Are there sex-based disparities in cataract surgery?

AIM:To investigate sex-based differences in the occurrence of intra-operative and post-operative complications and associated visual outcomes following cataract surgery.METHODS:This was a retrospective study of patients who had phacoemulsification cataract surgery at the University of Colorado School of Medicine.Data collected included the patient’s health history,ocular comorbidities,operative and post-operative complications,and the post-operative best corrected visual acuity(BCVA).The data were analyzed using univariate and multivariable logistic regression with generalized estimating equations to account for the correlation of some patients having two eyes included in the study.RESULTS:A total of 11977 eyes from 7253 patients were included in the study.Ocular comorbidities differed by sex,with males having significantly higher percentages of traumatic cataracts(males 0.7%vs females 0.1%),prior ocular surgery(6.7%vs 5.5%),and mature cataracts(2.8%vs 1.9%).Conversely,females had significantly higher rates of pseudoexfoliation(2.0%vs 3.2%).In unadjusted analysis,males had higher rates of posterior capsular rupture(0.8%vs 0.4%)and vitreous loss(1.0%vs 0.6%),but this difference was not significant after adjustment for confounders.Males had a significantly increased risk of post-operative retinal detachment,but in multivariable analysis this was no longer significant.Males were significantly less likely to undergo post-operative neodymium-doped yttrium aluminum garnet(Nd:YAG)laser capsulotomy for posterior capsule opacification(OR=0.8,95%CI=0.7-0.9,P=0.0005).The BCVA was slightly worse for males pre-operatively;but post-operatively,both sexes exhibited similar visual acuity of Snellen equivalent 20/25.CONCLUSION:The study finds that in a cohort of patients presenting for cataract surgery,sex differences exist in pre-operative comorbidities and surgical characteristics that contribute to higher rates of some complications for males.However,observed surgical complication rates exhibit almost no difference by sex after adjusting for pre-operative differences and post-operative BCVA is similar between sexes.

Iris manipulation during phacoemulsification:intraoperative and postoperative complications

AIM:To quantify intraoperative and postoperative complications in complex phacoemulsification cataract extraction(phacoemulsification)with iris manipulation compared to non-complex and complex phacoemulsification without iris manipulation.METHODS:All phacoemulsification cases at the University of Colorado between January 1,2014,and June 30,2017 were included.Exclusion criteria for the primary outcome of intraoperative complications were planned combination surgery and eyes with less than 28 d followup.Exclusion criteria for the secondary outcomes of postoperative complications were unplanned additional surgery,and chronic steroid eye drop use prior to surgery.Data including sex,race/ethnicity,surgery length,visual acuity,intraoperative and postoperative complications,and intraocular pressures(IOP)were collected and analyzed utilizing general linear and Logistic regression modeling.RESULTS:The medical records of 5772 eyes were reviewed(500 complex without iris manipulation,367 with iris manipulation).The number of any intraoperative complication in the complex with iris manipulation and complex without iris manipulation groups was 15(4.1%)and 26(5.2%),respectively,compared to 41(0.8%)in the non-complex group.Postoperative inflammation was found in 135(2.8%)non-complex cases,20(4.1%)complex cases without iris manipulation,and 20(5.6%)complex cases with iris manipulation.The adjusted odds ratio of postoperative inflammation in phacoemulsification with iris manipulation compared to non-complex was 2.3(95%CI:1.3-4.0,P=0.005).The rate of IOP spikes>10 mm Hg was significantly greater in cases with iris manipulation(P=0.001).CONCLUSION:Complex cases have more intraoperative complications.However,only complex cases with iris manipulation led to increase rates of postoperative inflammation and IOP spikes>10 mm Hg.

Association between axial length and toric intraocular lens rotation according to an online toric back-calculator

AIM: To assess the relationship between axial length(AL) and intraocular lens(IOL) rotation among eyes receiving a toric IOL and subsequently entered into an online toric back-calculator database.METHODS: Retrospective analysis of data collected online via astigmatismfix.com, a freely available online toric back-calculator where surgeons enter pre-and postoperative information to help manage residual postoperative astigmatism.Included records were deemed valid with entry of AL and IOL orientation between January 2017 and March 2019.Rotation was determined by a difference of ≥5° between pre-operative intended IOL orientation and actual post-operative IOL orientation.Frequency and magnitude of rotation are presented with means and associated standard deviation(SD).Linear regression models of this association are presented.RESULTS: Records of 6752 eyes were included in the analysis, of which 74.8% were determined to have a rotated IOL.The magnitude of rotation increased with each millimeter(mm) increase in AL with a mean rotation of 13.3°(SD: 12.8°) for eyes with AL 20-20.9 mm and a maximum mean rotation of 30.6°(SD: 30.3°) among eyes with AL 29-29.9 mm.General linear modeling demonstrated a significant association(P<0.0001) with a parameter estimate of 1.19(standard error: 0.159) and R;of 0.0083.CONCLUSION: Analysis from an online database indicates that toric IOLs inserted into eyes with longer AL are more likely to rotate and to rotate more degrees from the target axis.The findings from this study are clinically relevant for surgeons implanting toric IOLs.

Gender as an effect modifler in the relationship between hypertension and reticular pseudodrusen in patients with early or intermediate age-related macular degeneration

AIM: To determine whether the prevalence of treated hypertension is higher among males or females with early/intermediate(e/i) age-related macular degeneration(AMD) with and without bilateral reticular pseudodrusen(RPD).METHODS: Retrospective review of the records of patients with e/iAMD who were recruited into the University of Colorado AMD registry between July 2014 and November 2019.Images were classified using the Beckman Initiative criteria and presence/absence of RPD.Patients were categorized into three groups: 1) e/iAMD with RPD;2) e/iAMD without RPD;3) control patients who did not have AMD.Multinomial logistic regression analysis was used for adjusted analysis with odds ratios(OR) and confidence intervals(CI).RESULTS: There were 260 patients with e/iAMD of which 101 had bilateral RPD and 159 had no RPD, and 221 controls.Overall, 62% of patients were female and the three groups did not differ by gender.When stratified by gender, the female e/iAMD/RPD group had a higher prevalence of hypertension, 64.1% vs 45.2% for controls, OR=2.2(95%CI: 1.2-4.0).The frequency of hypertension in the e/iAMD/no RPD group was 54.1% and did not significantly differ from the control group.Among males, prevalence rates of treated hypertension did not differ.There is a significant interaction of hypertension and gender for the e/iAMD/RPD group such that women with e/iAMD who had RPD were significantly more likely to have hypertension(P=0.042).This relationship was not significant in the e/iAMD/no RPD group(P=0.269).CONCLUSION: Among females treated hypertension is significantly higher among e/iAMD/RPD patients, whereas for males there is no significant association.

Refractive outcomes among glaucoma patients undergoing phacoemulsification cataract extraction with and without Kahook Dual Blade goniotomy

Background:Glaucoma patients undergoing phacoemulsification alone have a higher rate of refractive surprise compared to patients without glaucoma.This risk is further increased with combined filtering procedures.Indeed,there are few and conflicting reports on the effect of combined phacoemulsification and micro-invasive glaucoma surgery(MIGS).Here,we look at refractive outcomes of glaucoma patients undergoing phacoemulsification with and without Kahook Dual Blade(KDB)goniotomy.Methods:Retrospective chart review of 385 glaucomatous eyes of 281 patients,which underwent either phacoemulsification alone(n=309)or phacoemulsification with KDB goniotomy(n=76,phaco-KDB)at the University of Colorado.The main outcome was refractive surprise defined as the difference in target and postoperative refraction spherical equivalent greater than±0.5 Diopter(D).Results:Refractive surprise greater than±0.5 D occurred in 26.3%of eyes in the phaco-KDB group and 36.2%in the phacoemulsification group(p=0.11).Refractive surprise greater than±1.0 D occurred in 6.6%for the phacoKDB group and 9.7%for the phacoemulsification group(p=0.08).There was no significant difference in risk of refractive surprise when pre-operative IOP,axial length,keratometry or performance of KDB goniotomy were assessed in univariate analyses.Conclusion:There was no difference between refractive outcomes of glaucomatous patients undergoing phacoemulsification with or without KDB goniotomy.