Cataract surgery outcomes: importance of co-morbidities in case mix.

Variation in patients' preoperative co-morbidities can have a significant effect on the outcomes of cataract surgery. To examine the effects of that variation, we did a retrospective study of the outcomes of extracapsular cataract surgery performed by seven surgeons. Medical records from 791 surgeries done from June 1, 1986, through May 31, 1989, were retrospectively examined. Variations in postoperative visual acuity and intraoperative and postoperative complications were documented. The relationships between preoperative ocular and systemic medical co-morbidities and postoperative visual results and complications were studied. A statistical model was developed to adjust for the preoperative co-morbidity case mix between physicians. Visual acuity rates varied by surgeon and surgical volume, but not significantly when adjusted for patient case mix.

What to do with limited view: the intumescent cataract.

In 1991, 2,967 consecutive cataract cases were analyzed in a prospective, observational study for the incidence of intumescent cataract. Thirty four (1.15%) of the cases were mature intumescent lenses. A deliberately small continuous curvilinear capsulorhexis (CCC) enlarged secondarily by the two-stage continuous curvilinear capsulorhexis (2-CCC) technique was the anterior capsulotomy approach of choice. Depending on the liquidity of the lens material, liquid cortex was aspirated using a 26- or 30-gauge needle before capsulorhexis or through a small CCC. Because of loss of CCC control, a can-opener capsulotomy was used in three of the 34 cases before being converted by the 2-CCC technique. The rigid nucleus was usually extracted using the down-slope nucleofractis phacoemulsification technique. Four (11.7%) of the 34 intumescent cases had anterior capsule tears during capsulotomy. Successful in-the-bag lens implantation was achieved in all cases. We describe a technique of CCC, 2-CCC, and down-slope sculpting nucleofractis phacoemulsification to manage intumescent cataracts.

Visual, refractive, and patient satisfaction results following bilateral photorefractive keratectomy for myopia.

Reports of the visual, refractive, and patient satisfaction results after photorefractive keratectomy (PRK) are now becoming available. The visual, refractive, and patient satisfaction results of 52 patients after bilateral excimer laser photorefractive keratectomy for myopia were studied. Patient satisfaction was measured using a five-part questionnaire. Initial patients obtained an overcorrection which necessitated adjusting the programmed correction to 75% of targeted correction.

Coronary arterial dominance associated with congenital bicuspid aortic valve.

Gross examination was done of 186 hearts, principally from adults, for the nature of the aortic valve and the source of the posterior descending coronary artery (origin from the right coronary artery indicated as right dominance, origin from the left circumflex artery as left dominance). Exclusive of cases with coarctation of the aorta, the overall incidence of left coronary dominance in cases with congenital bicuspid aortic valves was 24.4%, while in cases with tricuspid aortic valves the incidence was 9.5%. There appears to be a greater tendency for left coronary arterial dominance in coarctation of the aorta than in the general population regardless of the type of the aortic valve.