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Importance: Aligning outcome measures for cataract surgery, one of the most frequently performed procedures globally, may facilitate international comparisons that can drive improvements in the outcomes most meaningful to patients., Objective: To propose a minimum standard set of outcome measures for cataract surgery that enables global comparisons., Design, Setting, and Participants: A working group of international experts in cataract outcomes and registries was convened, along with a patient advocate, to agree on a consensus of outcome measures for cataract surgery. In a modified Delphi process, the group met regularly between November 10, 2012, and November 21, 2013, to discuss which outcomes to include in a standard set. Included factors were based on extant literature, existing registries, and the experience of group members. Similarly, a series of consensus discussions were held to determine a set of risk factors to be gathered for each patient. The final shortlist was compiled into a standard set. Analysis was performed from November 22, 2013, to April 5, 2014., Main Outcomes and Measures: Development of a recommended standard set encompassing preoperative metrics including patient risk factors, intraoperative factors including surgical complications, and postoperative cataract surgery outcomes., Results: The recommended standard set encompasses all patients treated for cataracts by 1 of 4 surgical approaches (phacoemulsification, sutured manual extracapsular cataract extraction, sutureless manual extracapsular cataract extraction, or intracapsular cataract extraction). The recommended metrics to be recorded preoperatively include demographics, ocular history and comorbidities, preoperative visual acuity, and patient-reported visual function. The recommended outcomes were split into intraoperative and postoperative metrics. Intraoperative outcomes include capsule-related problems, dislocation of lens nucleus fragments into the vitreous, and other complications. Postoperative outcomes include visual acuity, refractive error, patient-reported visual function, and early and late complications of surgery. The suggested follow-up for collection of postoperative outcomes is up to 3 months., Conclusions and Relevance: A minimum standard set of outcome measures for cataract surgery is important for meaningful comparison across contexts. The proposed data set is a compromise between all useful data and the practicalities of data collection.

Background: This study aims to assess the quality of various steps of manual small incision cataract surgery and predictors of quality, using video recordings., Design: This paper applies a retrospective study., Participants: Fifty-two trainees participated in a hands-on small incision cataract surgery training programme at rural Chinese hospitals., Methods: Trainees provided one video each recorded by a tripod-mounted digital recorder after completing a one-week theoretical course and hands-on training monitored by expert trainers. Videos were graded by two different experts, using a 4-point scale developed by the International Council of Ophthalmology for each of 12 surgical steps and six global factors. Grades ranged from 2 (worst) to 5 (best), with a score of 0 if the step was performed by trainers., Main Outcome Measures: Mean score for the performance of each cataract surgical step rated by trainers., Results: Videos and data were available for 49/52 trainees (94.2%, median age 38 years, 16.3% women and 77.5% completing > 50 training cases). The majority (53.1%, 26/49) had performed ≤ 50 cataract surgeries prior to training. Kappa was 0.57∼0.98 for the steps (mean 0.85). Poorest-rated steps were draping the surgical field (mean ± standard deviation = 3.27 ± 0.78), hydro-dissection (3.88 ± 1.22) and wound closure (3.92 ± 1.03), and top-rated steps were insertion of viscoelastic (4.96 ± 0.20) and anterior chamber entry (4.69 ± 0.74). In linear regression models, higher total score was associated with younger age (P = 0.015) and having performed >50 independent manual small incision cases (P = 0.039)., Conclusions: More training should be given to preoperative draping, which is poorly performed and crucial in preventing infection. Surgical experience improves ratings., (© 2015 Royal Australian and New Zealand College of Ophthalmologists.)

The femtosecond laser is a new and developing technology for cataract surgery. This technology is approved for the capulotomy, primary incisions, astigmatic incisions, and lens fragmentation. The femtosecond laser has the potential to offer significant advantages over current phacoemulification and will be the standard method of cataract extraction in ten years., (Copyright © 2015 Elsevier Inc. All rights reserved.)

The femtosecond laser was recently introduced to cataract surgery in order to replace several highly successful and low risk manual surgical techniques with automated laser techniques. Despite the hope that femtosecond laser-assisted cataract surgery (FLACS) would lead to safer and more predictable surgical outcomes, the literature consistently demonstrates that FLACS has provided no advantage over standard phacoemulsification cataract surgery (SP). Yet, the disadvantages of FLACS as compared to SP are clear. FLACS is more expensive and time-consuming, may increase surgical complications during the surgeon's initial learning period, introduces unique risks due to the additional steps of laser docking and treatment, and is limited in its scope of use as compared to SP due to factors including small pupils and orbital anatomy. While FLACS may one day prove to be advantageous for a small subset of patients, such as those with corneal endothelial cell dysfunction or zonular instability, these patients have not been the targets of this technology, and FLACS will not become the standard technique for cataract extraction in the coming decade., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Biometry has become one of the most important steps in modern cataract surgery and, according to the Royal College of Ophthalmologists Cataract Surgery Guidelines, what matters most is achieving excellent results. This paper is aimed at the NHS cataract surgeon and intends to be a critical review of the recent literature on biometry for cataract surgery, summarising the evidence for current best practice standards and available practical strategies for improving outcomes for patients. With modern optical biometry for the majority of patients, informed formula choice and intraocular lens (IOL) constant optimisation outcomes of more than 90% within ± 1 D and more than 60% within ± 0.5 D of target are achievable. There are a number of strategies available to surgeons wishing to exceed these outcomes, the most promising of which are the use of strict-tolerance IOLs and second eye prediction refinement.

Purpose: To determine the visual outcomes achieved in terms of efficacy and safety during a mass eye surgery campaign in a low-income developing country., Methods: Three hundred fifteen eyes of 305 patients underwent extracapsular cataract extraction with intraocular lens implantation in a prospective, analytical, experimental, and nonrandomized study on patients who underwent cataract surgery during the campaign that two Spanish nongovernmental organizations conducted in December 2008 in a district hospital in Bobo-Dioulasso (Burkina Faso)., Results: Mean age was 61.97 ± 14.39 years. The mean uncorrected distance visual acuity before surgery was 2.17 ± 0.7 (20/3000), which improved to 0.86 ± 0.64 logMAR (20/150) 3 months after cataract surgery. The mean spherical equivalent at 3 months was -0.87 ± 1.90 diopters. The corrected distance visual acuity was 0.52 ± 0.44 logMAR (20/60) 3 months after surgery, 68.7% of the patients had good visual outcomes, and 9.16% had poor outcomes. A total of 41.4% of the operated eyes showed a spherical equivalent within ± 1.00 diopter of emmetropia. The most common intraoperative complication was posterior capsule rupture (incidence, 2.9%, 9 of 315), and the most serious complication was expulsive hemorrhage (incidence, 0.3%, 1 of 315). Three months after surgery, 2.9% (9 of 315) of the eyes was affected by posterior capsular opacity., Conclusions: A mass cataract campaign performed in a developing country with the proper technique and standardized protocols of action improved the visual outcome of the patients. The rate of incidence of extracapsular extractions is comparable to that estimated for developed countries.

Intraocular lens (IOL) confusions and errors are among the most common postoperative adverse events. Errors may occur at any stage from the decision to operate to the insertion of the IOL. The most common errors occur during IOL selection pre-operative preparation (anaesthesia given before recognition that the intended IOL is not available), or intraoperatively (wrong IOL implanted because of confusion in the operating room). We review the mechanisms of errors reported in the literature and describe the experience at The Royal Victorian Eye and Ear Hospital. We also describe the implementation of an error-detection protocol and provide qualitative data on its performance., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Efficacy and safety of blue-light-filtering acrylic IOL (HMY) were assessed and proven from 3 months to 1 year of postoperative follow-up in a clinical study performed on 80 eyes of 45 patients. Postoperative corrected visual acuity of all the eyes was 6/12 or better and 78.8% of them achieved higher than 6/6. The rate of mean corneal endothelial cell density decrease stood at 5.0%. Mild complications were observed, but none were serious.

A retrospective audit of records of 370 eyes of 315 patients for whom extracapsular cataract extraction with posterior chamber intraocular lens implantation (ECCE-PC IOL) was performed between 1998 and 1999 was made to determine postoperative visual outcome and complications. One hundred and ninety three patients were males and one hundred and seventy seven were females making a male to female ratio of 1:0.9. At two months postoperatively 82 (30.4%) of eyes had uncorrected visual acuity of 6/18 or better; while 176 (53.7%) of eyes attained an uncorrected visual acuity between 6/18 and 6/60, and 31 (11.5%) had visual acuity between 3/60 and 6/60. 340 of 358 (94.9%) had a preoperative visual acuity of < 3/60. As a result of the surgery, the percentage of blind eyes dropped from 94.9% to 4.4%. The commonest intra operative and early postoperative complications encountered were posterior capsular tear with vitreous loss (5.7%) and striate keratopathy (11.1%) respectively. Posterior capsular opacity was documented in 17 (4.6%) eyes as a late postoperative complication. Routine biometry, to calculate Intra ocular Lens (IOL) power was not done and this was the major limitation of the study. In conclusion, the study increases awareness of cataract surgery outcomes and provides a feedback to achieve better results both in terms of quality and quantity in cataract surgery. Further study with biometric measurement is recommended.

Objectives: To survey and investigate the current trend of cataract surgery in Thai ophthalmologists in 2004., Material and Method: Questionnaires were sent to 600 ophthalmologists who were the members of the Ophthalmological Society and Royal Colleges of Ophthalmologists of Thailand. Data received from 248 (41.3%) of the recipients were analyzed and compared with those from the previous survey., Results: The majority of respondents were male (63.3%) while 36.7% were female. In cataract surgery, 99.2% were still doing cataract surgery, the average number of cataract surgery procedures per surgeon per month was 25.6, 89.8% preferred phacoemulsification, and 42.5% preferred acrylic lens. The posterior capsular tear was the most common complication., Conclusion: There are trends toward more cataract surgical procedures performed by a surgeon, increasing preference of topical anesthesia, small incision wound and foldable acrylic lenses which reflected the popularity of phacoemulsification.

Searching the way out for posterior capsule opacification was one of our goals in improving current cataract surgery techniques. The second goals was restoring accommodation but this goal prooved to remain unsolved. The bag-in-the-lens concept of IOL and implantation technique has been used in 271 patients of which 15 children. These patients have a follow-up of one month to 5 years. The optical axis of all these patients remained crystal clear, which allows us to conclude that the problem of PCO is solved by the bag-in-the-lens implantation concept. These very encouraging results inspired us to new ideas, which will receive priority in our research: accommodation and optimising the quality of vision by compensating for the ocular aberrations.

Background: A training course for cataract surgery with intraocular lens implantation was organised in April 1997 at the National Eye Centre, Kaduna, Nigeria. Operations were performed by six Nigerian consultant ophthalmologists under the supervision of two surgeons from Aravind Eye Hospital, India., Methods: A total of 175 eyes with uncomplicated cataracts were operated on after careful selection. All but six patients had extracapsular cataract extraction with posterior chamber intraocular lens insertion during the training programme., Results: The mean age of the patients at operation was 54. 2 years. One hundred and forty five of the operated eyes (85.8%) were blind before surgery of which six (3.6%) remained blind postoperatively. An uncorrected visual acuity of 6/60 or better was achieved in 87.3% eyes after surgery. Forty one patients (24.3%) were blind before surgery, two of whom (1.2%) remained blind afterwards. The most common intraoperative complication was posterior capsular rent which occurred in 10 eyes (5.7%); striate keratopathy/corneal oedema and cortical remnant were the most common immediate postoperative complications, occurring in 44.6% and 8.0%, respectively., Conclusion: With adequate surgical skills, extracapsular cataract extraction with posterior chamber intraocular lens implantation offers good visual rehabilitation even under training conditions.