‘Marked improvement’ in U.K. cataract surgery outcomes, survey finds

LISBON, Portugal — A nationwide survey of cataract surgery outcomes in the United Kingdom found a “marked improvement” compared with 1997 data, according to a physician involved with the study.

“A continuous prospective collection of data from National Health Service departments is being carried out throughout the country,” said Robert Johnston, MD, at the European Society of Cataract and Refractive Surgeons meeting. “We have so far analyzed the outcomes of 16,541 operations for age-related cataract. While the first stage of the survey was focused on preoperative data, the second part is dealing with outcomes, namely anesthetic complications, intraoperative and postoperative complications and postoperative visual acuity.”

A preliminary analysis of the data showed that phacoemulsification is currently performed in 99% of cases, compared with only 77% in 1997 and just over 5% in 1991.

The frequency of the five most commonly occurring intraoperative complications (posterior capsular rupture with or without vitreous loss, dropped nucleus, incomplete cortical cleanup and hyphema) fell from 7.5% in 1997 to 5.08% in 2002-2003. According to Dr. Johnston, a dramatic decrease in posterior capsular rupture from 4.4% to 1.35% is probably due to surgeons becoming more familiar with phaco techniques over the past decade.

Visual acuity results have slightly improved over the years, he said.

“A significant trend towards better outcomes when cataract surgery is performed at a relatively younger age could be an indication for lowering the threshold for cataract surgery,” Dr. Johnston noted.

While the overall frequency of postoperative complications dropped from 23% to 2.4%, the rate of endophthalmitis was substantially unchanged, with a slight decrease from 0.1% in 1997 to 0.03% in 2002-2003.

The survey was carried out across hospital eye departments in the United Kingdom using specialty-specific electronic clinical systems.

“This survey is the first collaborative study using electronic records through out the U.K.,” Dr. Johnston said. “The number of participants is constantly growing, and now we can probably rely on 60,000 to 70,000 cases per year, which will build a huge database with detailed records of every single cataract patient.”