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Office-Based Cataract Surgery

Population Health Outcomes Study of More than 21 000 Cases in the United States
Published:January 21, 2016DOI:https://doi.org/10.1016/j.ophtha.2015.12.020

      Purpose

      To identify safety and effectiveness outcomes of office-based cataract surgery. Each year, approximately 3.7 million cataract surgeries in the United States are performed in Ambulatory Surgery Center (ASC) and Hospital Outpatient Department (HOPD) locations. Medicare in July 2015 published a solicitation for expert opinion on reimbursing office-based cataract surgery.

      Design

      Large-scale, retrospective, consecutive case series of cataract surgeries performed in Minor Procedure Rooms (MPRs) of a large US integrated healthcare center.

      Participants

      More than 13 500 patients undergoing elective office-based cataract surgery.

      Methods

      Phacoemulsification cataract surgery performed in MPRs of Kaiser Permanente Colorado from 2011 to 2014.

      Main Outcome Measures

      Postoperative visual acuity and intraoperative and postoperative adverse events (AEs).

      Results

      Office-based cataract surgery was completed in 21 501 eyes (13 507 patients, age 72.6±9.6 years). Phacoemulsification was performed in 99.9% of cases, and manual extracapsular extraction was performed in 0.1% of cases. Systemic comorbidities included hypertension (53.5%), diabetes (22.3%), and chronic obstructive pulmonary disease (9.4%). Postoperative mean best-corrected visual acuity measured 0.14±0.26 logarithm of the minimum angle of resolution units. Intraoperative ocular AEs included 119 (0.55%) cases of capsular tear and 73 (0.34%) cases of vitreous loss. Postoperative AEs included iritis (n = 330, 1.53%), corneal edema (n = 110, 0.53%), and retinal tear or detachment (n = 30, 0.14%). No endophthalmitis was reported. Second surgeries were performed in 0.70% of treated eyes within 6 months. There were no life- or vision-threatening intraoperative or perioperative AEs.

      Conclusions

      This is the largest US study to investigate the safety and effectiveness of office-based cataract surgery performed in MPRs. Office-based efficacy outcomes were consistently excellent, with a safety profile expected of minimally invasive cataract procedures performed in ASCs and HOPDs.

      Abbreviations and Acronyms:

      AE (adverse event), ED (emergency department), KPCO (Kaiser Permanente Colorado), HOPD (Hospital Outpatient Department), IOL (intraocular lens), MPR (Minor Procedure Room)
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      Linked Article

      • Re: Ianchulev et al.: Office-based cataract surgery: population health outcomes study of more than 21 000 cases in the United States (Ophthalmology 2016;123:723-728)
        OphthalmologyVol. 124Issue 1
        • Preview
          We have a few questions about the recent article by Ianchulev et al1 on the outcomes of office-based cataract surgery. First, what was the rationale for prescribing topical prednisolone drops preoperatively in all the patients despite starting topical diclofenac drops concurrently? The duration of the postoperative regimen of topical corticosteroids was 4 weeks, even though the incidence of cystoid macular edema2 is maximum between 3 and 12 weeks postoperatively. Second, how many patients developed delayed postoperative endophthalmitis, that is, >1 month after surgery? Because patients with iritis/uveitis were followed for ≤5 months postoperatively, it is natural to have more patients diagnosed with this entity postoperatively.
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