Benchmarks for Outcome Indicators in Pediatric Cataract Surgery

VanderVeen, Deborah

Benchmarks for Outcome Indicators in Pediatric Cataract Surgery

Sunday, April 27, 2014: 8:01 AM

Room 155 (Boston Convention and Exhibition Center)

Deborah K. VanderVeen, MD, Children's Hospital Boston, Boston, Massachusetts, USA

Bharti Nihalani-Gangwani, MD, Boston Children's hospital, Boston, MA, USA

Olumuyiwa Adebona, MBChB, MPH, Boston Childrens Hospital, Boston, MA, USA

William H. Dean, MD, Boston Childrens Hospital, Boston, MA, USA

Narrative Responses:

Purpose
To evaluate valid benchmarks for outcome indicators in pediatric cataract surgery.

Methods
Chart review of cataract surgeries performed for patients <18 years of age from 2006-2013 at a single center by multiple surgeons. Patients with ocular co-morbidities were excluded. IOL power calculation formula was based on surgeon choice, typically based on globe axial length. Outcome measures were:

1) Final best corrected Snellen visual acuity (BCVA), h/o bilateral cataract

2) Prediction error (PE): Expected refraction-Actual refraction, assessed 1 month postoperatively, irrespective of age or laterality.

Results

BCVA was 20/40 or better in 94% (n=88 eyes, mean patient age: 8.4+4.6 years). The remaining 5 eyes with BCVA < 20/40 had amblyopia.
PE was within+0.5 D in 45.0%,+1.0 D in 68.2% and ± 2.0 D in 95.4% (n=173 eyes). Mean absolute PE was 1.0+0.9 in eyes with AL<22 mm (n=79) and mean PE was 0.8+0.5 in eyes with AL > 22 mm (n=94) (p=0.06, unpaired t test)

Conclusion
In children, cataract surgery should result in good vision in > 90% of uncomplicated cases; amblyopia is the most frequent cause of VA< 20/40. PE is somewhat greater than benchmark reported in adult studies.