Risk model for intraoperative complication during cataract surgery based on data from 900 000 eyes: previous intravitreal injection is a risk factor

Increased Risk ◽

Male Sex ◽

Univariate Analyses

Background/aimsThe aim of this study was to develop a risk model for intraoperative complication (IC) during cataract surgery, defined as posterior capsule rupture and/or zonular dehiscence, and to include previous intravitreal therapy (pIVT) in the model.MethodsThis retrospective register-based study covered patients reported to the Swedish National Cataract Register (SNCR) between 1 January 2010 and 30 June 2018. Odds ratios (ORs) were used to quantify association strength of each variable with IC. Data from the SNCR were cross referenced with the Swedish Macula Register to include data on pIVT. Variables statistically significant in the univariate analyses (p<0.05) were included in a multivariate logistic regression model.ResultsThe inclusion criteria were met by 907 499 eyes. The overall rate of IC was 0.86%. Variables significantly associated with IC were best corrected visual acuity ≥1.0 LogMAR (OR (adjusted): 1.75, p<0.001), age ≥90 years (OR: 1.25, p<0.001), male sex (OR: 1.09, p<0.01), pseudoexfoliation (OR: 1.33, p<0.001), glaucoma (OR: 1.11, p<0.05), diabetic retinopathy (OR: 1.35, p<0.001), pIVT (OR: 1.45, p<0.05), surgeon’s experience <600 surgeries (OR: 2.77, p<0.001), use of rhexis hooks (OR: 6.14, p<0.001), blue staining (OR: 1.87, p<0.001) and mechanical pupil dilation (OR: 1.52, p<0.001).ConclusionThe risk model can be used in the preoperative setting to predict the probability of IC, to facilitate planning of surgery and improving patient communication. Patients who have undergone intravitreal therapy prior to cataract surgery have an increased risk of IC during cataract surgery.

Risk Model for Intraoperative Complication during Cataract Surgery Based on Data from 900,000 Eyes – Previous Intravitreal Injection is a Risk Factor

10.1101/2020.12.08.20245738 ◽

2020 ◽

Author(s):

Poya Hård af Segerstad

Keyword(s):

Cataract Surgery ◽

Risk Model ◽

Blue Staining ◽

Multivariate Logistic Regression Model ◽

Intravitreal Therapy ◽

Corrected Visual Acuity ◽

Increased Risk ◽

Male Sex ◽

Univariate Analyses

ABSTRACTBackground/AimsThe aim of this study was to develop a risk model for intraoperative complication during cataract surgery and to include previous intravitreal therapy in the model.MethodsThis retrospective register-based study covered patients reported to the Swedish National Cataract Register (SNCR) between Jan. 1, 2010 and Jun. 30, 2018. Odds ratios (OR) were used to quantify association strength of each variable with intraoperative complication. Data from the SNCR were cross referenced with the Swedish Macula Register (SMR) to include data on previous intravitreal therapy. Variables statistically significant in the univariate analyses (P <0.05) were included in a multivariate logistic regression model.ResultsThe inclusion criteria were met by 907,499 eyes. The overall rate of intraoperative complication was 0.86%. After cross referencing, 3,451 eyes were identified in the SMR as having undergone intravitreal therapy prior to cataract surgery. Variables significantly associated with intraoperative complication (P<0.05) were best corrected visual acuity ≥1.0 LogMAR (adjusted OR): 1.75), age ≥90 years (OR: 1.25), male sex (OR: 1.09), pseudoexfoliation (OR: 1.33), glaucoma (OR: 1.11), diabetic retinopathy (OR: 1.35), previous intravitreal therapy (OR: 1.45), surgeon’s experience <600 surgeries (OR: 2.77), use of rhexis hooks (OR: 6.14), blue staining (OR: 1.87), and mechanical pupil dilation (OR: 1.52).ConclusionThe risk model can be used in the preoperative setting to predict the probability of intraoperative complication, to facilitate planning of surgery, and improving patient communication. Patients who have undergone intravitreal therapy prior to cataract surgery have an increased risk of intraoperative complication during cataract surgery.

Previous Intravitreal Therapy Is Associated with Increased Risk of Posterior Capsule Rupture during Cataract Surgery

Ophthalmology ◽

10.1016/j.ophtha.2016.02.014 ◽

2016 ◽

Vol 123 (6) ◽

pp. 1252-1256 ◽

Cited By ~ 13

Author(s):

Aaron Y. Lee ◽

Alexander C. Day ◽

Catherine Egan ◽

Clare Bailey ◽

Robert L. Johnston ◽

...

Keyword(s):

Cataract Surgery ◽

Posterior Capsule ◽

Intravitreal Therapy ◽

Increased Risk ◽

Capsule Rupture

Intraoperative Complications of Cataract Surgery Using Intracameral Illumination in the Elderly over 75 Years

Journal of Ophthalmology ◽

10.1155/2019/1594152 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5

Author(s):

Yu Jeong Kim ◽

Su Jin Park ◽

Jong Yeon Lee ◽

Dae Yeong Lee ◽

Dong Heun Nam

Keyword(s):

Cataract Surgery ◽

Intraoperative Complications ◽

Case Series ◽

The Elderly ◽

Posterior Capsule ◽

Anterior Capsule ◽

Surgery Group ◽

Capsule Rupture

Purpose. To evaluate intraoperative complications and utilization of adjunctive devices between microscope and intracameral illuminations during cataract surgery in the elderly over 75 years. Design. A retrospective, consecutive, interventional case series Participants. Two hundred eighty-six eyes of 184 patients older than 75 years who underwent cataract surgery using microscope and intracameral illuminations. Methods. A chart review was performed on an advanced cataract surgery group of 141 consecutive cases in which the intracameral illumination was used and on a standard cataract surgery group of 145 consecutive cases in which the intracameral illumination was not used. Main Outcome Measures. Intraoperative complications (posterior capsule rupture, radial tear of the anterior capsule, dropped nucleus, or sulcus-implanted/sclera-fixated IOL) and utilization of adjunctive devices (pupil expansion device or anterior capsule staining). Results. The frequency of use of the pupil expansion device was lower in the advanced cataract surgery group than that in the standard cataract surgery group (0.7% vs 6.9%; p=0.007). Furthermore, the rates of a posterior capsule rupture and at least one intraoperative complication were lower in the advanced cataract surgery group than those in the standard cataract surgery group (0.7% vs 4.8%; p=0.067) (0.7% vs 7.6%; p=0.004). Conclusions. In the current cohort of patients over 75 years, the rate of intraoperative complications was lower when using the intracameral illumination than that when using the conventional method. Cataract surgery using intracameral illumination would be good option for elderly people.

Simultaneous Bilateral Cataract Surgery in Outreach Surgical Camps

Ophthalmology and Eye Diseases ◽

10.1177/1179172117701738 ◽

2017 ◽

Vol 9 ◽

pp. 117917211770173 ◽

Cited By ~ 1

Author(s):

Kagmeni Giles ◽

Ebana Steve Robert ◽

Ebana Mvogo Come ◽

Peter Wiedemann

Keyword(s):

Postoperative Complications ◽

Cataract Surgery ◽

Rural Areas ◽

Small Incision Cataract Surgery ◽

Bilateral Cataract ◽

Visual Outcomes ◽

Rural Cameroon ◽

Transient Elevation

Objectives: The aim of this study was to evaluate the safety and visual outcomes of simultaneous bilateral cataract surgery (SBCS) with intraocular lens implantation performed in outreach surgical eye camps. Methods: The medical records of 47 consecutive patients who underwent simultaneous bilateral small-incision cataract surgery between January 2010 and December 2015 in outreach surgical camps in rural Cameroon were reviewed. The measures included postoperative visual outcomes and intraoperative and postoperative complications. Results: Data from 94 eyes of 47 participants (30 men, 17 women; mean age: 60.93 ± 13.58 years, range: 45-80 years) were included in this study. The presented best visual acuity (VA) was less than 3/60 in 100% of the eyes. At the 4-week follow-up, 84.04% of the eyes showed increased VA of 1 line or more ( P = .001).Of these, 71 (75.53%) achieved good VA (greater than 6/18). Intraoperative or postoperative complications occurred in 19 (20.21%) eyes. The most serious intraoperative complication was a posterior capsule rupture and vitreous loss (2 patients, 2 eyes). The postoperative complications included a transient elevation in the intraocular pressure (6 eyes), chronic corneal oedema (5 eyes), iris capture (3 eyes), lens decentration (2 eyes), and hyphema (1 eye). No cases of postoperative endophthalmitis were recorded. Conclusions: Under the strict observation of endophthalmitis prophylaxis, SBCS is an option to reduce the cataract blindness backlog in rural areas of developing countries.

Intravitreal injection is associated with increased posterior capsule rupture risk during cataract surgery: A meta-analysis

Ophthalmic Research ◽

10.1159/000521576 ◽

2021 ◽

Author(s):

Zhe Zhong ◽

Zhenghua He ◽

Xi Yu ◽

Ying Zhang

Keyword(s):

Cataract Surgery ◽

Intravitreal Injection ◽

Meta Analysis ◽

Posterior Capsule ◽

Current Evidence ◽

Significant Heterogeneity ◽

Odds Ratios ◽

Increased Risk ◽

Capsule Rupture

Abstract Background: Although observational studies have suggested that prior intravitreal therapy may predict posterior capsule rupture (PCR) during cataract surgery, this finding is still controversial. Objective: To summarize current evidence on the association between prior intravitreal injection (IVI) and PCR during cataract surgery. Methods: A systematic literature search was performed up to October 27th, 2021. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using random-effects models. The potential association between IVI and PCR in future cataract surgeries was assessed using the following two models: “pooling the odds ratios of PCR in eyes with and without previous IVI(s)” and “pooling the odds ratios for PCR relative to each increase in the number of prior injections.” The quality of included studies was appraised using the Newcastle-Ottawa Scale. Results: 6 cohort studies were included in this meta-analysis, with a total of 1,051,097 eyes that underwent cataract surgery. Of these, 7,034 eyes were associated with previous IVI. The pooled odds of PCR in eyes with prior IVI was 2.01 (95% CI: 1.35–3.00) times higher than that of eyes without an IVI history. An increase in the number of previous IVI conferred increased odds of PCR of 1.03 (95% CI: 1.01–1.06). After excluding studies that failed to account for confounders, the significantly increased risk was not altered, and the significant heterogeneity was minimized in both models. Conclusion: This meta-analysis provides evidence that previous IVI significantly increases the risk of PCR during future cataract surgery. The risk of PCR should be discussed preoperatively with patients. Further studies are required to validate our findings and explore the underlying mechanisms.

The effect of adjuvant radiotherapy on overall survival in adults with intracranial ependymoma

Neuro-Oncology Practice ◽

10.1093/nop/npz070 ◽

2019 ◽

Vol 7 (4) ◽

pp. 391-399

Author(s):

Roshan S Prabhu ◽

Christopher D Corso ◽

Matthew C Ward ◽

John H Heinzerling ◽

Reshika Dhakal ◽

...

Keyword(s):

Overall Survival ◽

Propensity Score ◽

Adjuvant Radiotherapy ◽

Subtotal Resection ◽

National Cancer Database ◽

Risk Of Death ◽

Increased Risk ◽

Intracranial Ependymoma ◽

Male Sex ◽

Grade 3

Abstract Background Adult intracranial ependymoma is rare, and the role for adjuvant radiotherapy (RT) is not well defined. Methods We used the National Cancer Database (NCDB) to select adults (age ≥ 22 years) with grade 2 to 3 intracranial ependymoma status postresection between 2004 and 2015 and treated with adjuvant RT vs observation. Four cohorts were generated: (1) all patients, (2) grade 2 only, (3) grade 2 status post–subtotal resection only, (4) and grade 3 only. The association between adjuvant RT use and overall survival (OS) was assessed using multivariate Cox and propensity score matched analyses. Results A total of 1787 patients were included in cohort 1, of which 856 patients (48%) received adjuvant RT and 931 (52%) were observed. Approximately two-thirds of tumors were supratentorial and 80% were grade 2. Cohorts 2, 3, and 4 included 1471, 345, and 316 patients, respectively. There was no significant association between adjuvant RT use and OS in multivariate or propensity score matched analysis in any of the cohorts. Older age, male sex, urban location, higher comorbidity score, earlier year of diagnosis, and grade 3 were associated with increased risk of death. Conclusions This large NCDB study did not demonstrate a significant association between adjuvant RT use and OS for adults with intracranial ependymoma, including for patients with grade 2 ependymoma status post–subtotal resection. The conflicting results regarding the efficacy of adjuvant RT in this patient population highlight the need for high-quality studies to guide therapy recommendations in adult ependymoma.

Anemia, sarcopenia, physical activity, and the risk of tuberculosis in the older population: a nationwide cohort study

Therapeutic Advances in Chronic Disease ◽

10.1177/20406223211015959 ◽

2021 ◽

Vol 12 ◽

pp. 204062232110159

Author(s):

Jung Eun Yoo ◽

Dahye Kim ◽

Hayoung Choi ◽

Young Ae Kang ◽

Kyungdo Han ◽

...

Keyword(s):

Physical Activity ◽

Screening Program ◽

Chronic Obstructive ◽

Older Population ◽

Timed Up And Go ◽

Obstructive Pulmonary Disease ◽

Mild Anemia ◽

Increased Risk ◽

Male Sex

Background: The aim of this study was to investigate whether physical activity, sarcopenia, and anemia are associated an with increased risk of tuberculosis (TB) among the older population. Methods: We included 1,245,640 66-year-old subjects who participated in the National Screening Program for Transitional Ages for Koreans from 2009 to 2014. At baseline, we assessed common health problems in the older population, including anemia and sarcopenia. The subjects’ performance in the timed up-and-go (TUG) test was used to predict sarcopenia. The incidence of TB was determined using claims data from the National Health Insurance Service database. Results: The median follow-up duration was 6.4 years. There was a significant association between the severity of anemia and TB incidence, with an adjusted hazard ratio (aHR) of 1.28 [95% confidence interval (CI), 1.20–1.36] for mild anemia and 1.69 (95% CI, 1.51–1.88) for moderate to severe anemia. Compared with those who had normal TUG times, participants with slow TUG times (⩾15 s) had a significantly increased risk of TB (aHR 1.19, 95% CI, 1.07–1.33). On the other hand, both irregular (aHR 0.88, 95% CI 0.83–0.93) and regular (aHR 0.84, 95% CI, 0.78–0.92) physical activity reduced the risk of TB. Male sex, lower income, alcohol consumption, smoking, diabetes, and asthma/chronic obstructive pulmonary disease increased the risk of TB. Conclusion: The risk of TB among older adults increased with worsening anemia, sarcopenia, and physical inactivity. Physicians should be aware of those modifiable predictors for TB among the older population.

Regulatory Role of Sex Hormones in Cardiovascular Calcification

International Journal of Molecular Sciences ◽

10.3390/ijms22094620 ◽

2021 ◽

Vol 22 (9) ◽

pp. 4620

Author(s):

Holly J. Woodward ◽

Dongxing Zhu ◽

Patrick W. F. Hadoke ◽

Victoria E. MacRae

Keyword(s):

Cardiovascular Disease ◽

Sex Differences ◽

Sexual Dimorphism ◽

Aortic Stenosis ◽

Sex Hormones ◽

Sex Hormone ◽

Increased Risk ◽

Male Sex ◽

Primary Male

Sex differences in cardiovascular disease (CVD), including aortic stenosis, atherosclerosis and cardiovascular calcification, are well documented. High levels of testosterone, the primary male sex hormone, are associated with increased risk of cardiovascular calcification, whilst estrogen, the primary female sex hormone, is considered cardioprotective. Current understanding of sexual dimorphism in cardiovascular calcification is still very limited. This review assesses the evidence that the actions of sex hormones influence the development of cardiovascular calcification. We address the current question of whether sex hormones could play a role in the sexual dimorphism seen in cardiovascular calcification, by discussing potential mechanisms of actions of sex hormones and evidence in pre-clinical research. More advanced investigations and understanding of sex hormones in calcification could provide a better translational outcome for those suffering with cardiovascular calcification.

Modeling of Bank Credit Risk Management Using the Cost Risk Model

Journal of Risk and Financial Management ◽

10.3390/jrfm14050211 ◽

2021 ◽

Vol 14 (5) ◽

pp. 211

Author(s):

Iryna Yanenkova ◽

Yuliia Nehoda ◽

Svetlana Drobyazko ◽

Andrii Zavhorodnii ◽

Lyudmyla Berezovska

Keyword(s):

Risk Management ◽

Decision Support ◽

Credit Risk ◽

Risk Model ◽

Bank Credit ◽

Credit Risk Management ◽

Loan Default ◽

Increased Risk ◽

Credit Portfolio ◽

Cost Risk

This article deals with the issue of managing bank credit risk using a cost risk model. Modeling of bank credit risk management was proposed based on neural-cell technologies, which expand the possibilities of modeling complex objects and processes and provide high reliability of credit risk determination. The purpose of the article is to improve and develop methodical support and practical recommendations for reducing the level of risk based on the value-at-risk (VaR) methodology and its subsequent combination with methods of fuzzy programming and symbiotic methodical support. The model makes it possible to create decision support subsystems for nonperforming loan management based on the neuro-fuzzy approach. For this paper, economic and mathematical tools (based on the VaR methodology) were used, which made it possible to analyze and forecast the dynamics of overdue payment; assess the quality of the credit portfolio of the bank; determine possible trends in bank development. A scientific and practical approach is taken to assess and forecast the degree of credit problematicity by qualitative criteria using a mathematical model based on a fuzzy technology, which can forecast the increased risk of loan default at an early stage in the process of monitoring the loan portfolio and model forecasting changes in the degree of credit problematicity on change of indicators. A methodology is proposed for the analysis and forecasting of indicators of troubled loan debt, which should be implemented as software and included in the decision support system during the process of monitoring the risk of the bank’s credit portfolio.

Relevance of comorbidities and antithrombotic medication as risk factors for reoperation in patients with chronic subdural hematoma

Neurosurgical Review ◽

10.1007/s10143-021-01537-x ◽

2021 ◽

Author(s):

Alexander Younsi ◽

Lennart Riemann ◽

Cleo Habel ◽

Jessica Fischer ◽

Christopher Beynon ◽

...

Keyword(s):

Clinical Outcome ◽

Multivariate Analyses ◽

Independent Predictor ◽

Perioperative Complications ◽

Chronic Subdural Hematoma ◽

Western Society ◽

Increased Risk ◽

Surgical Evacuation ◽

Antithrombotic Medication ◽

Univariate Analyses

AbstractIn an aging Western society, the incidence of chronic subdural hematomas (cSDH) is continuously increasing. In this study, we reviewed our clinical management of cSDH patients and identified predictive factors for the need of reoperation due to residual or recurrent hematomas with a focus on the use of antithrombotic drugs. In total, 623 patients who were treated for cSDH with surgical evacuation between 2006 and 2016 at our department were retrospectively analyzed. Clinical and radiological characteristics and laboratory parameters were investigated as possible predictors of reoperation with univariate and multivariate analyses. Additionally, clinical outcome measures were compared between patients on anticoagulants, on antiplatelets, and without antithrombotic medication. In univariate analyses, patients on anticoagulants and antiplatelets presented significantly more often with comorbidities, were significantly older, and their risk for perioperative complications was significantly increased. Nevertheless, their clinical outcome was comparable to that of patients without antithrombotics. In multivariate analysis, only the presence of comorbidities, but not antithrombotics, was an independent predictor for the need for reoperations. Patients on antithrombotics do not seem to necessarily have a significantly increased risk for residual hematomas or rebleeding requiring reoperation after cSDH evacuation. More precisely, the presence of predisposing comorbidities might be a key independent risk factor for reoperation. Importantly, the clinical outcomes after surgical evacuation of cSDH are comparable between patients on anticoagulants, antiplatelets, and without antithrombotics.