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

Transplanting embryonic stem cells onto damaged human corneal endothelium

AIM To investigate whether human embryonic stem cells (hESCs) could be made to attach, grow and differentiate on a human Descemet’s membrane (DM). METHODS Spontaneously differentiated hESCs were transferred onto a human corneal button with the endothelial layer removed using ocular sticks. The cells were cultured on a DM for up to 15 d. The genetically engineered hESC line expressed green fluorescent protein, which facilitated identification during the culture experiments, tissue preparation, and analysis. To detect any differentiation into human corneal endothelial-like cells, we analysed the transplanted cells by immunohistochemistry using specific antibodies. RESULTS We found transplanted cells form a single layer of cells with a hexagonal shape in the periphery of the DM. The majority of the cells were negative for octamer-binding transcription factor 4 but positive for paired box 6 protein, sodium potassium adenosine triphosphatase (NaKATPase), and Zona Occludens protein 1. In four of the 18 trials, the transplanted cells were found to express CK3, which indicates that the stem cells differentiated into corneal epithelial cells in these cases. CONCLUSION It is possible to get cells originating from hESCs to become established on a human DM, where they grow and differentiate into corneal endothelial-like cells in vitro.De Blindas Vänner, Gothenburg, and Greta Bergs Foundation, Lerum (to Charles Hanson); University of Akureyri Research Fund, the KEA Fund, and the Icelandic Council on Ageing (to Arsaell Arnarsson); and Gothenburg Medical Society, the Medical Faculty of the University of Gothenburg and the Herman Svensson Foundation (to Ulf Stenevi)Peer Reviewe

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

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

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

Analyzing Patient-Reported Outcomes to Improve Cataract Care.

PURPOSE: The purpose of this study was to analyze three models of how patient-reported outcome measures can be connected to clinical outcome measures in cataract surgery to identify opportunities for improvement of quality of care. METHODS: Three models were used to analyze the following questions: Is there a relationship between clinical parameters and patient-reported outcomes? (1) Is there a relationship between clinical parameters and a good or poor patient-reported outcome? (2) When and why do clinical and patient-reported outcomes diverge? (3) The study material to exemplify these models consisted of follow-up data on cataract extractions collected by the Swedish National Cataract Register in 2008 to 2011. Patient-reported outcome was measured using the Catquest-9SF questionnaire. A total of 9707 pairs of questionnaires completed before and after a cataract extraction were analyzed together with clinical data. RESULTS: Factors related to any change in patient-reported outcomes after surgery were the preoperative self-assessed visual function, the preoperative visual acuity in both eyes, the postoperative visual acuity, and ocular comorbidity. Factors related to poor patient-reported outcomes after surgery were good preoperative self-assessed visual functions, poor preoperative visual acuity in the better eye, ocular comorbidity, surgical complications, and large refractive deviation. Poor near vision after surgery was the main factor noted in situations where the clinical outcome was good and the patient-reported outcome was poor. Analyses 2 and 3 were the most useful analyses to give ideas for clinical improvement work. CONCLUSIONS: The best models to give ideas for improved quality of care by using a patient questionnaire in our study were analyzing the risk factors for a poor patient-reported outcome and analyzing the factors associated with disagreement between clinical outcomes and patient-reported outcomes