The Auckland Cataract Study: co-morbidity, surgical techniques, and clinical outcomes in a public hospital service

Abstract

Aim: To prospectively assess cataract surgery in a major New Zealand public hospital by defining presenting clinical parameters and surgical and clinical outcomes in a cohort of subjects just below threshold for treatment, based upon a points based prioritisation system. Methods: The prospective observational study comprised 488 eyes of 480 subjects undergoing consecutive cataract operations at Auckland Hospital. All subjects underwent extensive ophthalmic examination before and after surgery. Details of the surgical procedure, including any intraoperative difficulties or complications, were documented. Postoperative review was performed at 1 day and 4 weeks after surgery. Demographic data, clinical outcomes, and adverse events were correlated by an independent assessor. Results: The mean age at surgery was 74.9 (SD 9.6) years with a female predominance (62%). Significant systemic disease affected 80% of subjects, with 20% of the overall cohort exhibiting diabetes mellitus. 26% of eyes exhibited coexisting ocular disease and in 7.6% this affected best spectacle corrected visual acuity (BSCVA). A mean spherical equivalent of −0.49 (1.03) D and mean BSCVA of 0.9 (0.6) log MAR units (Snellen equivalent approximately 6/48) was noted preoperatively. Local anaesthesia was employed in 99.8% of subjects (94.9% sub-Tenon's). The majority of procedures (97.3%) were small incision phacoemulsification with foldable lens implant. Complications included: 4.9% posterior capsule tears, 3.8% cystoid macular oedema, and one case (0.2%) of endophthalmitis. Mean BSCVA after surgery was 0.1 (0.2) log MAR units (6/7.5 Snellen equivalent), with a mean spherical equivalent of −0.46 (0.89) D, and was 6/12 or better in 88% of all eyes. A drop in BSCVA, thought to be directly attributable to the surgical intervention, was recorded in a small percentage of eyes (1.5%) after surgery. Conclusion: This study provides a representative assessment of the management of cataract in the New Zealand public hospital system. A predominantly elderly, female population, frequently exhibiting significant systemic illness and coexisting ocular disease, relatively advanced cataracts, and poor BSCVA, presented for cataract surgery. The majority of subjects underwent small incision, phacoemulsification, day case surgery. While almost 90% achieved at least 6/12 BSCVA post-surgery, approximately 5% sustained an adverse intraoperative event and 1.5% of eyes exhibited a reduction in BSCVA postoperatively.

Pathogenic conjunctival bacteria associated with systemic co-morbidities of patients undergoing cataract surgery

“…[1][2][3][4][5][6][7][8][9][27][28][29]37,38 However, the prevalence of patients' systemic co-morbidities, without grouping them as a health status index, is rarely described in such series. 30,37,38 These co-morbidities could have been overrepresented among our patients (Table 1) because of our hospital being a tertiary one, which seems to be the case in the Auckland cataract study 38 too; in fact, in population cataract studies 2 or in those studies involving several settings 37,39 a lower rate of some systemic comorbidities was obtained. Our higher prevalence of systemic co-morbidities in men (Table 1) could introduce some bias in our results.…”

Influence of age on conjunctival bacteria of patients undergoing cataract surgery

“…[8][9][10][11][12][13][14][15] For these reasons we study the preoperative conjunctival bacteria of patients undergoing cataract surgery at different stages of age. These bacteria are the main source of contamination of intraocular surgery, 16,17 and it is possible that sometimes bacteria produce inflammation that could be treated without developing infectious postsurgical endophthalmitis; but it could damage ocular tissues as well.…”

Age-related maculopathy and cataract surgery outcomes: visual acuity and health-related quality of life

“…Relatively similar proportions of patients with (80.2%) and without (88.8%) preoperative ARM The proportions of our patients with and without ARM achieving VAZ6/12, 1-3 years after surgery, were similar to previously reported short-term cataract surgery visual outcomes. 2,12,[28][29][30] Using this same cohort, we previously reported that 82% of persons with ARM achieved VAZ6/12, 4 weeks after surgery. 24 Several studies have reported short-term (up to 1 year) postoperative best-corrected VA. 2,12,28,29 In general, VAZ6/12 was achieved overall in 90% of eyes, and in 95% of eyes without pre-existing ocular disease.…”

“…2,12,[28][29][30] Using this same cohort, we previously reported that 82% of persons with ARM achieved VAZ6/12, 4 weeks after surgery. 24 Several studies have reported short-term (up to 1 year) postoperative best-corrected VA. 2,12,28,29 In general, VAZ6/12 was achieved overall in 90% of eyes, and in 95% of eyes without pre-existing ocular disease. In the Auckland Cataract Study cohort of 97 patients aged 76.3 (79.9) years, randomly selected from 480 participants, 95% of eyes maintained a bestcorrected VAZ6/12, 2 years after surgery.…”