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Vol. 93. Issue 6.
Pages 274-282 (June 2018)
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Vol. 93. Issue 6.
Pages 274-282 (June 2018)
Original article
DOI: 10.1016/j.oftale.2018.03.003
Audit of cataract surgery in Cadiz: Visual outcomes and complications
Auditoría de la cirugía de catarata senil en Cádiz: resultados visuales y complicaciones
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L. Royo-Dujardina,d,
Corresponding author
lroyodujardin@yahoo.es

Corresponding author.
, E. Alcalde-Vílcheza, E. Rodríguez-de la Rúab, J.P. Novalbos-Ruizc
a Unidad de Gestión de Oftalmología, Hospitales Universitarios Puerta del Mar y Puerto Real, Cádiz, Andalucía, Spain
b Unidad de Gestión de Oftalmología, Hospitales Universitarios Virgen Macarena y Virgen del Rocío, Sevilla, Andalucía, Spain
c Departamento de Biomedicina, Biotecnología y Salud Pública, Universidad de Cádiz, Cádiz, Andalucía, Spain
d Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
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Tables (7)
Table 1. Distribution of subjects per cataract type in order of surgery.
Table 2. Percentage of patients with post-surgery complications analyzed by age group, presurgery visual acuity (VA), physical comorbidity, hyper-mature cataract and pseudoexfoliation.
Table 3. Degree of presurgery midriasis of patients in pharmacological treatment with anti-prostatics. Absent=0, scarce=1, medium=2, total=3.
Table 4. Post-surgery visual acuity readings one month after surgery (logMAR) per order of surgery and surgeon experience.
Table 5. Mean presurgery and post-surgery visual acuity and difference obtained after surgery (logMAR) per sociodemographic, clinic and surgical characteristics.
Table 6. Percentage of patients who reached visual acuity of 1.00, 0.40, 0.30 and 0.10logMAR one month after surgery.
Table 7. Differences between the Ophthalmology Units of Puerta del Mar-Puerto Real University hospitals (HUPM-PR) and the audit of the British Ophthalmologists Society (RCOpht NOD9).
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Abstract
Objective

To publish the outcomes and complications of age-related cataract surgery in Cadiz (Spain). Due to the lack of national audits, a comparison was made between the results obtained here and those of the most recent European audit, EUREQUO (2013), and the British audit RCOphth NOD (2015).

Methods

A prospective, longitudinal, before-after study of 312 patients undergoing cataract surgery in the University Hospitals of Puerta del Mar and Puerto Real (Cadiz), in 2013–14. Outcome measurements included sociodemographic characteristics, visual acuity (VA), symptoms secondary to cataract, ocular comorbidity, waiting time, expertise of surgeon (consultant vs. trainee), rate and type of surgical complications.

Results

The median age at surgery was 73.92±7.31. Almost all (98.3%) of patients at consultation had a VA ≥0.60logMAR, with a mean pre-surgical VA of 1.01logMAR (0.92–1.10). There was a 6.7% complication rate, with 3.8% posterior capsule ruptures and 2.8% corneal decompensations. No cases of endophthalmitis occurred. The mean post-operative VA was 0.28logMAR (0.22–0.33). More than three-quarters (78.8%) of cases achieved a post-operative VA0.3logMAR, and 27.6% of cases achieved a VA0.0logMAR.

Conclusions

Our success rate was inferior to the EUREQUO and RCOphth NOD studies, with the percentage of patients acquiring a postoperative VA0.3logMAR being 98% and 89%, respectively. However, the populations were not comparable. It is hoped that this study will encourage other public hospitals in Spain to undertake audits and share their results, in order to provide a tool for constructive criticism and quality improvement initiatives.

Keywords:
Cataract extraction
Treatment outcome
Visual acuity
Intraoperative complications
Postoperative complications
Public hospitals
Spain
Resumen
Objetivo

Dar a conocer los resultados y complicaciones de la cirugía de catarata senil en Cádiz. A falta de auditorías nacionales, comparamos nuestros resultados con la más reciente auditoría europea EUREQUO (2013) y con la auditoría británica RCOphth NOD (2015).

Métodos

Estudio longitudinal, prospectivo, antes-después de 312 pacientes intervenidos de cataratas en los Hospitales Universitarios Puerta del Mar y Puerto Real, en 2013-14. Variables recogidas: características sociodemográficas, agudeza visual (AV), síntomas secundarios a la catarata, comorbilidad ocular, tiempo de espera, preparación del cirujano (adjunto vs. residente), tasa y tipos de complicaciones quirúrgicas.

Resultados

La edad media de los pacientes fue de 73,92±7,31años. El 98,3% partieron de una AV ≥0,60logMAR (≤0,25decimal). La AV media preoperatoria fue de 1,01logMAR (0,92-1,10), equivalente a 0,20decimal (0,18-0,21). La tasa de complicaciones fue del 6,7%, con un 3,8% de roturas de cápsula posterior y un 2,8% de descompensaciones corneales. No se registraron casos de endoftalmitis. La AV media postoperatoria fue de 0,28logMAR (0,22-0,33), equivalente a 0,67decimal (0,64-0,70). El 78,8% de los pacientes intervenidos adquirieron una AV ≤0,3logMAR tras la cirugía (≥0,50decimal), y el 27,6% una AV ≤0,0logMAR (≥1,0decimal).

Conclusiones

Obtuvimos resultados inferiores a los del EUREQUO y a los del RCOphth NOD, donde se reporta una AV posquirúrgica ≤0,3logMAR (≥0,50decimal) en el 98 y en el 89% de los pacientes, respectivamente. Sin embargo, las poblaciones estudiadas son diferentes. Esperamos con nuestro estudio animar a otros hospitales públicos españoles a realizar auditorías y compartir resultados, como herramienta de autocrítica y mejora.

Palabras clave:
Extracción de catarata
Resultados del tratamiento
Agudeza visual
Complicaciones intraoperatorias
Complicaciones postoperatorias
Hospitales públicos
España

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