Zaćma – Rokowania, prognozy i postęp choroby

Zaćma
Rokowania, prognozy i postęp choroby

Zaćma jest główną przyczyną utraty widzenia globalnie, odpowiadając za 51% ślepoty i 33% upośledzenia widzenia. Operacja usunięcia zaćmy, zwłaszcza fakoemulsyfikacja (PHACO), pozostaje jedyną skuteczną metodą przywrócenia wzroku, z 90,65% pacjentów osiągających dobrą najlepszą skorygowaną ostrość wzroku (BCVA) 6 tygodni po zabiegu. Wyniki pooperacyjne zależą od wielu czynników, w tym obecności chorób współistniejących oczu (np. choroby siatkówki, jaskra, blizny rogówki), które znacząco zwiększają ryzyko złego wyniku wzrokowego (OR do 50,92). Wiek powyżej 70 lat oraz powikłania śródoperacyjne również pogarszają rokowanie. Standardy refrakcyjne zalecają, aby 85% pacjentów osiągało pooperacyjną refrakcję w granicach ±1D od przewidywanej wartości, a 55% w granicach ±0,5D.

Prognozy dla zaćmy – przewidywanie wyników leczenia

Standardy powodzenia operacji zaćmy
Czynniki wpływające na rokowanie po operacji zaćmy
Metody przewidywania wyników operacji zaćmy
Przewidywanie astygmatyzmu resztkowego
Prognozy dla specjalnych grup pacjentów
Powikłania długoterminowe wpływające na rokowanie
Współczesne trendy w opiece pooperacyjnej
Główne czynniki wpływające na rokowanie po operacji zaćmy
Kolejne rozdziały

Prognozy dla zaćmy – przewidywanie wyników leczenia

Zaćma (katarakta) stanowi wiodącą przyczynę utraty widzenia na świecie, odpowiadając za 51% przypadków ślepoty i 33% upośledzenia widzenia. ¹ Bez odpowiedniego leczenia większość pacjentów z zaćmą rozwinęłaby ciężkie upośledzenie widzenia. ² Obecnie operacja usunięcia zaćmy pozostaje jedyną skuteczną metodą przywrócenia wzroku, a przewidywanie wyników leczenia jest kluczowym elementem opieki przedoperacyjnej. ³

Standardy powodzenia operacji zaćmy

Liczne badania dokumentują korzystne wyniki operacji zaćmy zarówno pod względem ostrości wzroku, jak i poprawy jakości życia. Około 90% pacjentów z wszczepionym sztucznym implantem soczewki wewnątrzgałkowej (IOL) osiąga lepszą ostrość wzroku i jest zadowolonych z wyniku operacji. Ten poziom satysfakcji wzrasta do ponad 95% u pacjentów bez wcześniejszych problemów okulistycznych poza samą zaćmą. ⁴ Ogólnie operacja zaćmy jest uznawana za bezpieczną i skuteczną procedurę u większości pacjentów. ⁵

W badaniach przeprowadzonych w placówkach trzeciego stopnia referencyjności, 90,65% pacjentów osiągnęło dobry wynik wzrokowy według najlepszej skorygowanej ostrości wzroku (BCVA) 6 tygodni po operacji zaćmy metodą małego cięcia (SICS). ⁶ Według danych, 91,94% operowanych oczu osiągnęło najlepszą skorygowaną ostrość wzroku powyżej 6/60, podczas gdy 8,06% oczu miało ostrość poniżej 6/60. ⁷

W kontekście precyzji refrakcji pooperacyjnej, Królewskie Kolegium Okulistów (RCOphth) zaleca jako standard referencyjny, aby 85% pacjentów poddawanych rutynowej operacji zaćmy w ramach NHS osiągało pooperacyjną refrakcję ekwiwalentu sferycznego w granicach 1D od przewidywanej wartości, a 55% pacjentów w granicach 0,5D. ⁸

Czynniki wpływające na rokowanie po operacji zaćmy

Wyniki pooperacyjne mogą być zależne od wielu czynników związanych zarówno z pacjentem, jak i z procedurą chirurgiczną. ⁹

Współistniejące choroby oczu

Obecność chorób współistniejących oczu jest jednym z najważniejszych czynników prognostycznych. Analiza wieloczynnikowej regresji logistycznej wykazała, że pacjenci z przedoperacyjnymi współistniejącymi chorobami oczu mieli znacząco wyższe ryzyko złego wyniku wzrokowego (OR 50,92; 95% CI 10,23-253,37). ¹⁰ Do najczęstszych chorób współistniejących wpływających na rokowanie należą:

Choroby siatkówki (aOR 50,92; 95% CI: 10,23-253,37) ¹¹
Jaskra (aOR 13,75; 95% CI: 1,26-150,06) ¹²
Blizny rogówki (aOR 23,55; 95% CI: 3,01-184,02) ¹³
Inne schorzenia (aOR 12,14; 95% CI: 2,36-62,33) ¹⁴

Badania wykazały, że pacjenci z chorobami współistniejącymi oczu mieli 2,86 razy większe ryzyko złego wyniku wzrokowego w porównaniu do pacjentów bez takich chorób (AOR = 2,86, 95% CI [1,60-5,10]). ¹⁵ Według drugiego badania RAAB przeprowadzonego w 2018 roku, główną przyczyną złego wyniku wzrokowego po SICS były współistniejące choroby oczu, które odpowiadały za 43,6% przypadków. ¹⁶

Wiek pacjenta

Wiek pacjenta jest istotnym czynnikiem prognostycznym. Pacjenci w wieku 70 lat i starsi mieli około trzy razy większe szanse na uzyskanie złego wyniku w porównaniu do osób w wieku 40-49 lat (AOR = 3,16 CI [1,19-8,39]). ¹⁷ Wiek pacjenta, wraz z jego statusem finansowym oraz liczbą współistniejących chorób somatycznych i ocznych, stanowi główny czynnik wpływający na prognozę długości pobytu w szpitalu po leczeniu chirurgicznym. ¹⁸

Technika chirurgiczna i powikłania śródoperacyjne

Wybór techniki chirurgicznej ma istotny wpływ na wyniki pooperacyjne. Pacjenci poddani operacji zaćmy metodą małego cięcia (SICS) mieli prawie siedem razy większe szanse na uzyskanie złego wyniku w porównaniu do tych, którzy przeszli zabieg fakoemulsyfikacji (PHACO) (AOR = 5,56, [2,48-12,43]). ¹⁹

Powikłania śródoperacyjne znacząco zwiększają ryzyko złego wyniku wzrokowego. Pacjenci z powikłaniami śródoperacyjnymi mieli 4,49 razy większe szanse na uzyskanie złego wyniku (AOR = 4,49, [1,88-10,72]) niż ci bez powikłań. ²⁰ ²¹

Dodatkowo, badania wykazały istotny związek między pooperacyjnym stanem rogówki (keratopatia prążkowata) a wynikiem wzrokowym (aOR 16,59: 95% CI 3,54-77,70). ²² Pacjenci z pooperacyjnym zapaleniem wewnątrzgałkowym mieli 2,63 razy (AOR = 2,56, [1,40-4,94]) większe szanse na zły wynik niż ci bez zapalenia. ²³

Metody przewidywania wyników operacji zaćmy

Tradycyjne metody przewidywania ostrości wzroku

Różne narzędzia były stosowane do przewidywania potencjalnej ostrości wzroku u pacjentów z zaćmą, jednak ich skuteczność jest zróżnicowana:

Critical Flicker Frequency (CFF, częstotliwość krytycznego migotania) – wykazuje największą odporność na obecność zaćmy i daje najlepsze przewidywanie pooperacyjnej ostrości wzroku zarówno przy zaćmie z chorobami współistniejącymi, jak i bez nich. ²⁴ ²⁵
Optimal Reading Speed (ORS, optymalna prędkość czytania) – zapewnia podobną precyzję predykcyjną jak CFF w obecności zaćmy i chorób współistniejących. ²⁶
Potential Acuity Meter (PAM) i Laser Interferometer (LI) – wykazały ograniczoną zdolność kliniczną w przewidywaniu pooperacyjnej ostrości wzroku, szczególnie przy gęstych zmętnieniach. ²⁷

Badania porównujące skuteczność PAM i Visometer (Haag-Streit Lotmar) wykazały, że chociaż istnieje statystycznie istotna korelacja między tymi narzędziami a pooperacyjną BCVA, współczynnik korelacji jest słaby i tym samym klinicznie nieistotny. ²⁸ ²⁹ Jednak w przypadku pacjentów z zaćmą jądrową stopnia I i II oraz nieaktywnymi makulopatiami, PAM może być dokładną metodą przewidywania pooperacyjnej ostrości wzroku. ³⁰

Nowoczesne metody przewidywania – uczenie maszynowe

Najnowsze badania wskazują na skuteczność wykorzystania technik uczenia maszynowego (ML) w przewidywaniu ryzyka operacji zaćmy:

Badania wykazały, że modelowanie ML może z rozsądną dokładnością przewidywać 10-letnie ryzyko operacji zaćmy na podstawie samych danych z kwestionariuszy, wykazując niewielką przewagę nad konwencjonalnym modelem logistycznym. ³¹ ³²
Metody Gradient Boosting Machine (GBM) i Random Forest (RF) przewyższają konwencjonalny model regresji logistycznej i są dobrze dostosowane do dokładnego przewidywania ryzyka operacji zaćmy. ³³ ³⁴
Algorytmy ML różnią się od konwencjonalnych technik predykcyjnych niezależnością od wcześniejszych założeń, co pozwala uniknąć przeoczenia nieoczekiwanych, ale istotnych zmiennych. ³⁵

Zastosowanie aplikacji mobilnych do monitorowania wyników, takich jak BOOST Cataract, może ułatwić proces monitorowania w krajach o niskich i średnich dochodach i może odgrywać rolę w raportowaniu wyników, gdy zbieranie danych jest trudne z powodu niskiej częstotliwości obserwacji pooperacyjnych. ³⁶ Jednak niezawodność BOOST Cataract jest ograniczona do oczu, które uzyskują dobry wynik i mają przejrzystą rogówkę w pierwszym dniu po operacji. ³⁷

Przewidywanie astygmatyzmu resztkowego

W przewidywaniu astygmatyzmu resztkowego po operacji zaćmy można obecnie dość dobrze przewidzieć komponenty astygmatyzmu zgodnego z regułą (WTR) i przeciwnego do reguły (ATR). ³⁸ Jednak wciąż istnieją problemy z komponentem astygmatyzmu skośnego. ³⁹

Najważniejszym predyktorem astygmatyzmu resztkowego pozostaje astygmatyzm rogówkowy. ⁴⁰ Inne predyktory, takie jak astygmatyzm refrakcyjny, wiek i grubość soczewki, również są wymieniane, ale wszystkie z wyjątkiem astygmatyzmu rogówkowego są wątpliwe ze względu na możliwość zmiennych zakłócających. ⁴¹

Obecnie najlepszym podejściem jest przeprowadzenie przedoperacyjnej analizy wektorowej astygmatyzmu i przewidywanie astygmatyzmu resztkowego za pomocą równania regresji, gdy występuje niewielki lub żaden komponent astygmatyzmu skośnego. ⁴²

Prognozy dla specjalnych grup pacjentów

Pacjenci z jaskrą

U pacjentów z jaskrą, struktura przedniego odcinka oka może wpływać na wyniki refrakcyjne po operacji zaćmy. Badania wykazały, że duży vault soczewki (LV) jest istotnym predyktorem niezadowalającego wyniku refrakcyjnego po operacji zaćmy u pacjentów z jaskrą. ⁴³ ⁴⁴

Ogólna przewidywalność osiągnięcia refrakcji w granicach ±1,0 D od celu u pacjentów z jaskrą zamkniętego i otwartego kąta wynosiła odpowiednio 76,92% i 72,73%. ⁴⁵ Odsetek oczu z niezadowalającym wynikiem refrakcyjnym (MAE ≥ 1,0 D) wynosił około 25%, a im większa wartość LV, tym większa wartość MAE. ⁴⁶

Pacjenci z zwyrodnieniem barwnikowym siatkówki (RP)

Operacja zaćmy może poprawić ostrość wzroku u pacjentów z zwyrodnieniem barwnikowym siatkówki (RP) podczas długoterminowej obserwacji, chociaż zmiany ostrości wzroku wykazują tendencję spadkową. ⁴⁷ Operacja zaćmy nie jest zalecana dla pacjentów z niewidoczną strefą elipsoidalną siatkówki (EZ) w badaniu OCT przed operacją. ⁴⁸

Powikłania długoterminowe wpływające na rokowanie

Mimo wysokiego odsetka powodzeń, operacja zaćmy wiąże się z ryzykiem powikłań, które mogą wpłynąć na długoterminowe rokowanie:

Zmętnienie torebki tylnej – w miesiącach lub latach po operacji torebka tylna soczewki, która stanowi podporę dla soczewki wewnątrzgałkowej, może ulec pogrubieniu lub zmętnieniu. Jest to najczęstsze powikłanie pooperacyjne, które powoduje postępującą utratę wzroku u 10% pacjentów w ciągu 2 lat od operacji zaćmy. ⁴⁹
Torbielowaty obrzęk plamki (CME) – częstość występowania klinicznie istotnego CME po operacji zaćmy wynosi do 2%. ⁵⁰ Główne opcje leczenia CME po operacji zaćmy to miejscowe NLPZ lub sterydy, jednak brakuje wystarczających dowodów, aby ustalić optymalne podejście terapeutyczne. ⁵¹
Zapalenie wewnątrzgałkowe – stosowanie antybiotyków dokomorowych znacząco zmniejsza ryzyko zapalenia wnętrza gałki ocznej. ⁵² U pacjentów z zapaleniem błony naczyniowej zaleca się zwiększoną częstotliwość i przedłużone leczenie sterydami, a doustne sterydy należy stosować tylko w określonych przypadkach. ⁵³

Współczesne trendy w opiece pooperacyjnej

Zdalna opieka pooperacyjna po operacji zaćmy może zastąpić krótkoterminowe badania kliniczne, aby lepiej alokować zasoby szpitalne i zwiększyć efektywność czasową i kosztową. ⁵⁴ Połączenie kropli do oczu zawierających NLPZ i kortykosteroidy jest skuteczniejsze w zapobieganiu zapaleniu i CME po rutynowej operacji zaćmy w porównaniu do monoterapii. ⁵⁵

Natychmiastowa sekwencyjna obustronna operacja zaćmy (ISBCS) jest skuteczna i bezpieczna, ma wysoki stopień satysfakcji pacjentów i może być rozważana u pacjentów bez chorób współistniejących oczu indukujących powikłania. ⁵⁶

Główne czynniki wpływające na rokowanie po operacji zaćmy

Podsumowując, główne czynniki wpływające na rokowanie po operacji zaćmy to:

Obecność chorób współistniejących oczu (szczególnie choroby siatkówki, jaskra, blizny rogówki) ⁵⁷
Wiek pacjenta (gorsze rokowanie u osób starszych) ⁵⁸
Technika chirurgiczna (fakoemulsyfikacja zapewnia lepsze wyniki niż SICS) ⁵⁹
Powikłania śródoperacyjne ⁶⁰
Pooperacyjne zapalenie wewnątrzgałkowe ⁶¹
Stan rogówki po operacji ⁶²
Struktura przedniego odcinka oka (szczególnie u pacjentów z jaskrą) ⁶³

U pacjentów bez chorób współistniejących oczu operacja zaćmy zapewnia doskonałe wyniki, z ponad 95% satysfakcją pacjentów. ⁶⁴ Ciągłe doskonalenie technik chirurgicznych, dokładniejsze metody biometryczne i lepsze przewidywanie wyników za pomocą uczenia maszynowego mogą dodatkowo poprawić rokowanie dla pacjentów z zaćmą w przyszłości.

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Materiały źródłowe

#1 Cataract surgery visual outcome and associated factors | OPTH
https://www.dovepress.com/cataract-surgery-visual-outcome-and-associated-factors-among-adults-at-peer-reviewed-fulltext-article-OPTH
Cataract is the leading cause of blindness and the second leading cause of visual impairment worldwide, accounting for 51% and 33% of all cases, respectively. […] The visual outcome following cataract surgery fall below WHO recommendation. In this study, age, ocular co-morbidities, surgical method, surgeon status, intraoperative complication, SK, and ocular inflammation associated with post-operative Uveitis and anterior chamber reaction were associated with a poor visual outcome. […] About 231 individuals (59.8%) had poor visual results following cataract surgery. […] Age, ocular comorbidity, surgical technique, surgeon seniority, intraoperative complication, striate keratitis (SK), and post-operative ocular inflammation (anterior chamber reaction and uveitis) were all shown to be significantly (p-value less than 0.05) associated with visual outcome in multiple logistic regression.
#2 Prognosis for Cataracts | Hospital ClÃnic Barcelona
https://www.clinicbarcelona.org/en/assistance/diseases/cataracts/evolution-of-the-disease
Cataracts in adults follow a progressive course which is both variable and hard to predict. Without treatment, most patients with cataracts would develop severe visual impairment. […] Many studies have recorded favourable outcomes following cataract surgery, both in terms of visual acuity and improved quality of life. Around 90% of patients who receive an IOL implant have better visual acuity and are satisfied with the outcome of the operation. This level of satisfaction increases to over 95% in patients who do not have any eye problems prior to surgery, other than the cataract itself. […] In short, cataract surgery is a safe and successful procedure in most patients. […] The main causes of poor vision following surgery are due to: inadequate correction of the postoperative refractive error which can be resolved with glasses or by changing the intraocular lens; the failure to detect certain eye conditions prior to the operation, such as glaucoma, amblyopia (lazy eye), macular degeneration and other macular diseases; or surgical and postsurgical complications.
#3 ESCRS – ESCRS Guideline for Cataract Surgery
https://www.escrs.org/escrs-guideline-for-cataract-surgery/
Cataract is a leading cause of visual impairment, and surgical intervention remains the exclusive effective approach for vision restoration. […] The patient pathway for cataract management includes diagnostic and therapeutic steps such as screening, patient selection, preoperative diagnostics, treatment strategies, surgery itself and postoperative care. […] The selection of a specific target refraction highly depends on the selected IOL, expectations and preferences of the patient. The patient and ophthalmologist should take the shared decision for IOL target selection. (GRADE ++). […] The presence of patient characteristics and comorbidities can have an impact not only on the outcome in vision but also on the risks of surgery and postoperative complications. […] Significant ocular comorbidities, such as diabetic retinopathy, glaucoma, maculopathies, and uveitis should be identified during the preoperative evaluation since its presence can affect the postoperative visual acuity and function.
#4 Prognosis for Cataracts | Hospital ClÃnic Barcelona
https://www.clinicbarcelona.org/en/assistance/diseases/cataracts/evolution-of-the-disease
Cataracts in adults follow a progressive course which is both variable and hard to predict. Without treatment, most patients with cataracts would develop severe visual impairment. […] Many studies have recorded favourable outcomes following cataract surgery, both in terms of visual acuity and improved quality of life. Around 90% of patients who receive an IOL implant have better visual acuity and are satisfied with the outcome of the operation. This level of satisfaction increases to over 95% in patients who do not have any eye problems prior to surgery, other than the cataract itself. […] In short, cataract surgery is a safe and successful procedure in most patients. […] The main causes of poor vision following surgery are due to: inadequate correction of the postoperative refractive error which can be resolved with glasses or by changing the intraocular lens; the failure to detect certain eye conditions prior to the operation, such as glaucoma, amblyopia (lazy eye), macular degeneration and other macular diseases; or surgical and postsurgical complications.
#5 Prognosis for Cataracts | Hospital ClÃnic Barcelona
https://www.clinicbarcelona.org/en/assistance/diseases/cataracts/evolution-of-the-disease
Cataracts in adults follow a progressive course which is both variable and hard to predict. Without treatment, most patients with cataracts would develop severe visual impairment. […] Many studies have recorded favourable outcomes following cataract surgery, both in terms of visual acuity and improved quality of life. Around 90% of patients who receive an IOL implant have better visual acuity and are satisfied with the outcome of the operation. This level of satisfaction increases to over 95% in patients who do not have any eye problems prior to surgery, other than the cataract itself. […] In short, cataract surgery is a safe and successful procedure in most patients. […] The main causes of poor vision following surgery are due to: inadequate correction of the postoperative refractive error which can be resolved with glasses or by changing the intraocular lens; the failure to detect certain eye conditions prior to the operation, such as glaucoma, amblyopia (lazy eye), macular degeneration and other macular diseases; or surgical and postsurgical complications.
#6 Visual outcome and associated risk factors in patients following small incision cataract surgery at the National Referral Hospital, Bhutan | medRxiv
https://www.medrxiv.org/content/10.1101/2024.11.23.24317844v1.full-text
Purpose To evaluate small incision cataract surgery visual outcomes and associated risk factors in a tertiary eye care center in Bhutan. […] 285 (91.94%) of the cataract-operated eyes had best-corrected vision greater than 6/60, while 25 (8.06%) of the eyes had vision less than 6/60. […] At the 6-week follow-up visit, based on best-corrected visual acuity (BCVA), 90.65% had a good visual outcome. […] Analysis of multiple logistic regression showed that patients with preoperative ocular comorbidities (OR 50.92; 95% CI 10.23, 253.37) and those with operative complications (OR 16.59; 95% CI 3.54, 77.70) were significantly associated with poor visual outcome. […] This study shows that cataract surgery can restore good visual acuity. […] The second RAAB survey conducted in the country in 2018 found that following SICS, the main cause of poor visual outcome was ocular comorbidities in 43.6%.
#7 Visual outcome and associated risk factors in patients following small incision cataract surgery at the National Referral Hospital, Bhutan | medRxiv
https://www.medrxiv.org/content/10.1101/2024.11.23.24317844v1.full-text
Purpose To evaluate small incision cataract surgery visual outcomes and associated risk factors in a tertiary eye care center in Bhutan. […] 285 (91.94%) of the cataract-operated eyes had best-corrected vision greater than 6/60, while 25 (8.06%) of the eyes had vision less than 6/60. […] At the 6-week follow-up visit, based on best-corrected visual acuity (BCVA), 90.65% had a good visual outcome. […] Analysis of multiple logistic regression showed that patients with preoperative ocular comorbidities (OR 50.92; 95% CI 10.23, 253.37) and those with operative complications (OR 16.59; 95% CI 3.54, 77.70) were significantly associated with poor visual outcome. […] This study shows that cataract surgery can restore good visual acuity. […] The second RAAB survey conducted in the country in 2018 found that following SICS, the main cause of poor visual outcome was ocular comorbidities in 43.6%.
#8 Benchmark standards for refractive outcomes after NHS cataract surgery | Eye
https://www.nature.com/articles/6702954
On the basis of our data, using College formula, optimising A constants and partial coherence interferometry, a benchmark standard of 85% of patients achieving a final spherical equivalent within 1D of the predicted figure and 55% of patients within 0.5D should be adopted. […] This study calls for a benchmark of 85% of patients undergoing routine NHS cataract surgery to achieve a spherical-equivalent postoperative refraction within 1D of the predicted value to be established by the RCOphth. This high level of service should be achievable by any cataract service by using the continuous prospective collection of data for audit, the use of PCI whenever possible, and the customisation of A constants.
#9 ESCRS – ESCRS Guideline for Cataract Surgery
https://www.escrs.org/escrs-guideline-for-cataract-surgery/
Cataract is a leading cause of visual impairment, and surgical intervention remains the exclusive effective approach for vision restoration. […] The patient pathway for cataract management includes diagnostic and therapeutic steps such as screening, patient selection, preoperative diagnostics, treatment strategies, surgery itself and postoperative care. […] The selection of a specific target refraction highly depends on the selected IOL, expectations and preferences of the patient. The patient and ophthalmologist should take the shared decision for IOL target selection. (GRADE ++). […] The presence of patient characteristics and comorbidities can have an impact not only on the outcome in vision but also on the risks of surgery and postoperative complications. […] Significant ocular comorbidities, such as diabetic retinopathy, glaucoma, maculopathies, and uveitis should be identified during the preoperative evaluation since its presence can affect the postoperative visual acuity and function.
#10 Visual outcome and associated risk factors in patients following small incision cataract surgery at the National Referral Hospital, Bhutan | medRxiv
https://www.medrxiv.org/content/10.1101/2024.11.23.24317844v1.full-text
Purpose To evaluate small incision cataract surgery visual outcomes and associated risk factors in a tertiary eye care center in Bhutan. […] 285 (91.94%) of the cataract-operated eyes had best-corrected vision greater than 6/60, while 25 (8.06%) of the eyes had vision less than 6/60. […] At the 6-week follow-up visit, based on best-corrected visual acuity (BCVA), 90.65% had a good visual outcome. […] Analysis of multiple logistic regression showed that patients with preoperative ocular comorbidities (OR 50.92; 95% CI 10.23, 253.37) and those with operative complications (OR 16.59; 95% CI 3.54, 77.70) were significantly associated with poor visual outcome. […] This study shows that cataract surgery can restore good visual acuity. […] The second RAAB survey conducted in the country in 2018 found that following SICS, the main cause of poor visual outcome was ocular comorbidities in 43.6%.
#11 Visual outcome and associated risk factors in patients following small incision cataract surgery at the National Referral Hospital, Bhutan | medRxiv
https://www.medrxiv.org/content/10.1101/2024.11.23.24317844v1.full-text
Poor visual outcome was significantly associated with retinal disease (aOR 50.92; 95% CI: 10.23, 253.37), glaucoma (aOR 13.75; 95% CI: 1.26, 150.06), corneal scar (aOR 23.55; 95% CI: 3.01, 184.02), and others (aOR 12.14; 95% CI: 2.36, 62.33). […] The study found a significant association between striate keratopathy and visual outcome (aOR 16.59: 95% CI 3.54, 77.70). […] The improvement was mainly due to well-trained surgeons and operating assistants, better biometry services, and well-trained staff conducting biometry before the surgery. […] However, poor visual outcome was 8.06% (n=25) 6 weeks post-SICS which was more than the WHO recommendation (5%). […] The prospective assessment of surgical outcomes probably contributed to better surgical outcomes.
#12 Visual outcome and associated risk factors in patients following small incision cataract surgery at the National Referral Hospital, Bhutan | medRxiv
https://www.medrxiv.org/content/10.1101/2024.11.23.24317844v1.full-text
Poor visual outcome was significantly associated with retinal disease (aOR 50.92; 95% CI: 10.23, 253.37), glaucoma (aOR 13.75; 95% CI: 1.26, 150.06), corneal scar (aOR 23.55; 95% CI: 3.01, 184.02), and others (aOR 12.14; 95% CI: 2.36, 62.33). […] The study found a significant association between striate keratopathy and visual outcome (aOR 16.59: 95% CI 3.54, 77.70). […] The improvement was mainly due to well-trained surgeons and operating assistants, better biometry services, and well-trained staff conducting biometry before the surgery. […] However, poor visual outcome was 8.06% (n=25) 6 weeks post-SICS which was more than the WHO recommendation (5%). […] The prospective assessment of surgical outcomes probably contributed to better surgical outcomes.
#13 Visual outcome and associated risk factors in patients following small incision cataract surgery at the National Referral Hospital, Bhutan | medRxiv
https://www.medrxiv.org/content/10.1101/2024.11.23.24317844v1.full-text
Poor visual outcome was significantly associated with retinal disease (aOR 50.92; 95% CI: 10.23, 253.37), glaucoma (aOR 13.75; 95% CI: 1.26, 150.06), corneal scar (aOR 23.55; 95% CI: 3.01, 184.02), and others (aOR 12.14; 95% CI: 2.36, 62.33). […] The study found a significant association between striate keratopathy and visual outcome (aOR 16.59: 95% CI 3.54, 77.70). […] The improvement was mainly due to well-trained surgeons and operating assistants, better biometry services, and well-trained staff conducting biometry before the surgery. […] However, poor visual outcome was 8.06% (n=25) 6 weeks post-SICS which was more than the WHO recommendation (5%). […] The prospective assessment of surgical outcomes probably contributed to better surgical outcomes.
#14 Visual outcome and associated risk factors in patients following small incision cataract surgery at the National Referral Hospital, Bhutan | medRxiv
https://www.medrxiv.org/content/10.1101/2024.11.23.24317844v1.full-text
Poor visual outcome was significantly associated with retinal disease (aOR 50.92; 95% CI: 10.23, 253.37), glaucoma (aOR 13.75; 95% CI: 1.26, 150.06), corneal scar (aOR 23.55; 95% CI: 3.01, 184.02), and others (aOR 12.14; 95% CI: 2.36, 62.33). […] The study found a significant association between striate keratopathy and visual outcome (aOR 16.59: 95% CI 3.54, 77.70). […] The improvement was mainly due to well-trained surgeons and operating assistants, better biometry services, and well-trained staff conducting biometry before the surgery. […] However, poor visual outcome was 8.06% (n=25) 6 weeks post-SICS which was more than the WHO recommendation (5%). […] The prospective assessment of surgical outcomes probably contributed to better surgical outcomes.
#15 Cataract surgery visual outcome and associated factors | OPTH
https://www.dovepress.com/cataract-surgery-visual-outcome-and-associated-factors-among-adults-at-peer-reviewed-fulltext-article-OPTH
Those aged 70 and up had about three times increased odds of a poor outcome compared to those aged 40-49 years (AOR= 3.16 CI [1.198.39]). […] Patients with ocular comorbidity were 2.86 times more likely to have an increased risk of poor visual outcome compared with those without ocular comorbidity (AOR = 2.86, 95% CI [1.605.10]). […] When comparing those who had a small incision cataract surgical procedure to those who had a phacoemulsification (PHACO) treatment, the odds of having a poor outcome were almost seven times higher (AOR = 5.56, [2.4812.43]). […] Those who had an intraoperative complication had a 4.49 times higher chance of having a poor outcome (AOR = 4.49, [1.8810.72]) than others who did not. […] Patients with postoperative intra-ocular inflammation had 2.63 times (AOR = 2.56, [1.404.94]) greater odds of poor outcome than those without. […] The proportion of poor and good results was lower than the WHO recommendation.
#16 Visual outcome and associated risk factors in patients following small incision cataract surgery at the National Referral Hospital, Bhutan | medRxiv
https://www.medrxiv.org/content/10.1101/2024.11.23.24317844v1.full-text
Purpose To evaluate small incision cataract surgery visual outcomes and associated risk factors in a tertiary eye care center in Bhutan. […] 285 (91.94%) of the cataract-operated eyes had best-corrected vision greater than 6/60, while 25 (8.06%) of the eyes had vision less than 6/60. […] At the 6-week follow-up visit, based on best-corrected visual acuity (BCVA), 90.65% had a good visual outcome. […] Analysis of multiple logistic regression showed that patients with preoperative ocular comorbidities (OR 50.92; 95% CI 10.23, 253.37) and those with operative complications (OR 16.59; 95% CI 3.54, 77.70) were significantly associated with poor visual outcome. […] This study shows that cataract surgery can restore good visual acuity. […] The second RAAB survey conducted in the country in 2018 found that following SICS, the main cause of poor visual outcome was ocular comorbidities in 43.6%.
#17 Cataract surgery visual outcome and associated factors | OPTH
https://www.dovepress.com/cataract-surgery-visual-outcome-and-associated-factors-among-adults-at-peer-reviewed-fulltext-article-OPTH
Those aged 70 and up had about three times increased odds of a poor outcome compared to those aged 40-49 years (AOR= 3.16 CI [1.198.39]). […] Patients with ocular comorbidity were 2.86 times more likely to have an increased risk of poor visual outcome compared with those without ocular comorbidity (AOR = 2.86, 95% CI [1.605.10]). […] When comparing those who had a small incision cataract surgical procedure to those who had a phacoemulsification (PHACO) treatment, the odds of having a poor outcome were almost seven times higher (AOR = 5.56, [2.4812.43]). […] Those who had an intraoperative complication had a 4.49 times higher chance of having a poor outcome (AOR = 4.49, [1.8810.72]) than others who did not. […] Patients with postoperative intra-ocular inflammation had 2.63 times (AOR = 2.56, [1.404.94]) greater odds of poor outcome than those without. […] The proportion of poor and good results was lower than the WHO recommendation.
#18
http://journal.eu-jr.eu/health/article/view/281
The aim of the paper was to evaluate and determine the duration of the hospital treatment of patients with cataract. […] It has been demonstrated that patients age, his or her financial status, the number of concomitant somatic and eye diseases are the main peculiarities for the prognosis for long-lasting stay at hospital after surgical treatment. […] The most informative indices for hospital treatment of patients with cataract after surgery are patients age, his/her financial status, the number of concomitant somatic and eye diseases.
#19 Cataract surgery visual outcome and associated factors | OPTH
https://www.dovepress.com/cataract-surgery-visual-outcome-and-associated-factors-among-adults-at-peer-reviewed-fulltext-article-OPTH
Those aged 70 and up had about three times increased odds of a poor outcome compared to those aged 40-49 years (AOR= 3.16 CI [1.198.39]). […] Patients with ocular comorbidity were 2.86 times more likely to have an increased risk of poor visual outcome compared with those without ocular comorbidity (AOR = 2.86, 95% CI [1.605.10]). […] When comparing those who had a small incision cataract surgical procedure to those who had a phacoemulsification (PHACO) treatment, the odds of having a poor outcome were almost seven times higher (AOR = 5.56, [2.4812.43]). […] Those who had an intraoperative complication had a 4.49 times higher chance of having a poor outcome (AOR = 4.49, [1.8810.72]) than others who did not. […] Patients with postoperative intra-ocular inflammation had 2.63 times (AOR = 2.56, [1.404.94]) greater odds of poor outcome than those without. […] The proportion of poor and good results was lower than the WHO recommendation.
#20 Cataract surgery visual outcome and associated factors | OPTH
https://www.dovepress.com/cataract-surgery-visual-outcome-and-associated-factors-among-adults-at-peer-reviewed-fulltext-article-OPTH
Those aged 70 and up had about three times increased odds of a poor outcome compared to those aged 40-49 years (AOR= 3.16 CI [1.198.39]). […] Patients with ocular comorbidity were 2.86 times more likely to have an increased risk of poor visual outcome compared with those without ocular comorbidity (AOR = 2.86, 95% CI [1.605.10]). […] When comparing those who had a small incision cataract surgical procedure to those who had a phacoemulsification (PHACO) treatment, the odds of having a poor outcome were almost seven times higher (AOR = 5.56, [2.4812.43]). […] Those who had an intraoperative complication had a 4.49 times higher chance of having a poor outcome (AOR = 4.49, [1.8810.72]) than others who did not. […] Patients with postoperative intra-ocular inflammation had 2.63 times (AOR = 2.56, [1.404.94]) greater odds of poor outcome than those without. […] The proportion of poor and good results was lower than the WHO recommendation.
#21 Visual outcome and associated risk factors in patients following small incision cataract surgery at the National Referral Hospital, Bhutan | medRxiv
https://www.medrxiv.org/content/10.1101/2024.11.23.24317844v1.full-text
Purpose To evaluate small incision cataract surgery visual outcomes and associated risk factors in a tertiary eye care center in Bhutan. […] 285 (91.94%) of the cataract-operated eyes had best-corrected vision greater than 6/60, while 25 (8.06%) of the eyes had vision less than 6/60. […] At the 6-week follow-up visit, based on best-corrected visual acuity (BCVA), 90.65% had a good visual outcome. […] Analysis of multiple logistic regression showed that patients with preoperative ocular comorbidities (OR 50.92; 95% CI 10.23, 253.37) and those with operative complications (OR 16.59; 95% CI 3.54, 77.70) were significantly associated with poor visual outcome. […] This study shows that cataract surgery can restore good visual acuity. […] The second RAAB survey conducted in the country in 2018 found that following SICS, the main cause of poor visual outcome was ocular comorbidities in 43.6%.
#22 Visual outcome and associated risk factors in patients following small incision cataract surgery at the National Referral Hospital, Bhutan | medRxiv
https://www.medrxiv.org/content/10.1101/2024.11.23.24317844v1.full-text
Poor visual outcome was significantly associated with retinal disease (aOR 50.92; 95% CI: 10.23, 253.37), glaucoma (aOR 13.75; 95% CI: 1.26, 150.06), corneal scar (aOR 23.55; 95% CI: 3.01, 184.02), and others (aOR 12.14; 95% CI: 2.36, 62.33). […] The study found a significant association between striate keratopathy and visual outcome (aOR 16.59: 95% CI 3.54, 77.70). […] The improvement was mainly due to well-trained surgeons and operating assistants, better biometry services, and well-trained staff conducting biometry before the surgery. […] However, poor visual outcome was 8.06% (n=25) 6 weeks post-SICS which was more than the WHO recommendation (5%). […] The prospective assessment of surgical outcomes probably contributed to better surgical outcomes.
#23 Cataract surgery visual outcome and associated factors | OPTH
https://www.dovepress.com/cataract-surgery-visual-outcome-and-associated-factors-among-adults-at-peer-reviewed-fulltext-article-OPTH
Those aged 70 and up had about three times increased odds of a poor outcome compared to those aged 40-49 years (AOR= 3.16 CI [1.198.39]). […] Patients with ocular comorbidity were 2.86 times more likely to have an increased risk of poor visual outcome compared with those without ocular comorbidity (AOR = 2.86, 95% CI [1.605.10]). […] When comparing those who had a small incision cataract surgical procedure to those who had a phacoemulsification (PHACO) treatment, the odds of having a poor outcome were almost seven times higher (AOR = 5.56, [2.4812.43]). […] Those who had an intraoperative complication had a 4.49 times higher chance of having a poor outcome (AOR = 4.49, [1.8810.72]) than others who did not. […] Patients with postoperative intra-ocular inflammation had 2.63 times (AOR = 2.56, [1.404.94]) greater odds of poor outcome than those without. […] The proportion of poor and good results was lower than the WHO recommendation.
#24 Predictions of postoperative visual outcome in subjects with cataract: a preoperative and postoperative study
https://pmc.ncbi.nlm.nih.gov/articles/PMC1954778/
To assess the ability of critical flicker frequency (CFF) and optimal reading speed (ORS) to predict the potential vision in patients with cataract with and without ocular comorbidity. […] CFF was the PVT most resistant to the presence of cataract. Both CFF and ORS give a similar predictive precision in the presence of cataract and ocular comorbidity, although CFF seems more precise when the cataract is dense. […] The PAM and the LI showed a limited clinical capability in predicting postoperative visual acuity, particularly with dense opacities. The CFF shows the most promise as a PVT, particularly with dense cataract. […] The mean preoperative predictions were compared with the measured mean postoperative VAs for the cataract only groups in table 2, which indicated that all the PVTs underpredicted the postoperative VA.
#25 Predictions of postoperative visual outcome in subjects with cataract: a preoperative and postoperative study
https://pmc.ncbi.nlm.nih.gov/articles/PMC1954778/
A paired t test performed on groups A1 and A2 combined showed no statistically significant difference between CFF thresholds before (mean (SD) 39.4 (3.2)Hz) and after cataract surgery (39.1 (2.9)Hz; p=0.41), suggesting that the CFF measurement is largely independent of the presence or absence of cataract. […] The CFF was the most robust measurement in the presence of cataract. The CFF measurement seemed to give the best prediction of postoperative VA in the presence of cataract, both with and without comorbidity, in this sample of subjects.
#26 Predictions of postoperative visual outcome in subjects with cataract: a preoperative and postoperative study
https://pmc.ncbi.nlm.nih.gov/articles/PMC1954778/
To assess the ability of critical flicker frequency (CFF) and optimal reading speed (ORS) to predict the potential vision in patients with cataract with and without ocular comorbidity. […] CFF was the PVT most resistant to the presence of cataract. Both CFF and ORS give a similar predictive precision in the presence of cataract and ocular comorbidity, although CFF seems more precise when the cataract is dense. […] The PAM and the LI showed a limited clinical capability in predicting postoperative visual acuity, particularly with dense opacities. The CFF shows the most promise as a PVT, particularly with dense cataract. […] The mean preoperative predictions were compared with the measured mean postoperative VAs for the cataract only groups in table 2, which indicated that all the PVTs underpredicted the postoperative VA.
#27 Predictions of postoperative visual outcome in subjects with cataract: a preoperative and postoperative study
https://pmc.ncbi.nlm.nih.gov/articles/PMC1954778/
To assess the ability of critical flicker frequency (CFF) and optimal reading speed (ORS) to predict the potential vision in patients with cataract with and without ocular comorbidity. […] CFF was the PVT most resistant to the presence of cataract. Both CFF and ORS give a similar predictive precision in the presence of cataract and ocular comorbidity, although CFF seems more precise when the cataract is dense. […] The PAM and the LI showed a limited clinical capability in predicting postoperative visual acuity, particularly with dense opacities. The CFF shows the most promise as a PVT, particularly with dense cataract. […] The mean preoperative predictions were compared with the measured mean postoperative VAs for the cataract only groups in table 2, which indicated that all the PVTs underpredicted the postoperative VA.
#28 Comparison of the potential acuity meter and the visometer in cataract patients | Eye
https://www.nature.com/articles/6702165
To compare the GuytonMinkowski Potential Acuity Meter (PAM) and the Haag-Streit Lotmar Visometer (Visometer) in their ability to predict postoperative best corrected visual acuity (BCVA) in cataract surgery. […] Neither the PAM nor the Visometer predictions were statistically significant predictors of postoperative BCVA. […] We found no clinical benefit to support using the PAM or Visometer in the preoperative assessment of cataract patients with no known retinal or optic nerve pathology. […] The accuracy of both the PAM and the Visometer in predicting postoperative visual acuity in a large consecutive series of cataract patients with no known vision loss from pre-existing eye disease has been previously unknown. […] We found a statistically significant correlation between both PAM and Visometer with postoperative BCVA, yet the correlation coefficient was poor and thus clinically (or practically) insignificant.
#29 Comparison of the potential acuity meter and the visometer in cataract patients | Eye
https://www.nature.com/articles/6702165
PAM and Visometer both have high sensitivity and low specificity for predicting surgical success/failure. […] The positive predictive value (PPV) in this situation is the proportion of postoperatively defined successful surgeries out of all patients who were predicted to have a successful surgery with PAM or Visometer. […] Based on our data, 92.7% of all surgeries performed were successful. […] A preoperative prediction of surgical success from either PAM or Visometer is of no clinical value. […] Therefore, in patients undergoing cataract surgery that has no identified retinal or macular pathology, the PAM and Visometer have little usefulness and are potentially detrimental in the preoperative setting. […] We recommend that these preoperative instruments not be used for this purpose due to cost and the potential for withholding potentially vision-saving treatment from patients who may benefit. […] In conclusion, the use of the Potential Acuity Meter or Visometer in preoperative cataract assessment does not provide a clinically useful prediction of postoperative best-corrected visual acuity.
#30
https://journals.lww.com/ijo/fulltext/2015/63100/predicting_postoperative_visual_outcomes_in.6.aspx
To assess the accuracy of the potential acuity meter (PAM) in predicting postcataract surgery visual acuity outcome in patients with healed inactive maculopathies. […] The PAM is an accurate method of predicting postoperative visual acuity for eyes with nuclear cataracts Grade I and II and inactive maculopathies. […] The prediction of postcataract surgery visual acuity outcomes is challenging in patients with known maculopathies. Patients who have concomitant retinal disease are at the major risk for unsuccessful outcomes, and an accurate prediction of visual acuity is of great benefit to this population. […] Although the level of preoperative visual acuity should be considered as a factor that reflects the density of the lens opacity which might affect the performance of these patients on the PAM test, it is not as an absolute value. The preoperative BCVA in these patients could be partly related to maculopathies, and the PAM test could accurately predict their postoperative BCVA.
#31 Predicting the 10-year risk of cataract surgery using machine learning techniques on questionnaire data: findings from the 45 and Up Study
https://pmc.ncbi.nlm.nih.gov/articles/PMC9606508/
To investigate the feasibility and accuracy of using machine learning (ML) techniques on self-reported questionnaire data to predict the 10-year risk of cataract surgery, and to identify meaningful predictors of cataract surgery in middle-aged and older Australians. […] The study demonstrated that ML modelling was able to reasonably accurately predict the 10-year risk of cataract surgery based on questionnaire data alone and was marginally superior to the conventional logistic model. […] Our study presents the first attempt to use data from a prospective population-based cohort to evaluate the performance of different ML models on risk prediction for cataract surgery and identify key predictive variables without reliance on ocular biometric data. […] Our results show that the 10-year risk cataract surgery could be adequately predicted through self-reported variables only.
#32 Predicting the 10-year risk of cataract surgery using machine learning techniques on questionnaire data: findings from the 45 and Up Study | British Journal of Ophthalmology
https://bjo.bmj.com/content/106/11/1503
To investigate the feasibility and accuracy of using machine learning (ML) techniques on self-reported questionnaire data to predict the 10-year risk of cataract surgery, and to identify meaningful predictors of cataract surgery in middle-aged and older Australians. […] The study demonstrated that ML modelling was able to reasonably accurately predict the 10-year risk of cataract surgery based on questionnaire data alone and was marginally superior to the conventional logistic model. […] Our study presents the first attempt to use data from a prospective population-based cohort to evaluate the performance of different ML models on risk prediction for cataract surgery and identify key predictive variables without reliance on ocular biometric data. […] Our results show that the 10-year risk cataract surgery could be adequately predicted through self-reported variables only.
#33 Predicting the 10-year risk of cataract surgery using machine learning techniques on questionnaire data: findings from the 45 and Up Study
https://pmc.ncbi.nlm.nih.gov/articles/PMC9606508/
The GBM and RF approaches outperformed the conventional logistic regression model and were well suited for accurate risk prediction of cataract surgery. […] This study demonstrates that employing ML models on self-reported questionnaire responses alone is sufficient to undertake this cataract surgery prediction. […] The ML algorithms differ from conventional prediction techniques with its independence of prior assumptions, which avoids the possibility to overlook the unexpected but significant variables, or to identify essential risks in patients with several marginal risk factors (or no risk factors at all). […] This study has proven the feasibility and superiority of ML models that take a comprehensive list of predictive risk factors for automatic evaluation and modelling in predicting cataract surgery risk. […] Using extended 10-year follow-up data from the large-scale population-based 45 and Up Study, we have applied ML methods and established high accuracy risk prediction models for cataract surgery, based on non-clinical self-reported questionnaires.
#34 Predicting the 10-year risk of cataract surgery using machine learning techniques on questionnaire data: findings from the 45 and Up Study | British Journal of Ophthalmology
https://bjo.bmj.com/content/106/11/1503
The GBM and RF approaches outperformed the conventional logistic regression model and were well suited for accurate risk prediction of cataract surgery. […] This study demonstrates that employing ML models on self-reported questionnaire responses alone is sufficient to undertake this cataract surgery prediction. […] The accumulation of electronic medical data in hospitals and the increasing availability of data collection methods (eg, wearable devices, online questionnaires) may pave the way for further future studies on risk prediction using ML methods on a larger dataset with more variables, a larger sample size, a longer follow-up period and more diverse populations. […] Using extended 10-year follow-up data from the large-scale population-based 45 and Up Study, we have applied ML methods and established high accuracy risk prediction models for cataract surgery, based on non-clinical self-reported questionnaires.
#35 Predicting the 10-year risk of cataract surgery using machine learning techniques on questionnaire data: findings from the 45 and Up Study
https://pmc.ncbi.nlm.nih.gov/articles/PMC9606508/
The GBM and RF approaches outperformed the conventional logistic regression model and were well suited for accurate risk prediction of cataract surgery. […] This study demonstrates that employing ML models on self-reported questionnaire responses alone is sufficient to undertake this cataract surgery prediction. […] The ML algorithms differ from conventional prediction techniques with its independence of prior assumptions, which avoids the possibility to overlook the unexpected but significant variables, or to identify essential risks in patients with several marginal risk factors (or no risk factors at all). […] This study has proven the feasibility and superiority of ML models that take a comprehensive list of predictive risk factors for automatic evaluation and modelling in predicting cataract surgery risk. […] Using extended 10-year follow-up data from the large-scale population-based 45 and Up Study, we have applied ML methods and established high accuracy risk prediction models for cataract surgery, based on non-clinical self-reported questionnaires.
#36 Evaluation of the better operative outcome software tool to predict cataract surgical outcome in the early postoperative follow-up | BMC Ophthalmology | Full Text
https://bmcophthalmol.biomedcentral.com/articles/10.1186/s12886-023-03058-1
The BOOST Cataract app categorises outcome according to the WHO benchmark threshold of reference set more than 20 years ago. Good outcome is defined as a presenting visual acuity of 6/18 or better. […] Although reliability of BOOST Cataract app is fairly good, only for categorising good outcome, the mobile surgical outcome application facilitates the monitoring process in LMCIs and may play a roll in reporting outcomes where data collection is challenging due to low postoperative follow-up rates. […] Reliability of the BOOST Cataract app was only fairly good in eyes with clear cornea on the early postoperative follow-up and in patients who presented a good outcome on day 1.
#37 Evaluation of the better operative outcome software tool to predict cataract surgical outcome in the early postoperative follow-up | BMC Ophthalmology | Full Text
https://bmcophthalmol.biomedcentral.com/articles/10.1186/s12886-023-03058-1
The BOOST Cataract app categorises outcome according to the WHO benchmark threshold of reference set more than 20 years ago. Good outcome is defined as a presenting visual acuity of 6/18 or better. […] Although reliability of BOOST Cataract app is fairly good, only for categorising good outcome, the mobile surgical outcome application facilitates the monitoring process in LMCIs and may play a roll in reporting outcomes where data collection is challenging due to low postoperative follow-up rates. […] Reliability of the BOOST Cataract app was only fairly good in eyes with clear cornea on the early postoperative follow-up and in patients who presented a good outcome on day 1.
#38 Predicting Residual Astigmatism in Cataract Surgery
https://www.mdpi.com/2411-5150/6/4/70
The purpose of this review is to evaluate the prediction of postoperative residual astigmatism and to determine the best prediction method for astigmatism correction. […] In predicting residual astigmatism, the with-the-rule (WTR) and against-the-rule (ATR) astigmatism components can now be almost predicted. […] However, there are still issues with the oblique astigmatism component. […] In addition, corneal astigmatism is the most important predictor of postoperative residual astigmatism, and other predictors, such as refractive astigmatism, age, and lens thickness, have also been mentioned. […] However, all but corneal astigmatism are questionable because of the possibility of confounding variables. […] Several predictions of residual astigmatism have been reported, but complete prediction has not been possible.
#39 Predicting Residual Astigmatism in Cataract Surgery
https://www.mdpi.com/2411-5150/6/4/70
The purpose of this review is to evaluate the prediction of postoperative residual astigmatism and to determine the best prediction method for astigmatism correction. […] In predicting residual astigmatism, the with-the-rule (WTR) and against-the-rule (ATR) astigmatism components can now be almost predicted. […] However, there are still issues with the oblique astigmatism component. […] In addition, corneal astigmatism is the most important predictor of postoperative residual astigmatism, and other predictors, such as refractive astigmatism, age, and lens thickness, have also been mentioned. […] However, all but corneal astigmatism are questionable because of the possibility of confounding variables. […] Several predictions of residual astigmatism have been reported, but complete prediction has not been possible.
#40 Predicting Residual Astigmatism in Cataract Surgery
https://www.mdpi.com/2411-5150/6/4/70
The most important predictor of residual astigmatism remains corneal astigmatism. […] Recent technological advances have made it almost possible to predict WTR/ATR astigmatism by using regression equations, but the prediction of oblique astigmatism is still incomplete and requires further study. […] At present, it is best to perform a preoperative vector analysis of astigmatism and predict residual astigmatism by regression equation when there is little or no oblique astigmatism component.
#41 Predicting Residual Astigmatism in Cataract Surgery
https://www.mdpi.com/2411-5150/6/4/70
The purpose of this review is to evaluate the prediction of postoperative residual astigmatism and to determine the best prediction method for astigmatism correction. […] In predicting residual astigmatism, the with-the-rule (WTR) and against-the-rule (ATR) astigmatism components can now be almost predicted. […] However, there are still issues with the oblique astigmatism component. […] In addition, corneal astigmatism is the most important predictor of postoperative residual astigmatism, and other predictors, such as refractive astigmatism, age, and lens thickness, have also been mentioned. […] However, all but corneal astigmatism are questionable because of the possibility of confounding variables. […] Several predictions of residual astigmatism have been reported, but complete prediction has not been possible.
#42 Predicting Residual Astigmatism in Cataract Surgery
https://www.mdpi.com/2411-5150/6/4/70
The most important predictor of residual astigmatism remains corneal astigmatism. […] Recent technological advances have made it almost possible to predict WTR/ATR astigmatism by using regression equations, but the prediction of oblique astigmatism is still incomplete and requires further study. […] At present, it is best to perform a preoperative vector analysis of astigmatism and predict residual astigmatism by regression equation when there is little or no oblique astigmatism component.
#43 Anterior segment configuration as a predictive factor for refractive outcome after cataract surgery in patients with glaucoma | BMC Ophthalmology | Full Text
https://bmcophthalmol.biomedcentral.com/articles/10.1186/s12886-016-0359-1
To compare refractive outcomes after cataract surgery between patients with closed-angle and open-angle glaucoma and evaluate the influence of preoperative factors on refractive outcomes in patients with glaucoma. […] The overall predictability of achieving within1.0 D of target was 76.92 % and 72.73 %, respectively. […] Logistic regression modeling showed that large lens vault (LV) was a significant predictor of unsatisfactory refractive outcome after cataract surgery in patients with glaucoma. […] When considering cataract surgery in patients with glaucoma, surgeons should recognize that the refractive outcomes may be unsatisfactory in eyes with large LV. […] The percentage of eyes with unsatisfactory refractive outcome (MAE1.0 D) was about 25 % and the greater LV becomes, the more the MAE value increases.
#44 Anterior segment configuration as a predictive factor for refractive outcome after cataract surgery in patients with glaucoma | BMC Ophthalmology | Full Text
https://bmcophthalmol.biomedcentral.com/articles/10.1186/s12886-016-0359-1
In our study, LV was significantly associated with refractive outcomes in patients with glaucoma. […] The results of the logistic regression also showed that large LV was a significant predictor of unsatisfactory outcome after cataract surgery in patients with glaucoma (OR=2.331 and 38.293; P=0.039 and 0.020 using the SRK-II and SRK-T formulae, respectively). […] We suggest that surgeons consider preoperative LV when planning cataract surgery in patients with glaucoma.
#45 Anterior segment configuration as a predictive factor for refractive outcome after cataract surgery in patients with glaucoma | BMC Ophthalmology | Full Text
https://bmcophthalmol.biomedcentral.com/articles/10.1186/s12886-016-0359-1
To compare refractive outcomes after cataract surgery between patients with closed-angle and open-angle glaucoma and evaluate the influence of preoperative factors on refractive outcomes in patients with glaucoma. […] The overall predictability of achieving within1.0 D of target was 76.92 % and 72.73 %, respectively. […] Logistic regression modeling showed that large lens vault (LV) was a significant predictor of unsatisfactory refractive outcome after cataract surgery in patients with glaucoma. […] When considering cataract surgery in patients with glaucoma, surgeons should recognize that the refractive outcomes may be unsatisfactory in eyes with large LV. […] The percentage of eyes with unsatisfactory refractive outcome (MAE1.0 D) was about 25 % and the greater LV becomes, the more the MAE value increases.
#46 Anterior segment configuration as a predictive factor for refractive outcome after cataract surgery in patients with glaucoma | BMC Ophthalmology | Full Text
https://bmcophthalmol.biomedcentral.com/articles/10.1186/s12886-016-0359-1
To compare refractive outcomes after cataract surgery between patients with closed-angle and open-angle glaucoma and evaluate the influence of preoperative factors on refractive outcomes in patients with glaucoma. […] The overall predictability of achieving within1.0 D of target was 76.92 % and 72.73 %, respectively. […] Logistic regression modeling showed that large lens vault (LV) was a significant predictor of unsatisfactory refractive outcome after cataract surgery in patients with glaucoma. […] When considering cataract surgery in patients with glaucoma, surgeons should recognize that the refractive outcomes may be unsatisfactory in eyes with large LV. […] The percentage of eyes with unsatisfactory refractive outcome (MAE1.0 D) was about 25 % and the greater LV becomes, the more the MAE value increases.
#47
https://link.springer.com/article/10.1007/s40123-022-00563-2
Cataract surgery could improve visual acuity (VA) for patients with retinitis pigmentosa (RP) during long-term follow-up, and the surgery is not recommended for patients with invisible preoperative macular EZ. […] These results suggest that cataract surgery could improve VA for patients with RP during long-term follow-up, and the surgery is not recommended for patients with invisible preoperative macular ellipsoid zone examined by optical coherence tomography. […] In conclusion, cataract surgery could improve VA for patients with RP and cataract during the long-term follow-up, although changes in VA showed a downward trend. Moreover, cataract surgery is not recommended for patients with EZ-invisible RP, and OCT should be examined for patients with RP before cataract surgery.
#48
https://link.springer.com/article/10.1007/s40123-022-00563-2
Cataract surgery could improve visual acuity (VA) for patients with retinitis pigmentosa (RP) during long-term follow-up, and the surgery is not recommended for patients with invisible preoperative macular EZ. […] These results suggest that cataract surgery could improve VA for patients with RP during long-term follow-up, and the surgery is not recommended for patients with invisible preoperative macular ellipsoid zone examined by optical coherence tomography. […] In conclusion, cataract surgery could improve VA for patients with RP and cataract during the long-term follow-up, although changes in VA showed a downward trend. Moreover, cataract surgery is not recommended for patients with EZ-invisible RP, and OCT should be examined for patients with RP before cataract surgery.
#49 Prognosis for Cataracts | Hospital ClÃnic Barcelona
https://www.clinicbarcelona.org/en/assistance/diseases/cataracts/evolution-of-the-disease
In the months or years following surgery, the posterior lens capsule, which is the membrane that provides support at the back of the intraocular lens, may thicken or develop opacity. This is called posterior capsule opacification. It is the most common postoperative complication and causes a progressive loss of vision in 10% of patients within 2 years of undergoing a cataract operation.
#50 ESCRS – ESCRS Guideline for Cataract Surgery
https://www.escrs.org/escrs-guideline-for-cataract-surgery/
In patients with uveitis, an increased frequency and prolonged treatment with steroids is suggested. Oral steroids should be applied only in specific cases. […] The primary treatment options for CME after cataract surgery are topical NSAIDs or steroids. However, there is a lack of sufficient evidence to establish the optimal treatment approach for this condition. […] Postoperative remote care after cataract surgery might replace short-term clinical examination to better allocate hospital resources and increase time and cost efficiency. […] The incidence of clinically significant cystoid macular edema (CME) following cataract surgery has been reported to be as high as 2%. […] The use of intracameral antibiotics significantly reduces the risk of endophthalmitis. […] A combination of NSAIDs and corticosteroid eye drops is more effective to use after routine cataract surgery to prevent inflammation and CME compared to monotherapy. […] ISBCS (Immediate Sequential Bilateral Cataract Surgery) is effective and safe, has a high degree of patient satisfaction and can be considered in patients without complication-inducing ocular comorbidities.
#51 ESCRS – ESCRS Guideline for Cataract Surgery
https://www.escrs.org/escrs-guideline-for-cataract-surgery/
In patients with uveitis, an increased frequency and prolonged treatment with steroids is suggested. Oral steroids should be applied only in specific cases. […] The primary treatment options for CME after cataract surgery are topical NSAIDs or steroids. However, there is a lack of sufficient evidence to establish the optimal treatment approach for this condition. […] Postoperative remote care after cataract surgery might replace short-term clinical examination to better allocate hospital resources and increase time and cost efficiency. […] The incidence of clinically significant cystoid macular edema (CME) following cataract surgery has been reported to be as high as 2%. […] The use of intracameral antibiotics significantly reduces the risk of endophthalmitis. […] A combination of NSAIDs and corticosteroid eye drops is more effective to use after routine cataract surgery to prevent inflammation and CME compared to monotherapy. […] ISBCS (Immediate Sequential Bilateral Cataract Surgery) is effective and safe, has a high degree of patient satisfaction and can be considered in patients without complication-inducing ocular comorbidities.
#52 ESCRS – ESCRS Guideline for Cataract Surgery
https://www.escrs.org/escrs-guideline-for-cataract-surgery/
In patients with uveitis, an increased frequency and prolonged treatment with steroids is suggested. Oral steroids should be applied only in specific cases. […] The primary treatment options for CME after cataract surgery are topical NSAIDs or steroids. However, there is a lack of sufficient evidence to establish the optimal treatment approach for this condition. […] Postoperative remote care after cataract surgery might replace short-term clinical examination to better allocate hospital resources and increase time and cost efficiency. […] The incidence of clinically significant cystoid macular edema (CME) following cataract surgery has been reported to be as high as 2%. […] The use of intracameral antibiotics significantly reduces the risk of endophthalmitis. […] A combination of NSAIDs and corticosteroid eye drops is more effective to use after routine cataract surgery to prevent inflammation and CME compared to monotherapy. […] ISBCS (Immediate Sequential Bilateral Cataract Surgery) is effective and safe, has a high degree of patient satisfaction and can be considered in patients without complication-inducing ocular comorbidities.
#53 ESCRS – ESCRS Guideline for Cataract Surgery
https://www.escrs.org/escrs-guideline-for-cataract-surgery/
In patients with uveitis, an increased frequency and prolonged treatment with steroids is suggested. Oral steroids should be applied only in specific cases. […] The primary treatment options for CME after cataract surgery are topical NSAIDs or steroids. However, there is a lack of sufficient evidence to establish the optimal treatment approach for this condition. […] Postoperative remote care after cataract surgery might replace short-term clinical examination to better allocate hospital resources and increase time and cost efficiency. […] The incidence of clinically significant cystoid macular edema (CME) following cataract surgery has been reported to be as high as 2%. […] The use of intracameral antibiotics significantly reduces the risk of endophthalmitis. […] A combination of NSAIDs and corticosteroid eye drops is more effective to use after routine cataract surgery to prevent inflammation and CME compared to monotherapy. […] ISBCS (Immediate Sequential Bilateral Cataract Surgery) is effective and safe, has a high degree of patient satisfaction and can be considered in patients without complication-inducing ocular comorbidities.
#54 ESCRS – ESCRS Guideline for Cataract Surgery
https://www.escrs.org/escrs-guideline-for-cataract-surgery/
In patients with uveitis, an increased frequency and prolonged treatment with steroids is suggested. Oral steroids should be applied only in specific cases. […] The primary treatment options for CME after cataract surgery are topical NSAIDs or steroids. However, there is a lack of sufficient evidence to establish the optimal treatment approach for this condition. […] Postoperative remote care after cataract surgery might replace short-term clinical examination to better allocate hospital resources and increase time and cost efficiency. […] The incidence of clinically significant cystoid macular edema (CME) following cataract surgery has been reported to be as high as 2%. […] The use of intracameral antibiotics significantly reduces the risk of endophthalmitis. […] A combination of NSAIDs and corticosteroid eye drops is more effective to use after routine cataract surgery to prevent inflammation and CME compared to monotherapy. […] ISBCS (Immediate Sequential Bilateral Cataract Surgery) is effective and safe, has a high degree of patient satisfaction and can be considered in patients without complication-inducing ocular comorbidities.
#55 ESCRS – ESCRS Guideline for Cataract Surgery
https://www.escrs.org/escrs-guideline-for-cataract-surgery/
In patients with uveitis, an increased frequency and prolonged treatment with steroids is suggested. Oral steroids should be applied only in specific cases. […] The primary treatment options for CME after cataract surgery are topical NSAIDs or steroids. However, there is a lack of sufficient evidence to establish the optimal treatment approach for this condition. […] Postoperative remote care after cataract surgery might replace short-term clinical examination to better allocate hospital resources and increase time and cost efficiency. […] The incidence of clinically significant cystoid macular edema (CME) following cataract surgery has been reported to be as high as 2%. […] The use of intracameral antibiotics significantly reduces the risk of endophthalmitis. […] A combination of NSAIDs and corticosteroid eye drops is more effective to use after routine cataract surgery to prevent inflammation and CME compared to monotherapy. […] ISBCS (Immediate Sequential Bilateral Cataract Surgery) is effective and safe, has a high degree of patient satisfaction and can be considered in patients without complication-inducing ocular comorbidities.
#56 ESCRS – ESCRS Guideline for Cataract Surgery
https://www.escrs.org/escrs-guideline-for-cataract-surgery/
In patients with uveitis, an increased frequency and prolonged treatment with steroids is suggested. Oral steroids should be applied only in specific cases. […] The primary treatment options for CME after cataract surgery are topical NSAIDs or steroids. However, there is a lack of sufficient evidence to establish the optimal treatment approach for this condition. […] Postoperative remote care after cataract surgery might replace short-term clinical examination to better allocate hospital resources and increase time and cost efficiency. […] The incidence of clinically significant cystoid macular edema (CME) following cataract surgery has been reported to be as high as 2%. […] The use of intracameral antibiotics significantly reduces the risk of endophthalmitis. […] A combination of NSAIDs and corticosteroid eye drops is more effective to use after routine cataract surgery to prevent inflammation and CME compared to monotherapy. […] ISBCS (Immediate Sequential Bilateral Cataract Surgery) is effective and safe, has a high degree of patient satisfaction and can be considered in patients without complication-inducing ocular comorbidities.
#57 Visual outcome and associated risk factors in patients following small incision cataract surgery at the National Referral Hospital, Bhutan | medRxiv
https://www.medrxiv.org/content/10.1101/2024.11.23.24317844v1.full-text
Poor visual outcome was significantly associated with retinal disease (aOR 50.92; 95% CI: 10.23, 253.37), glaucoma (aOR 13.75; 95% CI: 1.26, 150.06), corneal scar (aOR 23.55; 95% CI: 3.01, 184.02), and others (aOR 12.14; 95% CI: 2.36, 62.33). […] The study found a significant association between striate keratopathy and visual outcome (aOR 16.59: 95% CI 3.54, 77.70). […] The improvement was mainly due to well-trained surgeons and operating assistants, better biometry services, and well-trained staff conducting biometry before the surgery. […] However, poor visual outcome was 8.06% (n=25) 6 weeks post-SICS which was more than the WHO recommendation (5%). […] The prospective assessment of surgical outcomes probably contributed to better surgical outcomes.
#58 Cataract surgery visual outcome and associated factors | OPTH
https://www.dovepress.com/cataract-surgery-visual-outcome-and-associated-factors-among-adults-at-peer-reviewed-fulltext-article-OPTH
Those aged 70 and up had about three times increased odds of a poor outcome compared to those aged 40-49 years (AOR= 3.16 CI [1.198.39]). […] Patients with ocular comorbidity were 2.86 times more likely to have an increased risk of poor visual outcome compared with those without ocular comorbidity (AOR = 2.86, 95% CI [1.605.10]). […] When comparing those who had a small incision cataract surgical procedure to those who had a phacoemulsification (PHACO) treatment, the odds of having a poor outcome were almost seven times higher (AOR = 5.56, [2.4812.43]). […] Those who had an intraoperative complication had a 4.49 times higher chance of having a poor outcome (AOR = 4.49, [1.8810.72]) than others who did not. […] Patients with postoperative intra-ocular inflammation had 2.63 times (AOR = 2.56, [1.404.94]) greater odds of poor outcome than those without. […] The proportion of poor and good results was lower than the WHO recommendation.
#59 Cataract surgery visual outcome and associated factors | OPTH
https://www.dovepress.com/cataract-surgery-visual-outcome-and-associated-factors-among-adults-at-peer-reviewed-fulltext-article-OPTH
Those aged 70 and up had about three times increased odds of a poor outcome compared to those aged 40-49 years (AOR= 3.16 CI [1.198.39]). […] Patients with ocular comorbidity were 2.86 times more likely to have an increased risk of poor visual outcome compared with those without ocular comorbidity (AOR = 2.86, 95% CI [1.605.10]). […] When comparing those who had a small incision cataract surgical procedure to those who had a phacoemulsification (PHACO) treatment, the odds of having a poor outcome were almost seven times higher (AOR = 5.56, [2.4812.43]). […] Those who had an intraoperative complication had a 4.49 times higher chance of having a poor outcome (AOR = 4.49, [1.8810.72]) than others who did not. […] Patients with postoperative intra-ocular inflammation had 2.63 times (AOR = 2.56, [1.404.94]) greater odds of poor outcome than those without. […] The proportion of poor and good results was lower than the WHO recommendation.
#60 Cataract surgery visual outcome and associated factors | OPTH
https://www.dovepress.com/cataract-surgery-visual-outcome-and-associated-factors-among-adults-at-peer-reviewed-fulltext-article-OPTH
Those aged 70 and up had about three times increased odds of a poor outcome compared to those aged 40-49 years (AOR= 3.16 CI [1.198.39]). […] Patients with ocular comorbidity were 2.86 times more likely to have an increased risk of poor visual outcome compared with those without ocular comorbidity (AOR = 2.86, 95% CI [1.605.10]). […] When comparing those who had a small incision cataract surgical procedure to those who had a phacoemulsification (PHACO) treatment, the odds of having a poor outcome were almost seven times higher (AOR = 5.56, [2.4812.43]). […] Those who had an intraoperative complication had a 4.49 times higher chance of having a poor outcome (AOR = 4.49, [1.8810.72]) than others who did not. […] Patients with postoperative intra-ocular inflammation had 2.63 times (AOR = 2.56, [1.404.94]) greater odds of poor outcome than those without. […] The proportion of poor and good results was lower than the WHO recommendation.
#61 Cataract surgery visual outcome and associated factors | OPTH
https://www.dovepress.com/cataract-surgery-visual-outcome-and-associated-factors-among-adults-at-peer-reviewed-fulltext-article-OPTH
Those aged 70 and up had about three times increased odds of a poor outcome compared to those aged 40-49 years (AOR= 3.16 CI [1.198.39]). […] Patients with ocular comorbidity were 2.86 times more likely to have an increased risk of poor visual outcome compared with those without ocular comorbidity (AOR = 2.86, 95% CI [1.605.10]). […] When comparing those who had a small incision cataract surgical procedure to those who had a phacoemulsification (PHACO) treatment, the odds of having a poor outcome were almost seven times higher (AOR = 5.56, [2.4812.43]). […] Those who had an intraoperative complication had a 4.49 times higher chance of having a poor outcome (AOR = 4.49, [1.8810.72]) than others who did not. […] Patients with postoperative intra-ocular inflammation had 2.63 times (AOR = 2.56, [1.404.94]) greater odds of poor outcome than those without. […] The proportion of poor and good results was lower than the WHO recommendation.
#62 Visual outcome and associated risk factors in patients following small incision cataract surgery at the National Referral Hospital, Bhutan | medRxiv
https://www.medrxiv.org/content/10.1101/2024.11.23.24317844v1.full-text
Poor visual outcome was significantly associated with retinal disease (aOR 50.92; 95% CI: 10.23, 253.37), glaucoma (aOR 13.75; 95% CI: 1.26, 150.06), corneal scar (aOR 23.55; 95% CI: 3.01, 184.02), and others (aOR 12.14; 95% CI: 2.36, 62.33). […] The study found a significant association between striate keratopathy and visual outcome (aOR 16.59: 95% CI 3.54, 77.70). […] The improvement was mainly due to well-trained surgeons and operating assistants, better biometry services, and well-trained staff conducting biometry before the surgery. […] However, poor visual outcome was 8.06% (n=25) 6 weeks post-SICS which was more than the WHO recommendation (5%). […] The prospective assessment of surgical outcomes probably contributed to better surgical outcomes.
#63 Anterior segment configuration as a predictive factor for refractive outcome after cataract surgery in patients with glaucoma | BMC Ophthalmology | Full Text
https://bmcophthalmol.biomedcentral.com/articles/10.1186/s12886-016-0359-1
In our study, LV was significantly associated with refractive outcomes in patients with glaucoma. […] The results of the logistic regression also showed that large LV was a significant predictor of unsatisfactory outcome after cataract surgery in patients with glaucoma (OR=2.331 and 38.293; P=0.039 and 0.020 using the SRK-II and SRK-T formulae, respectively). […] We suggest that surgeons consider preoperative LV when planning cataract surgery in patients with glaucoma.
#64 Prognosis for Cataracts | Hospital ClÃnic Barcelona
https://www.clinicbarcelona.org/en/assistance/diseases/cataracts/evolution-of-the-disease
Cataracts in adults follow a progressive course which is both variable and hard to predict. Without treatment, most patients with cataracts would develop severe visual impairment. […] Many studies have recorded favourable outcomes following cataract surgery, both in terms of visual acuity and improved quality of life. Around 90% of patients who receive an IOL implant have better visual acuity and are satisfied with the outcome of the operation. This level of satisfaction increases to over 95% in patients who do not have any eye problems prior to surgery, other than the cataract itself. […] In short, cataract surgery is a safe and successful procedure in most patients. […] The main causes of poor vision following surgery are due to: inadequate correction of the postoperative refractive error which can be resolved with glasses or by changing the intraocular lens; the failure to detect certain eye conditions prior to the operation, such as glaucoma, amblyopia (lazy eye), macular degeneration and other macular diseases; or surgical and postsurgical complications.