| 1. |
- Bro, Tomas, et al.
(författare)
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Two point four million cataract surgeries: 30 years with the Swedish National Cataract Register, 1992-2021
- 2023
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Ingår i: Journal of cataract and refractive surgery. - : Wolters Kluwer. - 1873-4502 .- 0886-3350. ; 49:8, s. 879-884
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Tidskriftsartikel (refereegranskat)abstract
- The present review summarizes data collected by the Swedish National Cataract Register (NCR), which by the end of 2021 contained data for more than 2.4 million cataract surgeries between 1992 and 2021. During these 30 years, the cataract surgery rate rose from 3700 to 12800. The coverage of NCR is very high including 93% of all cataract procedures in Sweden between 2010 and 2021. Independently of demographic changes, the proportion of operations of patients age 60 to 79 has increased while the proportion of 80 to 90+ has decreased. The median visual acuity of the first eye planned for surgery was 0.1 decimal in 1992 and has increased to 0.5 decimal in 2021. Patient-reported outcome measures have been registered with the Catquest-9SF questionnaire since 2008, demonstrating intervention at an earlier stage, but consistently favorable outcomes. Surgical complications have decreased; endophthalmitis has decreased from 0.10% to below 0.02%, and posterior capsule rupture from 2.8% to 0.6%.
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| 2. |
- Gustafsson, Ingemar, et al.
(författare)
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Current clinical practice in corneal crosslinking for treatment of progressive keratoconus in four Nordic countries
- 2023
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Ingår i: Acta Ophthalmologica. - : Wiley. - 1755-3768 .- 1755-375X. ; 101:1, s. 109-116
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To evaluate clinical practice in the diagnosis and treatment of progressive keratoconus with corneal crosslinking (CXL) in four Nordic countries.METHODS: A questionnaire was sent to all centres at which keratoconus patients are evaluated and CXL is performed in Sweden, Denmark, Norway and Iceland. Nineteen of 20 centres participated.RESULTS: CXL is performed approximately 1300 times per year in these four Nordic countries with a population of around 21.7 million (2019). In most cases, progression is evaluated using the Pentacam HR, and the maximum keratometry reading (Kmax ) is considered the most important parameter. The most frequently used treatment protocol in Scandinavia is the 9 mW/cm2 epi-off protocol, using hydroxylpropyl methylcellulose riboflavin (HPMC-riboflavin). The participants deemed the following areas to be in most need of improvement: adaptation of the CXL protocol to individual patients (5/19), the development of effective epi-on treatment protocols (4/19), optimal performance of CXL in thin corneas (4/19), improvement of the definition of progression (2/19), and diagnosis of the need for re-treatment (2/19).CONCLUSIONS: We concluded that the diagnosis of progressive keratoconus and the diagnostic equipment used are similar. Treatment strategies are also similar but are suitably different to provide an interesting basis for the comparison of treatment outcomes. The high degree of participation in this survey indicates the possibility of future scientific collaboration on CXL focusing on the areas deemed to need improvement. It would also be of interest to evaluate the possibility of creating a Nordic CXL Registry. The high number of CXL treatments performed ensures sufficient statistical power to solve many questions. Such a registry could be an important contribution to evidence-based care and would allow for longitudinal evaluation.
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| 3. |
- Lundström, Mats, et al.
(författare)
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Changing practice patterns in European cataract surgery as reflected in the European Registry of Quality Outcomes for Cataract and Refractive Surgery 2008 to 2017
- 2021
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Ingår i: Journal of cataract and refractive surgery. - : Wolters Kluwer. - 0886-3350 .- 1873-4502. ; 47:3, s. 373-378
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To study practice patterns in European cataract surgery over a 10-year period.SETTING: European clinics affiliated to the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO).DESIGN: Registry cohort study.METHODS: The EUREQUO contains preoperative, intraoperative, and postoperative parameters reported by surgeons in many European clinics. All data reported to the registry are anonymized. Preoperative parameters included age, sex, visual acuity, target refraction, ocular comorbidity, and surgical difficulties. Surgical data included anesthesia, surgical technique, intraocular lens optic biomaterial, and complications. Postoperative parameters included visual acuity, refraction, and short-term complications.RESULTS: During the study period (January 1, 2008, to December 31, 2017), a total of 2 714 108 cataract extractions were reported to the EUREQUO. Preoperative data changed over time, with decreases in mean age (74.5-73.0 years), proportion of women from 60.6% (100 373/165 628) to 57.2% (174 908/305 845), and proportion of coexisting eye diseases from 30.0% (49 638/165 650) to 27.0% (82 704/305 846) and with improvements in preoperative visual acuity (mean logarithm of minimum angle of resolution [logMAR] 0.46 to 0.37). The use of topical anesthesia increased over time from 28.1% (26 238/93 320) to 71.7% (130 525/182 083). Surgical complications showed a significant decrease from 2.5% (4107/165 650) to 1.2% (3573/305 846). The visual outcome improved over time (mean logMAR 0.08 to 0.05), as did the absolute median prediction error (0.38 diopter [D] to 0.28 D).CONCLUSIONS: Trends in European cataract surgery practice patterns from 2008 to 2017 have moved toward younger patients with better preoperative visual acuity, fewer surgical complications, and better predicted refractions and visual outcomes.
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| 4. |
- Lundström, Mats, et al.
(författare)
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Risk factors for dropped nucleus in cataract surgery as reflected by the European Registry of Quality Outcomes for Cataract and Refractive Surgery
- 2020
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Ingår i: Journal of Cataract and Refractive Surgery. - : Ovid Technologies (Wolters Kluwer Health). - 1873-4502 .- 0886-3350. ; 46:2, s. 287-292
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To analyze the incidence, risk factors, and outcomes of cataract surgery complicated by a dropped nucleus. SETTING: Patients who have received cataract surgery in 18 European countries. DESIGN: Retrospective cross-sectional register-based study. METHODS: Data from the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO) were analyzed. The EUREQUO contains preoperative baseline, intraoperative, and follow-up data. Intraoperative data include dropped nucleus as a complication. Baseline data such as demographic data, ocular comorbidities, surgical difficulties, and visual and refractive outcomes were tested for association with a dropped nucleus for the study period from January 1, 2008, to December 31, 2018. RESULTS: The number of reported patients with complete data was 1 715 348. Dropped nucleus was reported in 1221 eyes (0.071%) during the study period. White cataract, previous vitrectomy, poor preoperative visual acuity, small pupil, pseudoexfoliation, diabetic retinopathy, and male sex were significantly related to dropped nucleus. Year of surgery showed a significant trend of decreasing occurrence of dropped nucleus over time. Eyes with the complication of a dropped nucleus also had a poorer visual and refractive outcome compared with eyes with existing risk factors but no such complication. CONCLUSIONS: Many risk factors for dropped nucleus complications were identified. A significant trend of decreasing occurrence of dropped nucleus was found for the study period. The visual and refractive outcome was poorer for eyes with a dropped nucleus.
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| 5. |
- Segers, Maartje H. M., et al.
(författare)
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Anesthesia techniques and the risk of complications as reflected in the European registry of quality outcomes for cataract and refractive surgery
- 2022
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Ingår i: Journal of cataract and refractive surgery. - : Wolters Kluwer. - 0886-3350 .- 1873-4502. ; 48:12, s. 1403-1407
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 6. |
- Segers, Maartje H M, et al.
(författare)
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Outcomes of cataract surgery complicated by posterior capsule rupture in the European Registry of Quality Outcomes for Cataract and Refractive Surgery
- 2022
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Ingår i: Journal of cataract and refractive surgery. - : Wolters Kluwer. - 0886-3350 .- 1873-4502. ; 48:8, s. 942-946
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To analyze the outcomes of cataract surgery complicated by posterior capsule rupture (PCR).SETTING: European clinics affiliated to the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO).DESIGN: Retrospective cross-sectional register-based study.METHODS: Data were retrieved from the EUREQUO between January 1, 2008, and December 31, 2018. The database consists of data on demographics, intraoperative complications such as PCR, type of intraocular lens (IOL) material, postoperative refraction, corrected distance visual acuity (CDVA), and postoperative complications.RESULTS: 1 371 743 cataract extractions with complete postoperative data were reported in the EUREQUO. In 12 196 cases (0.9%), PCR was reported. After PCR, patients were more likely to receive a poly(methyl methacrylate) IOL (5.2% vs 0.4%, respectively) or no IOL (1.1% vs 0.02%, respectively) compared with patients without PCR. The refractive and visual outcomes in patients with PCR were significantly worse than in those without PCR (mean CDVA 0.13 ± 0.21 vs 0.05 ± 0.16 logMAR, P < .001; mean absolute biometry prediction error 1.15 ± 1.60 diopters [D] vs 0.41 ± 0.45 D, P < .001). A multivariate linear regression analysis, adjusting for potential explanatory variables, confirmed a statistically significant difference (0.04 logMAR, P < .001, and .70 D, P < .001, respectively). Patients with PCR had significantly more postoperative complications (corneal edema 0.88% vs 0.17%, adjusted odds ratio [aOR], 2.80 95% CI, 2.27-3.45, endophthalmitis 0.11% vs 0.02%, aOR, 4.40 95% CI, 2.48-7.81, uncontrolled intraocular pressure 0.55% vs 0.03%, aOR, 14.58 95% CI, 11.16-19.06, P < .001).CONCLUSIONS: Patients with PCR had significantly worse visual and refractive outcomes and more postoperative complications than patients without PCR. However, most of these patients achieved better postoperative visual acuity than that preoperatively.
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| 7. |
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| 8. |
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| 9. |
- Segers, Maartje H. M., et al.
(författare)
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Risk factors for posterior capsule rupture in cataract surgery as reflected in the European Registry of Quality Outcomes for Cataract and Refractive Surgery
- 2022
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Ingår i: Journal of cataract and refractive surgery. - : Ovid Technologies (Wolters Kluwer Health). - 0886-3350 .- 1873-4502. ; 48:1, s. 51-55
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To analyze the incidence and risk factors for posterior capsule rupture (PCR) in cataract surgery.SETTING: European clinics affiliated with the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO).DESIGN: Retrospective cross-sectional register-based study.METHODS: Data were obtained from the EUREQUO. The database contains data on demographics, comorbidities, and intraoperative complications, including PCR for the study period from January 1, 2008, to December 31, 2018. Univariate and multivariate logistic regression analyses were performed to estimate the (adjusted) odds ratio (OR) and 95% confidence intervals (CIs).RESULTS: We analyzed EUREQUO registry data of 2,853,376 patients, and 31,749 (1.1%) cataract surgeries were complicated by a PCR. Data were available of 2 853 376 patients, and 31 749 (1.1%) cataract surgeries were complicated by a PCR. The PCR rate ranged from 0.60% to 1.65% throughout the years, with a decreasing trend (P < .001). The mean age of the PCR cohort was 74.8 ± 10.5 years, and 17 29 (55.5%) patients were female. Risk factors most significantly associated with PCR were corneal opacities (OR 3.21, 95% CI, 3.02-3.41, P < .001), diabetic retinopathy (OR 2.74, 95% CI, 2.59-2.90, P < .001), poor preoperative visual acuity (OR 1.98, 95% CI, 1.88-2.07, P < .001), and white cataract (OR 1.87, 95% CI, 1.72-2.03, P < .001).CONCLUSIONS: Risk factors for PCR were identified based on the EUREQUO, and the incidence of this complication is decreasing over time.
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| 10. |
- Triepels, Ron J. M. A., et al.
(författare)
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Development of machine learning models to predict posterior capsule rupture based on the EUREQUO registry
- 2023
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Ingår i: Acta Ophthalmologica. - : John Wiley & Sons. - 1755-375X .- 1755-3768. ; 101:6, s. 644-650
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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