Auckland Cataract Study IV: Practical application of NZCRS cataract risk stratification to reduce phacoemulsification complications

Abstract

Importance: Reduction of intraoperative complications in phacoemulsification cataract surgery.Background: To assess practicability of a risk stratification system, the New Zealand Cataract Risk Stratification (NZCRS) system, in a major teaching hospital service, without investigator oversight, to ascertain whether benefits identified in research studies are maintained in busy clinical practice.Design: Prospective cohort study in a major public teaching hospital.Participants: Five hundred cases of phacoemulsification cataract surgery. Methods: NZCRS system inserted into 621 consecutive preoperative cataract patient files. Recommendation to allocate higher-risk cases to experienced surgeons.Main Outcome Measures: NZCRS system uptake and adherence, appropriate identification of high risk cases and intraoperative complication rates.Results: NZCRS scores calculated in 500 of 621 (80.5%) cases and 98 (19.6%) scored as "high risk." Cataract surgery (N = 500) performed by: 12 Registrars (20%), 4 Fellows (7.2%), 26 Consultants (72.8%). Risk scores adhered to in 99%.Overall intraoperative complications (3.0%) included iris prolapse 1.6% and posterior capsule tear 0.8%. No statistical difference in complication rates identified between surgeon grades. Mean best-corrected visual acuity was 6/10 (20/32). Postoperatively, cystoid macular oedema occurred in 3.2%. Rescoring by an experienced investigator noted a greater number of "high risk scores" (31.6% vs 19.6%) related to differences in subjective scoring of anterior chamber depth and cataract density.Conclusions and Relevance: Practical uptake of cataract risk stratification was promising in this study with NZCRS calculated in 80.5% with 99%

Application of Artificial Intelligence in the Analysis of Features Affecting Cataract Surgery Complications in a Teaching Hospital

“…The pursuit in providing continuously better results after this kind of surgery, also due to higher patient expectations, push physicians to reduce the incidence of complications (26). For this reason, identifying and stratifying patient preoperative risk factors is a topic of increasing interest (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14).…”

“…Nowadays, patient expectations induce physicians to limit the complication rate as much as possible and this is obviously more difficult in a teaching hospital. Today, intraoperative and postoperative cataract surgery complications are <10% and are usually mild and transient although in a few cases these events can lead to long-term visual dysfunction with strong dissatisfaction of patients (4). Most frequent intra-operative complications are posterior capsule rupture with or without vitreous loss (0.5-5.2%), intraoperative iris floppy syndrome or iris prolapse (0.5-2%) and iris or ciliary body injury (0.6-1.2%) (1).…”

“…For this reason, many studies have evaluated the most frequent features involved in cataract surgery results (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14).…”

The role of topical antibiotics in endophthalmitis prophylaxis in routine phacoemulsification cataract surgery?

“…We thank the author for his keen observations 1 in relation to our recent publication, the latest in the longitudinal Auckland Cataract Study (ACS) series IV: practical application of New Zealand Cataract Risk Stratification system to reduce phacoemulsification complications. 2 We agree that it is always worthwhile considering the utility of topical ocular antibiotics following routine small incision phacoemulsification surgery, given the relatively low incidence of endophthalmitis. 3 Indeed, with a reported incidence of 0.08%-0.35% 4 across a patient cohort eight times the size of the ACS IV 2 we agree that smaller studies, where patients routinely receive endophthalmitis prophylaxis involving povidone-iodine and subconjunctival cefazolin, lack the power to reveal clinical and statistical trends.…”

Are topical antibiotics needed following routine phacoemulsification cataract surgery?

“…We read with interest the recent article by Han et al regarding the Auckland Cataract Study (ACS) IV, noting there were no cases of post‐operative endophthalmitis reported (nor any in the current prospective ACS study of 2000 cases). This raised an interesting point in the utility of post‐operative topical antibiotics, which are almost universally prescribed despite a lack of evidence‐based practice.…”