improved in these very elderly patients, who tended to live for more than a year after undergoing cataract removal. Investigators concluded that the idea of cataract surgery in the most elderly is generally supported by the findings. However, for those with ocular comorbidities in this very senior age group, further studies are needed.

Complication rates of resident-performed cataract surgery: impact of early introduction of cataract surgery training

Erika Ellis, MD, Luke Saunders, PhD, Jeffrey Lee, MD, Weldon Haw, MD,
David Granet, MD, Chris Heichel, MD

In this retrospective case series, investigators set out to determine how the timing of when a resident initially begins cataract surgery impacts their complication rates. Those introduced to cataract surgery during the first year of residency included four residents who undertook 780 cataract cases. Three other residents were introduced to the procedure their final year when they performed 540 cases. Investigators found that there was an 8.5% major intraoperative complication rate for those who learned the procedure later as compared to the early group, with just a 3.1% rate. The later group also had a higher 7.6% anterior vitrectomy rate with a peak of 12% at around the first 20 cases versus 2.1% for early learners, which remained stable at 1–2% throughout training. Investigators concluded that rates of intraoperative complications and the need for anterior vitrectomy is significantly decreased when residents receive cataract training early rather than later in their residencies.

Predicting pseudophakic refractive error: interplay of biometry
prediction error, anterior chamber depth, and changes in corneal
curvature

Henry Wallace, BMSc (Hons), Stuti Misra, PhD, Sunny Li, BMSc (Hons),
James McKelvie, PhD

In this prospective case series, investigators compared the Hill-RBF method, the Barrett Universal II formula, and the SRK/T formula and examined how predicted refractive outcomes measured up to objective outcomes. They also considered the impact of keratometric changes and anterior chamber depth. Included were 100 cataract patients with a mean axial length of 23.4 mm. Investigators determined that at the 1-week follow-up, the Universal II formula was more accurate than the other methods. However, by the 3-month follow-up, all of the methods offered about equal efficacy. The mean absolute prediction error with the Universal II formula was 0.50 D, with the Hill-RBF this was at 0.49 D, and with the SRK/T this was about 0.52 D. When it came to predicting eyes within 0.25 D during this same 3-month period, the Hill-RBF method had the highest proportion of eyes in this range. Changes in keratometry tended to occur in the first 4 weeks, with corneal steepening generally occurring during this period. Meanwhile, during the 4- to 12-week postoperative period, there was a significant mean hyperopic shift. Investigators concluded that in these medium length eyes the Universal II and Hill-RBF methods bested the SRK/T formula. They advised practitioners during the 3-month postoperative period to expect a possible posterior IOL migration with accompanying progressive hyperopic shift.

In the Journal of Cataract & Refractive Surgery September 2018 In the Journal of Cataract & Refractive Surgery September 2018
Ophthalmology News - EyeWorld Magazine
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2018-09-03T14:50:25Z
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