Factors impacting cumulative dissipated energy levels and postoperative visual acuity outcome in cataract surgery

BMC Ophthalmology

Kuldev Singh¹  Saras Ramanathan²  Ying Han²  Michael Ryan²  Anh D. Bui²  Yinxi Yu³  Gui-Shuang Ying³  Zhimin Sun⁴  Yunzhen Wang⁴  Shengsong Huang⁴  Yangfan Yang⁴ 

[1] Department of Ophthalmology, Stanford University, Stanford, CA, USA;Department of Ophthalmology, University of California, San Francisco, 490 Illinois Street, 94158, San Francisco, CA, USA;Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, USA;State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China;

关键词: Cataract;    Phacoemulsification;    Cumulative dissipated energy;    CDE;    Visual outcome;   

DOI  :  10.1186/s12886-021-02205-w

来源: Springer

【 摘 要 】

PurposeTo determine factors impacting cumulative dissipated energy (CDE) and postoperative best-corrected visual acuity (BCVA) in phacoemulsification.DesignReview of 1102 cases at University of California, San Francisco (UCSF) and at Zhongshan Ophthalmic Center (ZOC), China.SubjectsPatients who underwent cataract surgery at UCSF 03/2014–03/2019 and at ZOC 10/2018–05/2019.MethodsPatient demographics, medical history, routine ocular examination, and surgical information, including disassembly method, complications, and surgeon training level were recorded. Univariable and multivariable regression models were used to determine factors associated with CDE and good postoperative BCVA (20/40 or better) at 1 month.Outcome measuresCDE, postoperative BCVA.ResultsIn multivariable analysis, patient age at time of surgery, diabetes, degree of nuclear sclerosis (NS), white-to-white corneal diameter, disassembly method, preoperative BCVA, surgeon training level, and surgical center were significantly associated with CDE. Log10CDE increased by 0.20–0.31 for patient age ≥ 70 years, by 0.07 if the patient had diabetes, by 0.12–0.41 for NS grade ≥ 2, by 0.48 per 10 mm increase in white-to-white corneal diameter, by 0.34–0.47 for disassembly method other than non-stop chop, by 0.16 per unit increase in preoperative logMAR BCVA, and by > 0.09 when phacoemulsification was performed by residents early in their training. Log10CDE was 0.33 higher at UCSF than ZOC. In multivariable analysis, worse baseline visual acuity and age above 90 years at time of surgery decreased the odds of good BCVA (OR = 0.26 per unit increase in preoperative logMAR BCVA; OR = 0.12 for age > 90); comorbid retinal issues decreased the odds of good postoperative BCVA (OR = 0.13–0.39); greater anterior chamber depth (ACD) or shorter axial length (AL), increased the odds of good postoperative outcome (OR = 2.64 per 1 mm increase ACD, OR = 0.84 per 1 mm increase AL).ConclusionsCataract grade determined by slit lamp exam and, for the first time, older patient age, were noted to be important predictors of high CDE. CDE was not a risk factor for postoperative BCVA measured at postoperative 1 month. When surgery was performed by trainees under supervision, lower training level was associated with higher CDE, but not with worse postoperative BCVA.

【 授权许可】

CC BY