White, Hypermature And Brunescent Cataracts: How Good Are We? Complication Rate And Compliance To Uk Standards
Published 2024 - 42nd Congress of the ESCRS
Reference: PPE1.01 | Type: ESONT Abstract | DOI: 10.82333/g689-s346
Authors: Kamal El-Badawi* 1 , Harrison Game 2 , Panos Vouzounis 3 , Parvin Begum 4 , Kwabena Frimpong-Ansah 3 , Tomas Cudrnak 3
1Queen Elizabeth The Queen Mother Hospital,Margate,United Kingdom, 2Fairfield General Hospital,Greater Manchester,United Kingdom, 3Ophthalmology,University Hospitals Plymouth,Plymouth,United Kingdom, 4University Hospitals Plymouth,Plymouth,United Kingdom
Purpose
The National Cataract Dataset (NCD) audit uses posterior capsule rupture (PCR) rate and visual acuity (VA) to define the standard of care and assess surgical quality. High-volume cataract lists, involving private providers and surgical training, pose challenges. The Royal College of Ophthalmologists' high volume cataract surgery risk stratification tool allocates white, hypermature or brunescent cataracts a score of two, which could end up in high-volume theatre lists without an anaesthetist. We aim to increase patient safety and surgical trainee involvement
Setting
University Hospitals Plymouth
Methods
Between 2017 and 2022, 110 eyes were operated on at Plymouth’s Royal Eye Infirmary (REI). Pre-operative metrics: patient demographics, urgency listing, additional risk factors. Surgical metrics: surgeon training level, anaesthetist presence. Successful outcomes assessed using VA cutoff of 6/12, PCR rate, ECCE conversion, and anterior vitrectomy post-op. Data analysed against NCD audit. Inclusion criteria: patients with mature cataracts operated at Plymouth’s REI
Results
Average age was 73.2 years. Of the 110 cases, consultant-level surgeons performed 96.4% and trainees 3.6%. Urgent cases constituted 44.5%, and 68.2% had an anaesthetist. 40% had additional risk factors. Post-op VA of 6/12 or better was achieved in 70.9. Of the 19.1% that didn’t achieve 6/12, 77.3% had a guarded prognosis. The overall complication rate was 6.4%, exceeding NCD data, with 7.26% being converted to ECCE and 3.64% requiring post-op anterior vitrectomies
Conclusions
Mature cataracts require urgent categorisation to mitigate complications. Our audit highlights the need to prevent multiple complex cases entering lists without an anaesthetist through a local cataract operating list template. The Royal College of Ophthalmologists’ risk stratification tool enhances patient safety and trainee learning. Triaging mature cataract surgeries aligns with NCD recommendations. Urgent categorization and strategic risk mitigation enhance patient outcomes and provide valuable learning opportunities for trainees