RESUMO
BACKGROUND: Older age is commonly associated with an increased risk of surgical complications and comparatively poor outcomes. PURPOSE: To report cataract surgery outcomes and risk indicators for patients aged 90 years and older. METHODS: Data collected as part of routine cataract care in 34 centres contributing to the United Kingdom Royal College of Ophthalmologists' National Ophthalmology Database (NOD) were analysed. Very elderly people undergoing cataract surgery were profiled in terms of demographics, pre- and postoperative best-measured visual acuity (VA), ocular co-morbidities, intraoperative posterior capsule rupture (PCR) or vitreous loss or both, and risk indicators for operative PCR and adverse VA outcome. RESULTS: 25,856 cataract operations in 19,166 people of 90 years or older between 2000 and 2014 are reported. Preoperative VA was available for 82.4% eyes, being 0.30 LogMAR or better in 21.5%. Postoperative VA was available for 61.8% eyes, being 0.30 LogMAR or better in 74.4%. For those without ocular co-morbidity, postoperative VA was 0.30 LogMAR or better in 84.7%. Various co-morbidities were present in 49% and contributed to an adverse VA outcome. PCR data were available for all operations and occurred in 2.7%. Significant risk indicators for PCR included pseudoexfoliation/phakodonesis, mature cataract, smaller pupil and worse preoperative VA. CONCLUSIONS: Slightly poorer cataract surgery outcome results were noted in patients of 90 years or older, more so in patients with ocular co-morbidity which was highly prevalent. However, surgeons should not be deterred from offering cataract surgery to the very elderly as successful visual rehabilitation remains achievable.
Assuntos
Extração de Catarata/efeitos adversos , Complicações Intraoperatórias , Oftalmologia/estatística & dados numéricos , Ruptura da Cápsula Posterior do Olho/epidemiologia , Medição de Risco/métodos , Sociedades Médicas/estatística & dados numéricos , Acuidade Visual , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Ruptura da Cápsula Posterior do Olho/etiologia , Prognóstico , Fatores de Risco , Reino Unido/epidemiologiaRESUMO
OBJECTIVES: To report outcome data on the first 5000 consecutive cataract cases at a new paperless eye unit and benchmark against the Royal College of Ophthalmologists' National Ophthalmology Database (RCOphth NOD). METHODS: Using the in-built audit tool of the electronic medical records system, data from all cataract operations performed between 1 April 2014 and 13 January 2017 were compiled. RESULTS: Five thousand and eight cases were recorded of which the overall intra-operative complication rate was 2.4%, the most common being posterior capsular rupture-1.14%. Follow-up data on post-operative complications were recorded in 98.6% of cases. Pre- and post-operative visual acuities was measured in 98.0% of cases. In all, 40.8% of eyes achieved a visual acuity of 6/6 or better and 90.7% achieved 6/12 or better. CONCLUSIONS: A data set of >5000 consecutive cataract operations was obtained in this eye department. The recording of pre- and post-operative visual acuity in 98% of cases compare very favourably to the RCOphth NOD Audit Report 2017 where pre- and post-operative visual acuities were recorded in only 57.1% of operations. Despite this difference, the outcome measures from this unit and RCOphth NOD were very similar, validating the results of the RCOphth NOD audit reports. Significantly, when applying the RCOphth NOD audit criteria for measuring post-operative visual acuity, approximately 15% of cases were excluded from the data set, reducing the completeness of the data set. Paperless ophthalmology units are feasible in today's NHS and can produce near complete cataract data sets; this can ultimately lead to more comprehensive and reliable aggregate cataract outcome data.
Assuntos
Extração de Catarata/estatística & dados numéricos , Registros Eletrônicos de Saúde/organização & administração , Complicações Intraoperatórias/epidemiologia , Oftalmologia/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Melhoria de Qualidade , Sistema de Registros , Idoso , Confiabilidade dos Dados , Feminino , Seguimentos , Humanos , Incidência , Masculino , Estudos Retrospectivos , Reino Unido/epidemiologia , Acuidade VisualRESUMO
PurposeTo develop a short, psychometrically robust and responsive cataract patient reported outcome measure suitable for use in high-volume surgical environments.MethodsA prospective study in which participants completed development versions of questionnaires exploring the quality of their eyesight using items harvested from two existing United Kingdom developed parent questionnaires. Participants were 822 patients awaiting cataract surgery recruited from 4 cataract surgical centres based in the UK. Exclusion criteria were other visually significant comorbidities and age <50 years. An iterative multi-stage process of evaluation using Rasch and factor analyses with sequential item reduction was undertaken.ResultsA definitive item set of just five items delivered performance in accordance with the requirements of the Rasch model: no threshold disordering, no misfitting items, Rasch-based reliability 0.90, person separation 2.98, Cronbach's α 0.89, good targeting of questions to patients with cataract with pre-operative item mean -0.41 logits and absence of significant floor or ceiling effects, minor deviations of item invariance, and confirmed unidimensionality. The test-re-test repeatability intra-class correlation coefficient was 0.89 with excellent responsiveness to surgery, Cohen's d -1.45 SD. Rasch calibration values are provided for Cat-PROM5 users.ConclusionsA psychometrically robust and highly responsive five-item cataract surgery patient reported outcome measure has been developed, which is suitable for use in high-volume cataract surgical services.
Assuntos
Extração de Catarata , Medidas de Resultados Relatados pelo Paciente , Psicometria/instrumentação , Inquéritos e Questionários/normas , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Estudos Prospectivos , Qualidade de Vida , Reprodutibilidade dos Testes , Reino UnidoRESUMO
Background Cataract surgery is the most frequently undertaken NHS surgical procedure. Visual acuity (VA) provides a poor indication of visual difficulty in a complex visual world. In the absence of a suitable outcome metric, recent efforts have been directed towards the development of a cataract patient-reported outcome measure (PROM) of sufficient brevity, precision, and responsiveness to be implementable in routine high volume clinical services.Aim To compare and contrast the two most promising candidate PROMs for routine cataract surgery.Method The psychometric performance and patient acceptability of the recently UK developed five-item Cat-PROM5 questionnaire was compared with the English translation of the Swedish nine-item Catquest-9SF using Rasch-based performance metrics and qualitative semistructured interviews.Results Rasch-based performance was assessed in 822 typical NHS cataract surgery patients across four centres in England. Both questionnaires demonstrated good to excellent performance for all metrics assessed, including Person Reliability Indices of 0.90 (Cat-PROM5) and 0.88 (Catquest-9SF), responsiveness to surgery (Cohen's standardized effect size) of 1.45 SD (Cat-PROM5) and 1.47 SD (Catquest-9SF) and they were highly correlated with each other (R=0.85). Qualitative assessments confirmed that both questionnaires were acceptable to patients, including in the presence of ocular comorbidities. Preferences were expressed for the shorter Cat-PROM5, which allowed patients to map their own issues to the questions as opposed to the more restrictive specific scenarios of Catquest-9SF.Conclusion The recently UK developed Cat-PROM5 cataract surgery questionnaire is shorter, with performance and patient acceptability at least as good or better than the previous 'best of class' Catquest-9SF instrument.
Assuntos
Extração de Catarata , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Medidas de Resultados Relatados pelo Paciente , Psicometria/instrumentação , Inquéritos e Questionários/normas , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Reino UnidoRESUMO
PURPOSE: To describe the relationships of axial length with ocular copathology, preoperative visual acuity, and posterior capsule rupture rates in patients undergoing cataract surgery.DesignThe Royal College of Ophthalmologists' National Ophthalmology Database (NOD) study. METHODS: Anonymised data on 180 114 eyes from 127 685 patients undergoing cataract surgery between August 2006 and November 2010 were collected prospectively from 28 sites. Data parameters included: demographics, biometry, ocular copathology, visual acuity measurements, and surgical complications including posterior capsule rupture, or vitreous loss or both (PCR). RESULTS: Consultant surgeons performed a higher proportion of operations on eyes whose axial length were at the extremes. Glaucoma and age related macular degeneration were more common in eyes with shorter axial lengths, whilst previous vitrectomy was associated with longer axial lengths. Eyes with brunescent or white cataracts or amblyopia were more common at both axial length extremes. Preoperative visual acuities were similar for eyes with axial length measurements up to approximately 28 mm and worse for eyes with longer axial length measurements. PCR rates showed little change with axial length (overall mean 1.95%, 95% CI: 1.89 to 2.01%), except for a borderline increase in eyes with axial length <20.0 mm where rates were 3.6% (95% CI: 2.0 to 6.3%). The likelihood of PCR in eyes with axial length <20.0 mm was 1.88 times higher than those of ≥20.0 mm (P=0.0373). CONCLUSION: Rates of ocular comorbidities vary by axial length. PCR rates in eyes with very short or long axial lengths were lower than expected.
Assuntos
Comprimento Axial do Olho/patologia , Extração de Catarata/estatística & dados numéricos , Bases de Dados Factuais , Oftalmopatias/epidemiologia , Oftalmologia/estatística & dados numéricos , Ruptura da Cápsula Posterior do Olho/epidemiologia , Acuidade Visual/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Estudos Prospectivos , Sociedades Médicas , Reino Unido , Corpo Vítreo/patologiaRESUMO
AIMS: To describe the outcomes of cataract surgery in the United Kingdom. METHODS: Anonymised data on 180 114 eyes from 127 685 patients undergoing cataract surgery between August 2006 and November 2010 were collected prospectively from 28 sites. Outcome measures included intraoperative and postoperative complication rates, and preoperative and postoperative visual acuities. RESULTS: Median age at first eye surgery was 77.1 years, 36.9% cases had ocular co-pathology and 41.0% patients underwent cataract surgery on both eyes. Preoperative visual acuity was 0.30 logMAR or better in 32.0% first eyes and 47.7% second eyes. Postoperative best-measured visual acuity was 0.00 and 0.30 logMAR or better in 50.8 and 94.6% eyes without ocular co-pathology, and 32.5 and 79.9% in eyes with co-pathology. For eyes without co-pathology, postoperative uncorrected distance visual acuity was 0.00 and 0.30 logMAR or better in 27.3 and 80.9% eyes. Posterior capsule rupture or vitreous loss or both occurred in 1.95% cases, and was associated with a 42 times higher risk of retinal detachment surgery within 3 months and an eight times higher risk of endophthalmitis. CONCLUSION: These results provide updated data for the benchmarking of cataract surgery. Visual outcomes, and the rate of posterior capsule rupture or vitreous loss or both appear stable over the past decade.
Assuntos
Extração de Catarata/efeitos adversos , Extração de Catarata/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Humanos , Complicações Intraoperatórias , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Ruptura da Cápsula Posterior do Olho/etiologia , Complicações Pós-Operatórias , Estudos Prospectivos , Reino Unido , Acuidade Visual , Descolamento do Vítreo/etiologiaRESUMO
AIMS: To report estimates of the prevalence of diabetic retinopathy (DR) and maculopathy grades for a large cohort of patients managed by the UK hospital eye service (HES). METHODS: Anonymised data were extracted from 30 UK NHS hospital trusts using a single ophthalmic electronic medical record (EMR) for the period from April 2000 to November 2010 to create the National Ophthalmology Database (NOD). From 2007, the EMR facilitated capture of a nationally agreed-upon standardised data set (DR Structured Assessment) relating to the presence or absence of clinical signs of DR and maculopathy. An algorithm in the software automatically calculated the Early Treatment of Diabetic Retinopathy Study grades of retinopathy and maculopathy. RESULTS: Between 2007 and 2010, 307,538 patients had data on the NOD, with 76,127 (24.8%) patients having been recorded as having diabetes. The proportion of patients with diabetes who had a structured assessment increased from 50.7% (2007) to 86.8% (2010). In each NHS year, 12.6-20.6% of eyes with structured assessments had no DR; 59.6-67.3% had non-proliferative DR; and 18.3-20.9% had active or regressed proliferative DR. Clinically significant macular oedema was present in 15.8-18.1% of eyes, and in 8.7-10.0% of eyes, this involved the central macula. CONCLUSION: This study provides contemporary estimates of the prevalence of retinopathy and maculopathy grades in a large cohort of patients with diabetes managed by the UK HES. Centre-involving diabetic macular oedema, potentially amenable to anti-VEGF therapy, is present in the eyes of almost 10% of these patients. This information is useful for clinicians, health-care economists, and commissioners involved in planning and delivering diabetic eye services.
Assuntos
Retinopatia Diabética/epidemiologia , Edema Macular/epidemiologia , Oftalmologia/estatística & dados numéricos , Medicina Estatal/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Bases de Dados Factuais , Retinopatia Diabética/classificação , Registros Eletrônicos de Saúde , Feminino , Departamentos Hospitalares , Humanos , Lactente , Edema Macular/classificação , Masculino , Pessoa de Meia-Idade , Prevalência , Reino Unido/epidemiologia , Adulto JovemRESUMO
AIM: To report the vitreoretinal (VR) surgical case mix in the United Kingdom, the intraoperative complication rate of pars plana vitrectomy (PPV), and the incidence of post-vitrectomy cataract extraction. METHODS: Participating hospitals prospectively collected ophthalmic data using a single electronic medical record system, with automatic extraction of anonymised data to a national database. This study included the subset of 11618 VR operations undertaken on 9619 eyes, of 8741 patients, over 8 years, from 27 sites. Surgical data included the indication for surgery, all procedure elements, and whether or not an intraoperative complication occurred. Post-vitrectomy cataract data were also analysed. The main outcome measures were a description of the indications for surgery, intraoperative PPV complication rate, and percentage of eyes undergoing post-vitrectomy cataract surgery (PVCS). RESULTS: The most common indications for VR intervention were retinal breaks and rhegmatogenous retinal detachment (48.5%), macular hole (9.8%), epiretinal membrane (9.6%), and diabetic eye disease (7.3%). Overall, 7.8% of PPVs had at least one intraoperative complication-the most common were iatrogenic retinal breaks (3.2%), and lens touch (1.2-1.6% of phakic eyes). PVCS occurred in 50.2, 68.7, and 74.0% of eyes at 1, 2, and 3 years, respectively. CONCLUSION: VR surgery is undertaken for a wide range of conditions, but a small number of diagnoses encompass the majority of cases. Intraoperative PPV complications are not uncommon, and post-vitrectomy cataract is to be expected in most phakic eyes.
Assuntos
Extração de Catarata/estatística & dados numéricos , Complicações Intraoperatórias , Vitrectomia , Idoso , Feminino , Humanos , Incidência , Complicações Intraoperatórias/epidemiologia , Complicações Intraoperatórias/etiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Prospectivos , Reino Unido/epidemiologia , Vitrectomia/efeitos adversos , Vitrectomia/métodosRESUMO
AIMS: To report risk factors for visual acuity (VA) improvement and harm following cataract surgery using electronically collected multi-centre data conforming to the Cataract National Dataset (CND). METHODS: Routinely collected anonymised data were remotely extracted from the electronic patient record systems of 12 participating NHS Trusts undertaking cataract surgery. Following data checks and cleaning, analyses were performed to identify risk indicators for: (1) a good acuity outcome (VA 6/12 or better), (2) the pre- to postoperative change in VA, and (3) VA loss (doubling or worse of the visual angle). RESULTS: In all, 406 surgeons from 12 NHS Trusts submitted data on 55,567 cataract operations. Preoperative VA was known for 55,528 (99.9%) and postoperative VA outcome for 40,758 (73.3%) operations. Important adverse preoperative risk indicators found in at least 2 of the 3 analyses included older age (3), short axial length (3), any ocular comorbidity (3), age-related macular degeneration (2), diabetic retinopathy (3), amblyopia (2), corneal pathology (2), previous vitrectomy (2), and posterior capsule rupture (PCR) during surgery (3). PCR was the only potentially modifiable adverse risk indicator and was powerfully associated with VA loss (OR=5.74). CONCLUSION: Routinely collected electronic data conforming to the CND provide sufficient detail for identification and quantification of preoperative risk indicators for VA outcomes of cataract surgery. The majority of risk indicators are intrinsic to the patient or their eye, with a notable exception being PCR during surgery.
Assuntos
Extração de Catarata/normas , Competência Clínica/normas , Registros Eletrônicos de Saúde/estatística & dados numéricos , Auditoria Médica/estatística & dados numéricos , Programas Nacionais de Saúde/estatística & dados numéricos , Oftalmologia/normas , Acuidade Visual/fisiologia , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Inglaterra/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade da Assistência à Saúde , Fatores de RiscoRESUMO
AIMS: To develop a methodology for case-mix adjustment of surgical outcomes for individual cataract surgeons using electronically collected multi-centre data conforming to the cataract national data set (CND). METHODS: Routinely collected anonymised data were remotely extracted from electronic patient record (EPR) systems in 12 participating NHS Trusts undertaking cataract surgery. Following data checks and cleaning, analyses were carried out to risk adjust outcomes for posterior capsule rupture rates for individual surgeons, with stratification by surgical grade. RESULTS: A total of 406 surgeons from 12 NHS Trusts submitted data on 55,567 cataract operations between November 2001 and July 2006 (86% from January 2004). In all, 283 surgeons contributed data on >25 cases, providing 54,319 operations suitable for detailed analysis. Case-mix adjusted results of individual surgeons are presented as funnel plots for all surgeons together, and separately for three different grades of surgeon. Plots include 95 and 99.8% confidence limits around the case-mix adjusted outcomes for detection of surgical outliers. CONCLUSIONS: Routinely collected electronic data conforming to the CND provides sufficient detail for case-mix adjustment of cataract surgical outcomes. The validation of these risk indicators should be carried out using fresh data to confirm the validity of the risk model. Once validated this model should provide an equitable approach for peer-to-peer comparisons in the context of revalidation.
Assuntos
Extração de Catarata/normas , Competência Clínica/normas , Complicações Intraoperatórias/epidemiologia , Oftalmologia/normas , Ruptura da Cápsula Posterior do Olho/epidemiologia , Extração de Catarata/estatística & dados numéricos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Inglaterra/epidemiologia , Humanos , Auditoria Médica , Oftalmologia/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Qualidade da Assistência à Saúde , Risco AjustadoRESUMO
AIMS/PURPOSE: To determine the prevalence of age-related maculopathy (ARM) and age-related macular degeneration (AMD) in men aged 65-83 years living in the Speedwell region of Bristol, United Kingdom and identify modifiable risk factors. METHODS: A total of 2348 men recruited to the Speedwell prospective cohort study in 1979 were followed up in 1997 with an eye questionnaire and had retinal photographs that were assessed using the International Classification System for ARM. RESULTS: In all, 934 men (66.8% response rate) attended with a mean of 17.9 years (15.3-20.6 years) follow-up. Early ARM (grades 2-3) was found in 9.2% (95% confidence interval (CI) 7.4%, 11.4%) and late age-related maculopathy (grade 4, AMD) in 0.5% (95% CI 0.2%, 1.2%). The risk of ARM (grades 2-4) was increased with raised C-reactive protein and consumption of lard and solid fats, whereas triglyceride levels were associated with a lower risk. The latter were confirmed in multivariable analyses and in addition, haemodynamic measures also predicted risk (eg mean arterial pressure odds ratio (OR) per z-score 1.37, 95% CI 1.04, 1.79). CONCLUSIONS: In a representative cohort of men aged 65-83 from Bristol, United Kingdom, many had macular changes that put them at higher risk of developing AMD. Various modifiable exposures were associated with an increased risk ARM/AMD. Opportunities for screening and undertaking secondary prevention interventions need to be explored to prevent progression of the disease and blindness.
Assuntos
Degeneração Macular/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Seguimentos , Humanos , Degeneração Macular/etiologia , Masculino , Análise Multivariada , Prevalência , Fatores de Risco , Reino Unido/epidemiologiaRESUMO
PURPOSE: Calculation of intraocular lens (IOL) power for implantation during cataract surgery depends on ocular biometric measurements. The aim of this study was to characterise the normal range of intra- and interindividual variation in axial length (AL) and corneal power (K) when IOLMaster measurements were possible and to derive recommendations as to which outlying measurements merit verification before acceptance. METHODS: The Medisoft electronic patient database contains prospectively collected data conforming to the United Kingdom (UK) Cataract National Dataset on 55,567 cataract operations. From this AL and K information on the 32,556 eyes (14,016 paired) of patients older than 25 years, without corneal pathology, history of intraocular surgery and who had all biometric measurements taken with the Zeiss IOLMaster (Carl Zeiss Meditec) were extracted. R 2.8.1 (R Foundation for Statistical Computing) was used for statistical analysis. RESULTS: Mean age was 76.4 years and 62.0% were female. Mean (95% confidence interval) values for AL, mean K and corneal astigmatism were 23.40 (21.27-26.59) mm, 43.90 (40.94-47.01) D and 1.04 (<2.50) D. Nearly all astigmatism was either with or against the rule. Differences between paired eyes were not statistically significant. 95% individuals had asymmetry of AL and mean K<0.70 mm and 0.92 D, respectively. CONCLUSIONS: On the basis of approximation of the 95% CI above, it is suggested that AL, mean K and keratometric astigmatism measurements outside the ranges 21.30-26.60 mm, 41.00-47.00 D and >2.50 D, respectively, and intraindividual asymmetry of AL >0.70 mm or mean K>0.90 D should be verified before acceptance.
Assuntos
Extração de Catarata , Implante de Lente Intraocular , Lentes Intraoculares , Refração Ocular , Idoso , Idoso de 80 Anos ou mais , Astigmatismo/etiologia , Comprimento Axial do Olho , Biometria , Auditoria Clínica , Córnea/anatomia & histologia , Feminino , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Reino UnidoRESUMO
AIMS: To demonstrate variations in posterior capsule rupture (PCR) rate between surgeons of the same and different grades as a by-product of routine clinical care. METHOD: NHS departments using electronic medical record (EMR) systems to collect the Cataract National Dataset (CND) were invited to submit data. Data were remotely extracted, anonymised, assessed for conformity and completeness, and analysed for rates of PCR for individual surgeons within each of the three grades. RESULTS: Data were extracted on 55,567 cataract operations performed at 12 NHS trusts by 406 surgeons between November 2001 and July 2006. Data on the grade of 404 of the 406 surgeons who contributed to the study were available for 55,515 cases (99.9%) and were used for this analysis. Variation in PCR rate between surgeons was highest for the most junior grade of surgeon and between those surgeons contributing relatively few cases to the data set. Variation in PCR was lowest among experienced surgeons contributing large numbers of cases to the data set. CONCLUSIONS: Considerable variation in PCR rate exists both between and within surgical grades. Routine electronic collection of the CND allows detailed analysis of variations in PCR rates between individual surgeons. To define acceptable limits for this benchmark complication of cataract surgery, further work is needed to adjust surgeons' outcomes for the case mix complexity.
Assuntos
Extração de Catarata/efeitos adversos , Competência Clínica/normas , Implante de Lente Intraocular/efeitos adversos , Cápsula Posterior do Cristalino/lesões , Ruptura/etiologia , Auditoria Clínica , Competência Clínica/estatística & dados numéricos , Estudos Transversais , Humanos , Incidência , Estudos Prospectivos , Medicina Estatal , Reino Unido/epidemiologiaRESUMO
AIMS: To pilot the use of the Cataract National Dataset (CND) using multi-centre data from Electronic Patient Record (EPR) systems and to demonstrate the ability of the CND to deliver certain of its intended benefits, including detailed preoperative profiling of cataract surgery patients and updating of benchmark standards of care in the NHS and beyond. METHODS: NHS departments using EPR systems to collect a minimum preoperative, anaesthetic, operative and postoperative data set, the CND, were invited to submit data, which were remotely extracted, anonymised, assessed for conformity and completeness, and analysed. RESULTS: Four-hundred and six surgeons from 12 NHS Trusts submitted data on 55,567 cataract operations between November 2001 and July 2006 (86% from January 2004). Mean age (SD) was 75.4 (10.4) years, 62.0% female. Surgery was for first eyes in 58.5%, under local anaesthesia in 95.5% and by phacoemulsification in 99.7%. Trainees performed 33.9% of operations. Preoperative visual acuity (VA) was 6/12 or better in 42.9% eyes overall, in 35.3% first eyes and in 55.3% second eyes. Complication rates included the following: posterior capsule rupture and/or vitreous loss of 1.92%, simple zonule dialysis of 0.46% and retained lens fragments of 0.18%. Postoperative VA of 6/12 or better (and 6/6 or better) was achieved for 91.0% (45.9%) of all eyes, 94.7% (51.0%) of eyes with no co-pathologies and 79.9% (30.2%) of eyes with one or more co-pathologies respectively. CONCLUSIONS: The CND is fit for purpose, is able to deliver useful benefits and can be collected as part of routine clinical care via EPR systems. This survey confirms shifts in practice since the 1997-1998 UK National Survey with full conversion to phacoemulsification, better preoperative acuity, a halving of the surgical 'index' benchmark complication of posterior capsule rupture and/or vitreous loss, and improved VA outcomes.
Assuntos
Extração de Catarata/normas , Catarata/fisiopatologia , Idoso , Anestesia/estatística & dados numéricos , Extração de Catarata/estatística & dados numéricos , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Humanos , Masculino , Auditoria Médica , Oftalmologia/estatística & dados numéricos , Cuidados Pré-Operatórios , Padrões de Referência , Reino Unido , Transtornos da Visão/fisiopatologia , Acuidade Visual/fisiologiaRESUMO
AIMS: The vulnerability of the eye means that ocular air gun injuries figure prominently in the medical literature. This Study reports the results of the first ocular air gun injury surveillance study. METHODS: Ocular air gun injuries were reported to the British Ophthalmic Surveillance Unit (BOSU; United Kingdom and Eire) for the period November 2001-December 2002 (13 months). Two questionnaires were used to collect demographic details, circumstances of injury, details of injuries, medical management and outcome. RESULTS: A total of 105 initial and 99 follow-up questionnaires were returned. Eighty-six ocular air gun injuries occurred during the last 12 months of surveillance yielding a corrected, estimated incidence of 91-115 injuries/year. Injuries were most frequent in August/September, and 90% (95/105) of victims were men with mean age of 17.5 years (74% under 18 years). In all, 40% (32/81) of injuries occurred at home and 53% (43/81) in a public place. 23% (19/84) of injuries were deliberate, 66% (69/104) of injuries were severe and 20% (21/105) resulted in ruptured globes. In all, 54% (48/89) required hospital admission and 41 required surgery. A total of 11% (12/105) of eyes were either enucleated or eviscerated. Final visual acuity was
Assuntos
Ferimentos Oculares Penetrantes/epidemiologia , Ferimentos por Arma de Fogo/epidemiologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Ar Comprimido , Ferimentos Oculares Penetrantes/etiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Vigilância da População , Inquéritos e Questionários , Reino Unido/epidemiologia , Adulto JovemRESUMO
AIMS: To compare the quality of referrals and listing rates of direct optometric referrals vs traditional GP referrals for cataract surgery. METHODS: A retrospective cohort of 124 patients referred for cataract surgery was identified (62 via optometric pathway and 62 via GP pathway). The quality of the referral was assessed by establishing if it contained adequate information relating to the College of Optometrists' referral framework document. Age, sex, drug history, listing rate, operative rate, and visual acuity (best corrected) at referral and at the postoperative visit were recorded and compared between the two referral pathways using the Fisher's exact test. RESULTS: Optometric referrals, relative to GP referrals, were more likely to include information relating to objective visual loss (100 vs 87%, P=0.0061) and to counsel the patient (97 vs 18%, P=0.0001). GP referrals, relative to optometric referrals, were more likely to comment on personal circumstances (32 vs 3%, P=0.0001), past medical history (95 vs 68%, P=0.0001), and drug history (94 vs 69%, P=0.0009). Operative rates were higher for the optometric direct referrals relative to GP referrals (87 vs 69%, P=0.0284). There was no difference in the visual acuity before or after surgery between the pathways. CONCLUSIONS: Optometric direct cataract referrals provide better information on objectively measured vision and better delivery of preoperative counselling. Traditional GP referrals contain better medical history, drug information, and details of personal circumstances. Rates of surgery were slightly higher with optometric referrals.
Assuntos
Extração de Catarata , Medicina de Família e Comunidade/organização & administração , Optometria/organização & administração , Encaminhamento e Consulta/organização & administração , Idoso , Idoso de 80 Anos ou mais , Catarata/complicações , Catarata/fisiopatologia , Extração de Catarata/estatística & dados numéricos , Procedimentos Clínicos/organização & administração , Feminino , Humanos , Masculino , Prontuários Médicos/normas , Pessoa de Meia-Idade , Estudos Retrospectivos , Transtornos da Visão/diagnóstico , Transtornos da Visão/etiologia , Acuidade VisualRESUMO
AIMS: This study aims to establish the prevalence of aspirin, dipyridamole, clopidogrel, and warfarin use in patients undergoing cataract surgery, and to compare local anaesthetic and intraoperative complication rates between users and non-users. METHODS: The Cataract National Dataset was remotely extracted and anonymised on 55,567 operations at 12 NHS Trusts using electronic patient records (EPRs) between 2001 and 2006. RESULTS: This report analyses 48,862 of the 55,567 operations from the eight centres, which routinely recorded a drug history. In all, 28.1% of the 48,862 patients were taking aspirin, 5.1% warfarin, 1.9% clopidogrel, and 1.0% dipyridamole. The recording of any complication of a sharp needle or subtenon's cannula local anaesthetic block was increased in patients taking clopidogrel, 8.0% (P<0.0001) or warfarin, 6.2% (P=0.0026) vs non-users, 4.3%, but no increase in potentially sight-threatening complications was identified. The incidence of subconjunctival haemorrhage was increased in patients taking clopidogrel, 4.4% (P<0.0001) or warfarin, 3.7% (P<0.0001) vs non-users, 1.7%. The recording of any operative complication was increased in those taking clopidogrel, 7.3% (P=0.0002) vs non-users, 4.4%, but the haemorrhagic operative complications of choroidal/suprachoroidal haemorrhage and hyphaema were not significantly increased. The non-haemorrhagic complication of posterior capsular rupture (PCR) was increased in those taking clopidogrel, 3.23% (P=0.0057) vs non-users, 1.77%. CONCLUSIONS: Clopidogrel or warfarin use was associated with a significant increase in minor complications of sharp needle and subtenon's cannula local anaesthesia but was not associated with a significant increase in potentially sight-threatening local anaesthetic or operative haemorrhagic complications.
Assuntos
Anestésicos Locais/efeitos adversos , Anticoagulantes/efeitos adversos , Extração de Catarata , Complicações Intraoperatórias/induzido quimicamente , Inibidores da Agregação Plaquetária/efeitos adversos , Idoso , Aspirina/efeitos adversos , Perda Sanguínea Cirúrgica , Extração de Catarata/estatística & dados numéricos , Hemorragia da Coroide/induzido quimicamente , Clopidogrel , Dipiridamol/efeitos adversos , Hemorragia Ocular/induzido quimicamente , Humanos , Cápsula do Cristalino/lesões , Fatores de Risco , Ruptura , Ticlopidina/efeitos adversos , Ticlopidina/análogos & derivados , Varfarina/efeitos adversosRESUMO
BACKGROUND: Higher or equal rates of mortality are associated with cataract surgery compared with the general population. Cataract surgery has advanced, and the clinical characteristics of the patient undergoing cataract surgery have changed. AIMS: To reinvestigate survival following cataract surgery. METHOD: Survival data were gathered up to the end of 2006 on 933 consecutive patients who underwent cataract surgery between December 2000 and February 2001. These data were compared with national and regional mortality figures, and standardised mortality ratios (SMR) were calculated. RESULTS: After adjusting for age and sex, there was a statistically significant reduced mortality compared with national (SMR = 0.88 (95% CI 0.79 to 0.99)) and regional figures (SMR = 0.87 (95% CI 0.78 to 0.98)). CONCLUSION: All previous studies found decreased survival among cataract surgery cohorts. These data differ from data at earlier times, as cataract surgery seems to be associated with increased survival. This illustrates the need for continual re-evaluation of accepted medical knowledge in the light of changes in practice and population demographics.