Variation in cataract surgery practice and clinical outcomes

Area of Science:

• Ophthalmology
• Surgical Techniques
• Patient Outcomes

Background:

• Cataract surgery is a common procedure with various surgical techniques.
• Surgeon experience and patient factors may influence surgical outcomes.
• Understanding the impact of surgical approach and surgeon volume is crucial for optimizing patient care.

Purpose of the Study:

• To investigate the relationship between surgical technique (phacoemulsification vs. ECCE), surgeon characteristics, patient factors, and clinical outcomes in cataract surgery.
• To determine if surgeon volume influences the choice of technique and patient outcomes.
• To assess the occurrence of adverse events and visual acuity improvement based on surgical method and surgeon experience.

Main Methods:

• Seventy-five ophthalmologists were recruited and stratified by annual cataract surgery volume.
• 772 patients undergoing first eye cataract surgery were enrolled; data from 717 (93%) were analyzed.
• Preoperative, perioperative, and 4-month postoperative data were collected and analyzed.

Main Results:

• Phacoemulsification was used in 65% of cases, ECCE in 35%.
• ECCE was associated with ocular comorbidity and surgeon experience (>21 years).
• High-volume surgeons (>200 cases/year) were more likely to perform phacoemulsification.
• No significant differences in visual acuity or adverse events were found between techniques or volume strata.
• Posterior capsular opacification was more frequent with cortical opacification and in patients treated by high-volume surgeons.

Conclusions:

• Neither phacoemulsification nor ECCE, nor surgeon volume, demonstrated a difference in clinical outcomes (visual acuity, adverse events) except for posterior capsular opacification.
• High surgeon volume was independently associated with performing phacoemulsification and reporting posterior capsular opacification.