Impact Of Structured Preoperative Risk Stratification On Visual And Safety Outcomes In Cataract Surgery: Retrospective Quality Improvement Study

Evaluate the effect of implementing a structured preoperative risk stratification protocol on combined visual and safety outcomes in routine cataract surgery.

Private eye hospital " excellence clinique ophtalmologique"  Algiers, Algeria.

This retrospective comparative study included 200 consecutive eyes undergoing phacoemulsification over a five-month period(September 2024- February 2025). One hundred eyes were operated before and 100 after implementation of a preoperative risk stratification protocol. The protocol incorporated  biometric verification, systematic ocular examination, risk assessment, surgical complexity grading,and preoperative surgical checklist. Inclusion criteria were: age-related cataract, availability of complete eye examination and biometry recording , and minimun one-month postoperative follow-up. Exclusion criteria included combined surgical procedures, previous corneal refractive surgery, advanced ocular comorbidities and incomplete follow-up data.

the primary endpoint was a combined outcome defined as achievement of CDVA >20/25, absence of intraoperative or early postoperative complications. Secondary endpoints included posterior capsular rupture and refractive surprise >1,00 D. The proportion of eyes achieving the combined endpoint improved from 68% to 84% after protocol integration. Posterior capsular rupture decreased from 3% to 1%. Refractive surprise was decreased from 12% to 5%. Overall visual predictibility and surgical safety improved following stucturd preoperative assessment

Implementation of a structured preoperative risk stratification protocol was associated with significative improvemet in combined visual and safety outcomes. Systematic preoperative evaluation and checklist integration represent practical quality improvement strategies in high volume cataract surgery.