Eyeworld

EW CATARACT 34 February 2017 by Stefanie Petrou Binder, MD, EyeWorld Contributing Writer A 10-year retrospective study reveals excellent cataract outcomes for veterans at the VAMC in D.C. N inety-nine percent of U.S. veterans achieved final postoperative best correct- ed visual acuities (BCVA) of 20/40 or better, in cases without ocular morbidities, and mean final vision was 20/200 (medi- an 20/40) in cases with pre-existing ocular morbidities, according to a study presented at the 2016 Amer- ican Academy of Ophthalmology annual meeting. Cataract surgery in the VA system Of the nearly 9 million U.S. Veterans Health Administration (VHA) cur- rently enrolled veterans, more than 5 million are 65 years of age or old- er, of which an estimated 17% will develop cataracts by 2020. M. Teresa Magone, MD, Veterans Affairs Med- ical Center (VAMC), Washington, D.C., presented the results of the first comprehensive 10-year study of cataract outcomes in U.S. veterans. The retrospective analysis showed excellent visual outcomes, even in subgroups of patients with surgical complications. "A previous VHA study showed visual improvements in 82.6% of patients. 1 However, like many other studies, the outcomes have con- founding factors such as pre-existing systemic and ocular comorbidities that can significantly affect the post- operative outcomes," Dr. Magone said in a poster presentation of her study. "Our study was designed to extract and separate subgroups with and without ocular comorbidities through detailed electronic med- ical record reviews. This enabled a focused analysis of the surgical outcomes of all cataract surgeries performed at our institution over a period of 10 consecutive years. To the best of our knowledge this is the largest study on cataract surgery out- comes in a predominantly African American veteran population." 10-year retrospective The study involved a detailed retro- spective chart and operative report review of all consecutive cataract surgeries undertaken at the VAMC in Washington, D.C. during a 10-year interval from 2002 to 2012 (n=2,451 patients) and the categorization of patients into groups: patients whose surgery involved phaco either with or without preexisting comorbid conditions affecting their visual out- come, and patients who underwent extracapsular cataract extraction (ECCE) either with or without preex- isting comorbidities affecting their visual outcome. Most of the patients in the study who underwent phaco plus IOL implantation did not have visually significant ocular comorbid- ities (n=1,885 patients). Their mean age was 71 years, 1,168 individuals (62%) were African American, 665 (35%) were Caucasian, and 3% were other. Thirty-seven veterans (2%) were female, 253 (13.4%) had glau- coma, and 712 (38%) had diabetes mellitus (DM). Phaco patients with visually relevant ocular morbidities (n=534) were a mean age of 72 years, 325 (60.8%) were African American, 194 (36.7%) were Caucasian, and 13 (2.5%) were other. Of the patients in this group, 23 (4.3%) were female, 10 (0.8%) had zonular dehiscence, and 238 (44.5%) had DM. Co- morbidities included: proliferative diabetic retinopathy (10%), non-pro- liferative diabetic retinopathy (9%), ARMD (16%), advanced glauco- ma (8.2%), retinal vein occlusion (3.2%), epiretinal membrane (9.5%), amblyopia (3.7%), optic neuropathy (4.3%), pre-existing CSME (8%), and others. Nineteen patients underwent ECCE and were free of visually rele- vant ocular morbidities. Their mean age was 72.8 years, 15 were African American (79%) and four (21%) Caucasian, and five had DM (26%). Thirteen patients underwent ECCE who had comorbidities. Their mean age was 79.9 years, nine (69%) were African American, four (13%) were Caucasian, one had a preoperative lens subluxation (7.7%), and five had DM (38.4%). Other comorbid- ities in this group included prolif- erative diabetic retinopathy (7.7%), retinal vein occlusion (7.7%), mac- ular scars/heme/dystrophy (7.7%), history of retinal detachment (7.7%), optic neuropathy (23%), and amblyopia (7.7%). The final best corrected visual acuity was 20/40 or better in 99.8% and 20/25 or better in 95.5% of sub- jects with phaco plus IOL implanta- tion and no ocular diseases. Surgical complications were experienced Cataract care for U.S. veterans multifocal could have been consid- ered as an option, but I did not plan for that. It was relatively easy to reopen the inferior portion of the bag with viscodissection and extricate the inferior haptic, which freed up without difficulty. It was interesting to find that the superior haptic in the sulcus was coated with pigment when I examined it. I think it was irritating the ciliary body rather than rubbing against the posterior iris. This is why she had pain but no iris transillumination defects. This lens was cut in half and removed. Reopening the capsular bag com- pletely after that was somewhat difficult as the edge of the radial tear that was fused to the posterior capsule was very fibrosed and ad- herent, so I decided to work on the opposite side picking along between the anterior and posterior capsule at about 12 o'clock with a 26 gauge spatulated LASIK cannula. Once a plane was established I was able to inject viscoelastic and sweep across, breaking adhesions to complete- ly reopen the bag. A decision was made to place a ReSTOR one-piece lens in the capsular bag, orienting the haptics away from the radial tear. She subsequently had a YAG capsulotomy performed and a small slit lamp LRI to address 0.75 D of with-the-rule astigmatism that was reduced to 0.25 D. She was very hap- py with the visual outcome of her procedure, but she was even happier that her chronic eye pain was finally resolved. EW Editors' note: The physicians have no financial interests related to their comments. Contact information Gorovoy: blehet@gorovoyeye.com Lyons: rlyons@clearviewlaservision.com McKee: mckee@swhec.org Pilkinton: dpilkinton@comcast.net Safran: safran12@comcast.net Van Norman: rvanno01@gmail.com Mixed continued from page 32 Presentation spotlight

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