OUTCOMES OF SMALL-INCISION CATARACT-SURGERY

Purpose: To compare cataract surgery outcome measures 4 months postope ratively and determine their association with changes in the eye's fun ctional state, Setting: Department of Ophthalmology, Heisinki Universi ty Central Hospital, Finland, Methods: This longitudinal study compris ed 219 consecutive patients having first-eye or second-eye cataract su rgery by one surgeon. In most patients, the technique consisted of sma ll-incision cataract surgery with in-the-bag intraocular lens implanta tion. Patients were interviewed and clinical data obtained preoperativ ely and 4 months postoperatively. Adverse events occurring within 24 h ours and 4 months postoperatively were compared with changes in global measures of vision. Surgical success in terms of surgically induced a stigmatism (SIA) was measured at 4 months using vector analysis of the changes in astigmatism and defining the extent to which the surgical goal was achieved. The association between the surgical astigmatism go als and global measures of vision was analyzed. Results: The percentag e of patients showing improvement 4 months after first-eye cataract su rgery varied by outcome measure: Snellen visual acuity (95.0%), VF-14 score (89.4%), satisfaction with vision (80.1%), self-reported trouble with vision (75.8%), and cataract symptoms (75.1%), Changes in Snelle n acuity after second-eye cataract surgery were similar but VF-14 chan ges were significantly less than after first-eye surgery. Changes in g lobal measures of vision were also better after first-eye surgery. The correlation between the change in VF-14 score and global measures of vision was stronger than between the change in Snellen acuity and the same general outcome measures. A good correlation was also seen betwee n the changes in VF-14 scores and cataract symptoms. Mean SIA in all e yes was 0.2 diopter (D) +/- 0.7 (SD); 91.2% were within +/- 1.0 D of p reoperative values. Failure to achieve surgical astigmatism goals was not associated with patients in whom global measures of vision did not improve, nor was there a correlation between adverse events occurring within 24 hours or 4 months postoperatively and global measures of vi sion. The only association was between ocular comorbidity or potential risk factors of phacoemulsification and adverse events seen within 24 hours and al 4 months. Conclusion: Estimates of the proportion of pat ients benefiting from cataract surgery varied with the outcome measure used to determine benefit, The change in the VF-14 score was a better measure than Snellen acuity of the benefit of cataract surgery.