Development of machine learning models to predict posterior capsule rupture based on the EUREQUO registry.

PURPOSE: To evaluate the performance of different probabilistic classifiers to predict posterior capsule rupture (PCR) prior to cataract surgery. METHODS: Three probabilistic classifiers were constructed to estimate the probability of PCR: a Bayesian network (BN), logistic regression (LR) model, and multi-layer perceptron (MLP) network. The classifiers were trained on a sample of 2 853 376 surgeries reported to the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO) between 2008 and 2018. The performance of the classifiers was evaluated based on the area under the precision-recall curve (AUPRC) and compared to existing scoring models in the literature. Furthermore, direct risk factors for PCR were identified by analysing the independence structure of the BN. RESULTS: The MLP network predicted PCR overall the best (AUPRC 13.1 ± 0.41%), followed by the BN (AUPRC 8.05 ± 0.39%) and the LR model (AUPRC 7.31 ± 0.15%). Direct risk factors for PCR include preoperative best-corrected visual acuity (BCVA), year of surgery, operation type, anaesthesia, target refraction, other ocular comorbidities, white cataract, and corneal opacities. CONCLUSIONS: Our results suggest that the MLP network performs better than existing scoring models in the literature, despite a relatively low precision at high recall. Consequently, implementing the MLP network in clinical practice can potentially decrease the PCR rate.

Anesthesia techniques and the risk of complications as reflected in the European Registry of Quality Outcomes for Cataract and Refractive Surgery.

PURPOSE: To determine the trends in anesthesia techniques for cataract surgery over the past decade and their relationship to surgical complications. SETTING: Clinics affiliated with the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO). DESIGN: Retrospective cross-sectional register-based study. METHODS: Variables include patient demographics, visual acuity, ocular comorbidities, surgery characteristics, intraoperative complications, and postoperative complications for the study period from January 2008, to December 2018. The anesthesia methods registered in the EUREQUO and included in the study are topical, combined topical and intracameral, sub-Tenon, regional, and general anesthesia. Multivariate logistic regression models for each complication were constructed to estimate the adjusted odds ratio (OR) and 95% CIs. RESULTS: Complete data were available of 1 354 036 cataract surgeries. Topical anesthesia increased significantly over time (from 30% to 76%, P < .001). Sub-Tenon and regional anesthesia decreased (from 27% and 38% to 16% and 6%, respectively, P < .001), and general and combined topical and intracameral anesthesia remained stable (around 2%). Sub-Tenon (OR, 0.80; 95% CI, 0.71-0.91, P < .001), regional (0.74; 95% CI, 0.71-0.78, P < .001), general (0.53; 95% CI, 0.50-0.56, P < .001), and intracameral anesthesia (0.76; 95% CI, 0.64-0.90, P = .001) carried a significantly decreased risk of posterior capsule rupture (PCR), with and without dropped nucleus, compared with topical anesthesia. The risk of endophthalmitis was significantly lower with regional anesthesia compared with topical anesthesia (OR, 0.60; 95% CI, 0.44-0.82, P = .001). CONCLUSIONS: The use of topical anesthesia for cataract surgery increased over time. Topical anesthesia is associated with an increased risk of PCR with and without dropped nucleus, and endophthalmitis.

Ophthalmologists' attitudes toward immediate sequential bilateral cataract surgery: Dutch national survey.

PURPOSE: To evaluate current practice patterns of immediate sequential bilateral cataract surgery (ISBCS) in the Netherlands and assess ophthalmologists' attitudes toward performing ISBCS in future cataract care. SETTING: Dutch ophthalmic society members. DESIGN: Cross-sectional study (national survey). METHODS: An electronic survey on ISBCS was sent as part of an annual survey on cataract practice patterns to members of the Dutch ophthalmic society. Questions regarding current ISBCS practice patterns, willingness to perform ISBCS routinely in future care, reasons for performing ISBCS, and reasons for not performing ISBCS were included. Data were analyzed using descriptive statistics. RESULTS: 237 (45.6%) of 520 survey recipients responded to the overall survey. Data on the ISBCS questions were available from 227 respondents. 62 ophthalmologists (27.3%) currently performed ISBCS, predominantly in low patient volumes (90.3% on 1 to 5 patients per month). However, 108 (47.6%) of 227 ophthalmologists considered performing ISBCS routinely in future practice. Procedures for which ISBCS was mainly considered included age-related cataract surgery using topical and general anesthesia. Availability of separate products and instruments for both eyes and patient advantages were considered of high importance when performing ISBCS. Main reasons for not performing ISBCS included the risk for endophthalmitis and potential medicolegal aspects. CONCLUSIONS: Although ISBCS is currently not a routine procedure in the Netherlands, it is considered by almost 50% of surgeons. To improve implementation on a national level, potential barriers identified in this survey (fear of bilateral endophthalmitis, potential medicolegal issues, and a lack of availability of separate products for both eyes) should be addressed.

Outcomes of cataract surgery complicated by posterior capsule rupture in the European Registry of Quality Outcomes for Cataract and Refractive Surgery.

PURPOSE: To analyze the outcomes of cataract surgery complicated by posterior capsule rupture (PCR). SETTING: European clinics affiliated to the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO). DESIGN: Retrospective cross-sectional register-based study. METHODS: Data were retrieved from the EUREQUO between January 1, 2008, and December 31, 2018. The database consists of data on demographics, intraoperative complications such as PCR, type of intraocular lens (IOL) material, postoperative refraction, corrected distance visual acuity (CDVA), and postoperative complications. RESULTS: 1 371 743 cataract extractions with complete postoperative data were reported in the EUREQUO. In 12 196 cases (0.9%), PCR was reported. After PCR, patients were more likely to receive a poly(methyl methacrylate) IOL (5.2% vs 0.4%, respectively) or no IOL (1.1% vs 0.02%, respectively) compared with patients without PCR. The refractive and visual outcomes in patients with PCR were significantly worse than in those without PCR (mean CDVA 0.13 ± 0.21 vs 0.05 ± 0.16 logMAR, P < .001; mean absolute biometry prediction error 1.15 ± 1.60 diopters [D] vs 0.41 ± 0.45 D, P < .001). A multivariate linear regression analysis, adjusting for potential explanatory variables, confirmed a statistically significant difference (0.04 logMAR, P < .001, and .70 D, P < .001, respectively). Patients with PCR had significantly more postoperative complications (corneal edema 0.88% vs 0.17%, adjusted odds ratio [aOR], 2.80 95% CI, 2.27-3.45, endophthalmitis 0.11% vs 0.02%, aOR, 4.40 95% CI, 2.48-7.81, uncontrolled intraocular pressure 0.55% vs 0.03%, aOR, 14.58 95% CI, 11.16-19.06, P < .001). CONCLUSIONS: Patients with PCR had significantly worse visual and refractive outcomes and more postoperative complications than patients without PCR. However, most of these patients achieved better postoperative visual acuity than that preoperatively.

Risk factors for posterior capsule rupture in cataract surgery as reflected in the European Registry of Quality Outcomes for Cataract and Refractive Surgery.

PURPOSE: To analyze the incidence and risk factors for posterior capsule rupture (PCR) in cataract surgery. SETTING: European clinics affiliated with the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO). DESIGN: Retrospective cross-sectional register-based study. METHODS: Data were obtained from the EUREQUO. The database contains data on demographics, comorbidities, and intraoperative complications, including PCR for the study period from January 1, 2008, to December 31, 2018. Univariate and multivariate logistic regression analyses were performed to estimate the (adjusted) odds ratio (OR) and 95% confidence intervals (CIs). RESULTS: We analyzed EUREQUO registry data of 2,853,376 patients, and 31,749 (1.1%) cataract surgeries were complicated by a PCR. Data were available of 2 853 376 patients, and 31 749 (1.1%) cataract surgeries were complicated by a PCR. The PCR rate ranged from 0.60% to 1.65% throughout the years, with a decreasing trend (P < .001). The mean age of the PCR cohort was 74.8 ± 10.5 years, and 17 29 (55.5%) patients were female. Risk factors most significantly associated with PCR were corneal opacities (OR 3.21, 95% CI, 3.02-3.41, P < .001), diabetic retinopathy (OR 2.74, 95% CI, 2.59-2.90, P < .001), poor preoperative visual acuity (OR 1.98, 95% CI, 1.88-2.07, P < .001), and white cataract (OR 1.87, 95% CI, 1.72-2.03, P < .001). CONCLUSIONS: Risk factors for PCR were identified based on the EUREQUO, and the incidence of this complication is decreasing over time.

Changing practice patterns in European cataract surgery as reflected in the European Registry of Quality Outcomes for Cataract and Refractive Surgery 2008 to 2017.

PURPOSE: To study practice patterns in European cataract surgery over a 10-year period. SETTING: European clinics affiliated to the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO). DESIGN: Registry cohort study. METHODS: The EUREQUO contains preoperative, intraoperative, and postoperative parameters reported by surgeons in many European clinics. All data reported to the registry are anonymized. Preoperative parameters included age, sex, visual acuity, target refraction, ocular comorbidity, and surgical difficulties. Surgical data included anesthesia, surgical technique, intraocular lens optic biomaterial, and complications. Postoperative parameters included visual acuity, refraction, and short-term complications. RESULTS: During the study period (January 1, 2008, to December 31, 2017), a total of 2 714 108 cataract extractions were reported to the EUREQUO. Preoperative data changed over time, with decreases in mean age (74.5-73.0 years), proportion of women from 60.6% (100 373/165 628) to 57.2% (174 908/305 845), and proportion of coexisting eye diseases from 30.0% (49 638/165 650) to 27.0% (82 704/305 846) and with improvements in preoperative visual acuity (mean logarithm of minimum angle of resolution [logMAR] 0.46 to 0.37). The use of topical anesthesia increased over time from 28.1% (26 238/93 320) to 71.7% (130 525/182 083). Surgical complications showed a significant decrease from 2.5% (4107/165 650) to 1.2% (3573/305 846). The visual outcome improved over time (mean logMAR 0.08 to 0.05), as did the absolute median prediction error (0.38 diopter [D] to 0.28 D). CONCLUSIONS: Trends in European cataract surgery practice patterns from 2008 to 2017 have moved toward younger patients with better preoperative visual acuity, fewer surgical complications, and better predicted refractions and visual outcomes.

Cataract surgery of eyes with previous vitrectomy: risks and benefits as reflected in the European Registry of Quality Outcomes for Cataract and Refractive Surgery.

PURPOSE: To explore the frequency and outcomes of cataract surgery in eyes with previous vitrectomy. SETTING: Fifteen European countries. DESIGN: Retrospective cross-sectional register-based study. METHODS: The European Registry of Quality Outcomes of Cataract and Refractive Surgery (EUREQUO) contains data on baseline characteristics, surgery, and follow-up for cataract surgeries. Previous vitrectomy is included as a mandatory parameter in baseline characteristics. According to the protocol for EUREQUO, consecutive cases should be reported by participating units. RESULTS: This study included data from units in 15 European countries from 2008 to 2018; 1 715 348 cataract extractions with follow-up data were reported to EUREQUO. Previous vitrectomy was reported in 19 416 eyes comprising 1.1% of all cases. This proportion was about the same for each study year. Most patients were men, and their mean age was 64.1 years compared with 73.7 years for the rest of the database. The preoperative visual acuity was modestly worse in postvitrectomy eyes compared with the opposite (corrected distance visual acuity [CDVA] 0.45 vs 0.25, respectively). A postoperative CDVA of 0.5 or better was achieved by 82.8% of the postvitrectomy eyes compared with 95.6% for the non-postvitrectomy eyes. The absolute mean biometry prediction error for the same groups was 0.52 diopters (D) vs 0.43 D, respectively. CONCLUSIONS: Patients undergoing cataract extraction after previous vitrectomy were younger and mostly men. Their visual and refractive outcomes were slightly inferior compared with the patients without vitrectomy.

Risk factors for dropped nucleus in cataract surgery as reflected by the European Registry of Quality Outcomes for Cataract and Refractive Surgery.

PURPOSE: To analyze the incidence, risk factors, and outcomes of cataract surgery complicated by a dropped nucleus. SETTING: Patients who have received cataract surgery in 18 European countries. DESIGN: Retrospective cross-sectional register-based study. METHODS: Data from the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO) were analyzed. The EUREQUO contains preoperative baseline, intraoperative, and follow-up data. Intraoperative data include dropped nucleus as a complication. Baseline data such as demographic data, ocular comorbidities, surgical difficulties, and visual and refractive outcomes were tested for association with a dropped nucleus for the study period from January 1, 2008, to December 31, 2018. RESULTS: The number of reported patients with complete data was 1 715 348. Dropped nucleus was reported in 1221 eyes (0.071%) during the study period. White cataract, previous vitrectomy, poor preoperative visual acuity, small pupil, pseudoexfoliation, diabetic retinopathy, and male sex were significantly related to dropped nucleus. Year of surgery showed a significant trend of decreasing occurrence of dropped nucleus over time. Eyes with the complication of a dropped nucleus also had a poorer visual and refractive outcome compared with eyes with existing risk factors but no such complication. CONCLUSIONS: Many risk factors for dropped nucleus complications were identified. A significant trend of decreasing occurrence of dropped nucleus was found for the study period. The visual and refractive outcome was poorer for eyes with a dropped nucleus.

[Corneal perforation due to 'lost' contact lenses]. / Corneaperforatie door 'zoekgeraakte' contactlenzen.

An 87-year-old woman with Alzheimer's disease was referred to our eye clinic with a large corneal perforation of her right eye. On further examination a total of 15 contact lenses were found under the upper eyelid of her right eye; several lenses were also found in her left eye. During further evaluation we learned that our patient had experienced severe, recurrent and painful blepharoconjunctivitis for the past 3 years, for which she had consulted several ophthalmologists and other medical practitioners. The last time our patient had inserted a contact lens was more than 3 years previously. We therefore concluded that the retained contact lenses had caused an infectious ulcer which led to a corneal perforation. The patient underwent a perforating keratoplasty, which restored the eyesight in her right eye. Removal of the retained contact lenses gave our patient relief from her severe chronic eye pain.

Randomized controlled European multicenter trial on the prevention of cystoid macular edema after cataract surgery in diabetics: ESCRS PREMED Study Report 2.

PURPOSE: To compare the efficacy of perioperative treatment strategies, in addition to topical bromfenac 0.09% and dexamethasone 0.1%, to reduce the risk for developing cystoid macular edema (CME) after uneventful cataract surgery in diabetic patients. SETTING: Twelve European study centers. DESIGN: Randomized clinical trial. METHODS: Diabetic patients having phacoemulsification cataract surgery were randomly allocated to receive no additional treatment, a subconjunctival injection with 40 mg triamcinolone acetonide, an intravitreal injection with 1.25 mg bevacizumab, or a combination of both. The main outcomes were the difference in central subfield mean macular thickness, corrected distance visual acuity, and the incidence of CME and clinically significant macular edema within 6 and 12 weeks postoperatively. RESULTS: The study comprised 213 patients. At 6 and 12 weeks postoperatively, the central subfield mean macular thickness was 12.3 µm and 9.7 µm lower, respectively, in patients who received subconjunctival triamcinolone acetonide than patients who did not (P = .007 and P = .014, respectively). No patient who received subconjunctival triamcinolone acetonide developed CME. Intravitreal bevacizumab had no significant effect on macular thickness. CONCLUSIONS: Diabetic patients who received a subconjunctival injection with triamcinolone acetonide at the end of cataract surgery had a lower macular thickness and macular volume at 6 and 12 weeks postoperatively than patients who did not. Intravitreal bevacizumab had no significant effect.

European multicenter trial of the prevention of cystoid macular edema after cataract surgery in nondiabetics: ESCRS PREMED study report 1.

PURPOSE: To compare the efficacy of a topical nonsteroidal antiinflammatory drug, topical corticosteroid, and a combination of both drugs to prevent the occurrence of cystoid macular edema (CME) after cataract surgery in nondiabetic patients. SETTING: Twelve European study centers. DESIGN: Randomized clinical trial. METHODS: Nondiabetic patients having uneventful cataract surgery were included in this study. Patients were randomized to receive topical bromfenac 0.09% twice daily for 2 weeks or dexamethasone 0.1% 4 times daily with 1 drop less per day every following week, or a combination of both. The primary outcome was the difference in central subfield mean macular thickness 6 weeks postoperatively. Secondary outcome measures included corrected distance visual acuity as well as the incidence of CME and clinically significant macular edema (CSME) within 6 weeks and 12 weeks postoperatively. RESULTS: This study comprised 914 patients. Six weeks postoperatively, the central subfield mean macular thickness was 288.3 µm, 296.0 µm, and 284.5 µm in the bromfenac group, dexamethasone group, and combination treatment group, respectively (overall P = .006). The incidence of clinically significant macular edema within 12 weeks postoperatively was 3.6%, 5.1%, and 1.5%, respectively (overall P = .043). CONCLUSION: Patients treated with a combination of topical bromfenac 0.09% and dexamethasone 0.1% had a lower risk for developing CSME after cataract surgery than patients treated with a single drug.

Risk factors for refractive error after cataract surgery: Analysis of 282 811 cataract extractions reported to the European Registry of Quality Outcomes for cataract and refractive surgery.

PURPOSE: To analyze risk factors for refractive error after cataract surgery and provide a benchmark for refractive outcomes after standard cataract surgery. SETTING: One hundred cataract surgery clinics from 12 European countries. DESIGN: Multicenter database study. METHODS: Data on consecutive cataract extractions reported to the European Registry of Quality Outcomes for Cataract and Refractive Surgery between January 1, 2014 and December 31, 2015 were analyzed in terms of demographics, preoperative corrected distance visual acuity (CDVA), target refraction, coexisting eye diseases, surgical difficulties including previous ophthalmic interventions, type of surgery, intraocular lens (IOL), and surgical complications. For clinics committed to reporting follow-up data within 7 to 60 days after surgery, postoperative CDVA and refraction were analyzed. RESULTS: Of the 548 392 cases analyzed, follow-up data were available for 282 811 cases. The absolute mean biometry prediction error in spherical equivalent was 0.42 diopters (D). A biometry prediction error within ±0.50 D was achieved for 205 675 eyes (72.7%). A biometry prediction error within ±1.0 D was achieved for 263 015 eyes (93.0%). Poor preoperative CDVA, target refraction, coexisting eye diseases, surgical difficulties including previous ophthalmic interventions, and surgical complications were in varying degrees related to a postoperative refractive error. CONCLUSIONS: Several risk factors (poor preoperative CDVA, ocular comorbidity, and previous eye surgery) were related to poor refractive outcomes after cataract extraction. When these risk factors are present, care should be taken with the preoperative examination and choice of IOL to avoid a refractive surprise. The average outcomes can be used as a refractive outcome benchmark.

Femtosecond laser-assisted cataract surgeries reported to the European Registry of Quality Outcomes for Cataract and Refractive Surgery: Baseline characteristics, surgical procedure, and outcomes.

PURPOSE: To describe a large cohort of femtosecond laser-assisted cataract surgeries in terms of baseline characteristics and the related outcomes. SETTING: Eighteen cataract surgery clinics in 9 European countries and Australia. DESIGN: Prospective multicenter case series. METHODS: Data on consecutive eyes having femtosecond laser-assisted cataract surgery in the participating clinics were entered in the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO). A trained registry manager in each clinic was responsible for valid reporting to the EUREQUO. Demographics, preoperative corrected distance visual acuity (CDVA), risk factors, type of surgery, type of intraocular lens, visual outcomes, refractive outcomes, and complications were reported. RESULTS: Complete data were available for 3379 cases. The mean age was 64.4 years ± 10.9 (SD) and 57.8% (95% confidence interval [CI], 56.1-59.5) of the patients were women. A surgical complication was reported in 2.9% of all cases (95% CI, 2.4-3.5). The mean postoperative CDVA was 0.04 ± 0.15. logarithm of the minimum angle of resolution. A biometry prediction error (spherical equivalent) was within ±0.5 diopter in 71.8% (95% CI, 70.3-73.3) of all surgeries. Postoperative complications were reported in 3.3% (95% CI, 2.7-4.0). Patients with good preoperative CDVA had the best visual and refractive outcomes; patients with poor preoperative visual acuity had poorer outcomes. CONCLUSIONS: The visual and refractive outcomes of femtosecond laser-assisted cataract surgery were favorable compared with manual phacoemulsification. The outcomes were highly influenced by the preoperative visual acuity, but all preoperative CDVA groups had acceptable outcomes.

Femtosecond laser-assisted cataract surgery versus standard phacoemulsification cataract surgery: Study from the European Registry of Quality Outcomes for Cataract and Refractive Surgery.

PURPOSE: To compare the visual, refractive, and adverse outcomes of femtosecond laser-assisted cataract surgery and conventional phacoemulsification cataract surgery. SETTING: Cataract surgery clinics in 9 European countries and Australia (femtosecond-assisted) and 18 European countries and Australia (conventional). DESIGN: Multicenter case-control study. METHODS: Eyes having femtosecond laser-assisted cataract surgery were matched to eyes from the European Registry of Quality Outcomes for Cataract and Refractive Surgery phacoemulsification cataract surgery database for preoperative corrected distance visual acuity (CDVA), age, and preoperative risk factors. Intraoperative and postoperative complications, postoperative CDVA, and refractive outcome were compared. The follow-up was 7 to 60 days. RESULTS: The study matched 2814 femtosecond-assisted cases to 4987 conventional phacoemulsification cases. Femtosecond-assisted surgery compared as follows to conventional phacoemulsification: posterior capsule complications, 0.7% versus 0.4%; postoperative logMAR CDVA, 0.05 (6/6-3) versus 0.03 (6/6-2); worse postoperative CDVA at follow-up (by 5 letters or more), 1.0% versus 0.4%; CDVA 0.3 (6/12) or better, 96.3% versus 97.1%; absolute biometry prediction error, 0.43 diopter (D) versus 0.40 D; within ±0.5 D of target, 72% versus 74.3%; and postoperative complications, 3.4% versus 2.3%. CONCLUSIONS: Femtosecond laser-assisted cataract surgery did not yield better visual or refractive outcomes than conventional phacoemulsification cataract surgery. Intraoperative complications were similar and low in both groups. Postoperative complications were lower in conventional phacoemulsification cataract surgery. FINANCIAL DISCLOSURE: None of the authors has a financial or proprietary interest in any material or method mentioned.

Cataract surgery outcomes in corneal refractive surgery eyes: Study from the European Registry of Quality Outcomes for Cataract and Refractive Surgery.

PURPOSE: To analyze visual outcomes after cataract surgery in patients with previous corneal refractive surgery. SETTING: Cataract surgery clinics in 18 European countries and Australia. DESIGN: Database study. METHODS: Cases of cataract extraction with corneal refractive surgery eyes (corneal refractive cases) were identified from all cataract extractions reported to the European Registry of Quality Outcomes for Cataract and Refractive Surgery database over a 5-year period. Preoperative and postoperative measurements and trends over time were analyzed. RESULTS: Of 807,220 cataract extractions, 1229 (0.15%) were corneal refractive cases. There was a significant increase, over time, in the number of corneal refractive cases (P < .001). Corneal refractive patients were younger than patients without corneal refractive surgery (nonrefractive patients) (62.9 years versus 74.0 years; P < .001) but had similar mean preoperative and postoperative corrected-distance visual acuity (CDVA) (preoperative logMAR 0.44[6/16] for both [P = .286]; postoperative logMAR 0.06[6/7] for both [P = .245]). Postoperative CDVA was worse than preoperative CDVA in 35 (4%) corneal refractive and 8,999 (1.5%) nonrefractive patients (P < .001). In all, 74 (8.5%) of 873 corneal refractive versus 16,566 (2.8%) /584,496 nonrefractive patients, having cataract surgery, had preoperative CDVA of logMAR 0.0[6/6] or better (P < .001). Nineteen (54.3%) of 35 corneal refractive case patients who had worse postoperative CDVA had preoperative CDVA of logMAR 0.0(6/6) or better. CONCLUSION: Cataract surgery has been reported with increasing frequency in corneal refractive surgery patients, since 2008. These patients had preoperative CDVA similar to those of patients without previous corneal refractive surgery but were younger and were at higher risk of worse postoperative CDVA, especially if they had preoperative CDVA of logMAR 0.0(6/6) or better. FINANCIAL DISCLOSURE: No author has any financial or proprietary interest in any material, or method, mentioned.

The European registry of quality outcomes for cataract and refractive surgery (EUREQUO): a database study of trends in volumes, surgical techniques and outcomes of refractive surgery.

BACKGROUND: A European web-based registry for refractive surgery was established in 2008; The European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO). The aim of the registry was to improve treatment and standards of care for refractive surgery. Further aims were to offer a tool for benchmarking by establishing a reference database and for surgeons to enter and analyze their own outcomes. The purpose of this study was to characterize the registry and analyze the data collected during its first decade. METHODS: The characteristics of the web-based registry are described. Data collected from February 4(th) 2004 until June 30(th) 2014 are included in the analysis. The database is analyzed in terms of surgical technique, indications for surgery, complications, and refractive and visual outcomes. RESULTS: Data have been reported from 47 centers in 14 countries until mid-2014. About 4,000 procedures were reported annually. The most frequent procedure was laser-assisted in-situ keratomileusis (LASIK) with 11697 reported surgeries. Over time in the database, LASIK declined (p < 0.001) while photorefractive keratectomy (PRK) and refractive lens exchange (RLE) increased (p < 0.001 for both procedures). The indications for surgery, in terms of preoperative refraction and age, were stable over time, for all types of procedures. Surgical complications were reported infrequently and with a well-known relationship to the type of surgical procedure. The reported refractive outcomes were good. The visual outcomes indicate a significant increase of visual acuity after high myopia treatment by phakic intraocular lens in the anterior (phakic IOL AC) and the posterior (phakic IOL PC) chamber and a poorer visual outcome, after both myopia and hyperopia treatment, by epithelial LASIK (Epi-LASIK). CONCLUSIONS: We describe the establishment of a European registry for refractive surgery. The database increases at a rate of approximately 4000 refractive procedures per year. The most frequent procedure is LASIK, but both PRK and RLE are an increasing part of the reported procedures. The indications for surgery have been stable over time. Surgical complications and visual outcome vary, depending on the type of surgery.