- Email: [email protected]
Five-year mortality and associated intraoperative factors after cataract surgery
CORRESPONDENCE
3. Tosi GM, Casprini F, Malandrini A, et al. Phacoemulsification without intraocular lens implantation in patients with high myopia; long-term results. J Cataract Refract Surg 2003; 29:1127–1131 4. Tseng S-H, Chen FK. A randomized clinical trial of combined topical-intracameral anesthesia in cataract surgery. Ophthalmology 1998; 105:2007–2011 5. Jacobi PC, Dietlein TS, Jacobi FK. A comparative study of topical vs retrobulbar anesthesia in complicated cataract surgery. Arch Ophthalmol 2000; 118:1037–1043
Five-year mortality and associated intraoperative factors after cataract surgery
P
revious studies show that cataract development is associated with increased mortality.1–3 We studied the 5-year mortality rate after cataract extraction in our department and tried to determine intraoperative factors associated with increased postoperative mortality. A retrospective analysis was made of all adults who had cataract extraction in 1996. Patients who died in the following 5 years were identified, and the death rate was compared with that for the region. Surgery was performed in 1086 adults; 29.9% died during the 5-year period. A matched population in the North West has a cumulative death rate of 34.8% (Office of National Statistics, Dataset PD19814), a significantly higher mortality rate than that in our investigation (95% confidence interval [CI], 0.01 to 0.09), showing that over the 5-year period, the death rate was significantly lower in patients who had cataract surgery in 1996 than in the area’s general population. Consultants performed surgery in 65.9% of the patients, of which 28.4% died. Of those operated on by more junior surgeons, 32.9% died. Although there was a 4.5% increased death rate in patients whose surgery was performed by junior surgeons, this is not significant. This correlation was attempted to see whether junior surgeons were more willing to perform surgery in a particular patient group or whether junior surgeons perform more surgery in older patients. We found that those who had cataracts treated by junior surgeons did not have an increased risk of dying. Patients who had general anesthesia had a significantly lower mortality rate. Of cases done under general anesthesia, 13.97% died within the 5 years, compared with 31.40% of those who had the procedure under a local anesthesia (95% CI, 0.097 to 0.249). 2452
The mean age of those having a general anesthesia procedure was 65.97 years, compared with 78.75 years in those with extraction performed under a local block. This is the likely reason for the significant difference and is a reflection of the more elderly population being less suitable for general anesthesia or the younger population, generally a more anxious population, requiring general anesthesia. No significant difference was found between the death rates after phacoemulsification and after extracapsular cataract extraction. It has been suggested that cataract development is a “marker” for generalized protein maturation and is, in part, the reason for the associated increase in the mortality rate.4 The modern climate of small-incision surgery and the associated willingness to perform the surgery at an earlier stage of cataract development has pushed the difference in observed mortality beyond 5 years, suggesting a longer follow-up of the modern procedures is required to observe what was once seen in the short term. Perhaps the increased quality of life after cataract surgery has a positive effect on health. Finally, cataract extraction did not appear on any death certificate. JONATHAN MARK DURNIAN, MB CHB, BSC M.F. RAINES, FRCS, FRCOPHTH Blackpool, United Kingdom
References 1. McKibbin M, Mohammed M, James TE, Atkinson PL. Short-term mortality among middle-aged cataract surgery patients. Eye 2001; 15:209–212 2. Knudsen EB, Baggesen K, Naeser K. Mortality and causes of mortality among cataract-extracted patients. A 10-year follow-up. Acta Ophthalmol Scand 1999; 77:99–102 3. Thompson JR, Sparrow JM, Gibson JM, Rosenthal AR. Cataract and survival in an elderly nondiabetic population. Arch Ophthalmol 1993; 111:675–679 4. Meddings DR, Marion SA, Barer ML, et al. Mortality rates after cataract extraction. Epidemiology 1999; 10: 288–293
Sliding scale of IOL power for sulcus fixation using computer simulation
W
e previously reported1 adjusting intraocular lens (IOL) power for sulcus fixation. For sulcus fixation in eyes with a normal axial length (22.00 to 24.50 mm), the IOL power should be 1.00 diopter (D) less than the
J CATARACT REFRACT SURG—VOL 30, NOVEMBER 2004
3. Tosi GM, Casprini F, Malandrini A, et al. Phacoemulsification without intraocular lens implantation in patients with high myopia; long-term results. J Cataract Refract Surg 2003; 29:1127–1131 4. Tseng S-H, Chen FK. A randomized clinical trial of combined topical-intracameral anesthesia in cataract surgery. Ophthalmology 1998; 105:2007–2011 5. Jacobi PC, Dietlein TS, Jacobi FK. A comparative study of topical vs retrobulbar anesthesia in complicated cataract surgery. Arch Ophthalmol 2000; 118:1037–1043
Five-year mortality and associated intraoperative factors after cataract surgery
P
revious studies show that cataract development is associated with increased mortality.1–3 We studied the 5-year mortality rate after cataract extraction in our department and tried to determine intraoperative factors associated with increased postoperative mortality. A retrospective analysis was made of all adults who had cataract extraction in 1996. Patients who died in the following 5 years were identified, and the death rate was compared with that for the region. Surgery was performed in 1086 adults; 29.9% died during the 5-year period. A matched population in the North West has a cumulative death rate of 34.8% (Office of National Statistics, Dataset PD19814), a significantly higher mortality rate than that in our investigation (95% confidence interval [CI], 0.01 to 0.09), showing that over the 5-year period, the death rate was significantly lower in patients who had cataract surgery in 1996 than in the area’s general population. Consultants performed surgery in 65.9% of the patients, of which 28.4% died. Of those operated on by more junior surgeons, 32.9% died. Although there was a 4.5% increased death rate in patients whose surgery was performed by junior surgeons, this is not significant. This correlation was attempted to see whether junior surgeons were more willing to perform surgery in a particular patient group or whether junior surgeons perform more surgery in older patients. We found that those who had cataracts treated by junior surgeons did not have an increased risk of dying. Patients who had general anesthesia had a significantly lower mortality rate. Of cases done under general anesthesia, 13.97% died within the 5 years, compared with 31.40% of those who had the procedure under a local anesthesia (95% CI, 0.097 to 0.249). 2452
The mean age of those having a general anesthesia procedure was 65.97 years, compared with 78.75 years in those with extraction performed under a local block. This is the likely reason for the significant difference and is a reflection of the more elderly population being less suitable for general anesthesia or the younger population, generally a more anxious population, requiring general anesthesia. No significant difference was found between the death rates after phacoemulsification and after extracapsular cataract extraction. It has been suggested that cataract development is a “marker” for generalized protein maturation and is, in part, the reason for the associated increase in the mortality rate.4 The modern climate of small-incision surgery and the associated willingness to perform the surgery at an earlier stage of cataract development has pushed the difference in observed mortality beyond 5 years, suggesting a longer follow-up of the modern procedures is required to observe what was once seen in the short term. Perhaps the increased quality of life after cataract surgery has a positive effect on health. Finally, cataract extraction did not appear on any death certificate. JONATHAN MARK DURNIAN, MB CHB, BSC M.F. RAINES, FRCS, FRCOPHTH Blackpool, United Kingdom
References 1. McKibbin M, Mohammed M, James TE, Atkinson PL. Short-term mortality among middle-aged cataract surgery patients. Eye 2001; 15:209–212 2. Knudsen EB, Baggesen K, Naeser K. Mortality and causes of mortality among cataract-extracted patients. A 10-year follow-up. Acta Ophthalmol Scand 1999; 77:99–102 3. Thompson JR, Sparrow JM, Gibson JM, Rosenthal AR. Cataract and survival in an elderly nondiabetic population. Arch Ophthalmol 1993; 111:675–679 4. Meddings DR, Marion SA, Barer ML, et al. Mortality rates after cataract extraction. Epidemiology 1999; 10: 288–293
Sliding scale of IOL power for sulcus fixation using computer simulation
W
e previously reported1 adjusting intraocular lens (IOL) power for sulcus fixation. For sulcus fixation in eyes with a normal axial length (22.00 to 24.50 mm), the IOL power should be 1.00 diopter (D) less than the
J CATARACT REFRACT SURG—VOL 30, NOVEMBER 2004