Auckland cataract study 2: clinical outcomes of phacoemulsification cataract surgery in a public teaching hospital

IMPORTANCE: A contemporary benchmark for the most common ophthalmic surgery. BACKGROUND: To assess patient characteristics and outcomes of contemporary phacoemulsification cataract surgery in a New Zealand public teaching hospital setting. DESIGN: Prospective observational study. PARTICIPANTS: Consecutive cases (n = 500) of phacoemulsification surgery between April and June 2015. METHODS: An independent observer assessed clinical and surgical data preoperatively and 4-6 weeks postoperatively. MAIN OUTCOME MEASURES: Visual acuity, intraoperative and postoperative complications. RESULTS: Mean age was 72.3 ± 11.9 years and 57% female. Mean preoperative best-measured visual acuity was 6/30. Ocular comorbidity was present in 45.8% of eyes, most commonly glaucoma (10%), age-related macular degeneration (8%) and diabetic retinopathy (8%). Systemically, hypertension (59%) and diabetes mellitus (31%) were prevalent. Mean contralateral best-measured visual acuity was 6/12 (n = 495) with 62% being phakic. The rate of posterior capsular tear was 2.6% and cystoid macular oedema 3.5%. Intraoperative complication rates were not significantly different between surgeon levels (P = 0.234). However, registrars had fewer postoperative complications than fellows (2.2% vs. 11.9%, P = 0.012). Postoperatively, mean unaided and best-measured visual acuity were 6/12 and 6/9. CONCLUSIONS AND RELEVANCE: This study reports current phacoemulsification surgery outcomes in a major public teaching institution. A large proportion of patients exhibited systemic and ocular comorbidities, relatively dense cataracts and poor presenting visual acuity. However, visual outcomes and intraoperative complication rates were not statistically different between trainees and senior surgeons. Generally, outcomes reflect international standards and have improved since the last comparable study in this region.