Factors impacting cumulative dissipated energy levels and postoperative visual acuity outcome in cataract surgery

Abstract Purpose To determine factors impacting cumulative dissipated energy (CDE) and postoperative best-corrected visual acuity (BCVA) in phacoemulsification. Design Review of 1102 cases at University of California, San Francisco (UCSF) and at Zhongshan Ophthalmic Center (ZOC), China. Subjects Patients who underwent cataract surgery at UCSF 03/2014–03/2019 and at ZOC 10/2018–05/2019. Methods Patient demographics, medical history, routine ocular examination, and surgical information, including disassembly method, complications, and surgeon training level were recorded. Univariable and multivariable regression models were used to determine factors associated with CDE and good postoperative BCVA (20/40 or better) at 1 month. Outcome measures CDE, postoperative BCVA. Results In multivariable analysis, patient age at time of surgery, diabetes, degree of nuclear sclerosis (NS), white-to-white corneal diameter, disassembly method, preoperative BCVA, surgeon training level, and surgical center were significantly associated with CDE. Log10CDE increased by 0.20–0.31 for patient age ≥ 70 years, by 0.07 if the patient had diabetes, by 0.12–0.41 for NS grade ≥ 2, by 0.48 per 10 mm increase in white-to-white corneal diameter, by 0.34–0.47 for disassembly method other than non-stop chop, by 0.16 per unit increase in preoperative logMAR BCVA, and by > 0.09 when phacoemulsification was performed by residents early in their training. Log10CDE was 0.33 higher at UCSF than ZOC. In multivariable analysis, worse baseline visual acuity and age above 90 years at time of surgery decreased the odds of good BCVA (OR = 0.26 per unit increase in preoperative logMAR BCVA; OR = 0.12 for age > 90); comorbid retinal issues decreased the odds of good postoperative BCVA (OR = 0.13–0.39); greater anterior chamber depth (ACD) or shorter axial length (AL), increased the odds of good postoperative outcome (OR = 2.64 per 1 mm increase ACD, OR = 0.84 per 1 mm increase AL). Conclusions Cataract grade determined by slit lamp exam and, for the first time, older patient age, were noted to be important predictors of high CDE. CDE was not a risk factor for postoperative BCVA measured at postoperative 1 month. When surgery was performed by trainees under supervision, lower training level was associated with higher CDE, but not with worse postoperative BCVA.

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Abstract 126: Comparison of Flow Diversion and Coiling in Large Unruptured Intracranial Saccular Aneurysms

Stroke ◽

10.1161/str.45.suppl_1.126 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Nohra Chalouhi ◽

Stavropoula Tjoumakaris ◽

Robert M Starke ◽

L Fernando Gonzalez ◽

Ciro Randazzo ◽

...

Keyword(s):

Clinical Outcomes ◽

Multivariable Analysis ◽

Flow Diversion ◽

Similar Proportion ◽

Anterior Communicating Artery ◽

Patient Age ◽

Aneurysm Size ◽

Patient Âgé ◽

Complete Obliteration ◽

Saccular Aneurysms

Background and purpose: Flow diversion has emerged as an important tool for management of intracranial aneurysms. The purpose of this study was to compare flow diversion and traditional embolization strategies in terms of safety, efficacy, and clinical outcomes in patients with unruptured, large saccular aneurysms (≥ 10 mm). Methods: Forty patients treated with the Pipeline Embolization Device (PED) were matched in a 1:3 fashion with 120 patients treated with coiling based on patient age and aneurysm size. Fusiform and anterior communicating artery aneurysms were eliminated from the analysis. Procedural complications, angiographic results, and clinical outcomes were analyzed and compared. Results: There were no differences between the 2 groups in terms of patient age, gender, aneurysm size, and aneurysm location. The rate of procedure-related complications did not differ between the PED (7.5%) and the coil group (7.5% p=1). At the latest follow-up, a significantly higher proportion of aneurysms treated with PED (86%) achieved complete obliteration compared to coiled aneurysms (41%, p<0.001). In multivariable analysis, coiling was an independent predictor of nonocclusion. Retreatment was necessary in fewer patients in the PED group (2.8%) than the coil group (37%, p<0.001). A similar proportion of patients attained a favorable outcome (mRS 0-2) in the PED group (92%) and the coil group (94%, p=0.8). Conclusion: The PED provides higher aneurysm occlusion rates than coiling, with no additional morbidity and similar clinical outcomes. These findings suggest that the PED is a preferred treatment option for large unruptured saccular aneurysms.

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Comparison of real-world treatment outcomes of femtosecond laser-assisted cataract surgery and phacoemulsification cataract surgery: A retrospective, observational study from an outpatient clinic in France

European Journal of Ophthalmology ◽

10.1177/1120672120925766 ◽

2020 ◽

pp. 112067212092576

Author(s):

Philippe Charles Crozafon ◽

Christine Bouchet ◽

Monia Zignani ◽

Ray Griner ◽

Samuel D Foster ◽

...

Keyword(s):

Visual Acuity ◽

Femtosecond Laser ◽

Cataract Surgery ◽

Multiple Comparisons ◽

Posterior Capsule Opacification ◽

Dissipated Energy ◽

Corneal Oedema ◽

Corrected Distance Visual Acuity ◽

Cumulative Dissipated Energy ◽

Phacoemulsification Cataract Surgery

Purpose: This study compared real-world safety and efficacy outcomes of cataract surgery performed with LenSx femtosecond laser-assisted cataract surgery or manual phacoemulsification cataract surgery procedures. Methods: A retrospective observational study used data from anonymised electronic medical records to compare mean cumulative dissipated energy, the proportion of eyes reaching emmetropia, mean change in best-corrected distance visual acuity and the proportion of eyes with post-surgical complications, including corneal oedema and posterior capsule opacification. Results were adjusted for multiple comparisons for primary and secondary objectives. Results: Data from 811 phacoemulsification cataract surgery and 496 femtosecond laser-assisted cataract surgery procedures were analysed. Mean cumulative dissipated energy was significantly lower for femtosecond laser-assisted cataract surgery (6.5 percent-seconds) than for phacoemulsification cataract surgery (14.3 percent-seconds; p < 0.0001) procedures. More femtosecond laser-assisted cataract surgery (81.2%) procedures achieved emmetropia (⩽ 0.5 dioptre) than did phacoemulsification cataract surgery (73.5%) procedures, although this difference was not statistically significant. Mean change in best-corrected distance visual acuity and the proportion of eyes with corneal oedema, posterior capsule opacification or other complications were not significantly different between cohorts when adjusted for multiple comparisons. Conclusions: In this single-centre, single-surgeon retrospective electronic medical record database study using divide and conquer technique, femtosecond laser-assisted cataract surgery was associated with significantly lower cumulative dissipated energy when compared to manual phacoemulsification cataract surgery. This supports the hypothesis that femtosecond laser-assisted cataract surgery involves less mechanical trauma, which might lead to more consistent refractive and safety outcomes than manual phacoemulsification cataract surgery, though such outcomes were found to be comparable in this study.

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Prophylactic Intravitreal Bevacizumab After Plaque Radiotherapy for Uveal Melanoma: Analysis of Visual Acuity, Tumor Response, and Radiation Complications in 1131 Eyes Based on Patient Age

Asia-Pacific Journal of Ophthalmology ◽

10.1097/apo.0000000000000271 ◽

2020 ◽

Vol 9 (1) ◽

pp. 29-38

Author(s):

Michael Chang ◽

Lauren A. Dalvin ◽

Mehdi Mazloumi ◽

Andrei Martin ◽

Antonio Yaghy ◽

...

Keyword(s):

Visual Acuity ◽

Uveal Melanoma ◽

Tumor Response ◽

Intravitreal Bevacizumab ◽

Patient Age ◽

Patient Âgé ◽

Plaque Radiotherapy

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Abstract WP253: Impact of a Stroke Coordinator on Improving Time to Treatment at Telestroke Sites.

Stroke ◽

10.1161/str.48.suppl_1.wp253 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Lidia B Yamada ◽

Manuel C Gurry ◽

Jillian B Harvey ◽

Ellen Debenham ◽

Christine A Holmstedt ◽

...

Keyword(s):

South Carolina ◽

Acute Stroke ◽

Rural Areas ◽

Multivariable Analysis ◽

Categorical Variables ◽

Stroke Severity ◽

Stroke Patients ◽

Patient Age ◽

Time To Treatment ◽

Patient Âgé

Background: The implementation of Telestroke systems has made stroke expertise accessible to patients evaluated in hospitals located in rural areas. Yet, decreasing time from emergency department (ED) arrival to administration of intravenous tPA is still a challenge in many rural hospitals. Stroke coordinators can provide staff training on stroke recognition and implement strategies for faster assessment of acute stroke patients. We sought to determine if the presence of a stroke coordinator (SC) at Telestroke sites contributed to decreased door-to-registration (DTR) and door-to-needle (DTN) time in the ED. Methods: Data from Telestroke consultations at 22 different community hospitals in South Carolina (2008 - 2016) were analyzed. DTR and DTN were compared between consults when a SC was employed or not at the respective hospitals at the time of the consultation. T-tests and chi squared were used to examine differences in continuous and categorical variables, respectively. Estimates for each outcome were determined using a log link general linear model, with a gamma distribution, adjusting for patient age, sex, site, and stroke severity (NIH stroke scale) on admission. Results: Of 8441 Telestroke consultations performed, 5842 (69%) were included in the DTR analysis, with the remainder excluded due to incomplete data. DTN was available for 1056 consultations. Adjusted mean DTR time was 23.3 minutes shorter (31.6 vs. 54.9, p≤0.001) for consultations in sites that employ a SC vs. those without. Mean DTN time was 29.7 minutes shorter in sites with a SC (64.5 vs. 94.2, p≤0.001). The multivariable analysis showed that employment of a SC, site, patient age and NIHSS were significantly related to shorter DTR and DTN. Conclusions: Employment of a stroke coordinator at remote hospitals receiving Telestroke services can significantly decrease time to registration and time to treatment of patients presenting with acute stroke symptoms, which may improve outcomes for stroke patients.

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Patient Age May Indicate Basal Cell Nevus Syndrome

Skin & Allergy News ◽

10.1016/s0037-6337(06)71526-1 ◽

2006 ◽

Vol 37 (9) ◽

pp. 39

Author(s):

Diana Mahoney

Keyword(s):

Basal Cell ◽

Patient Age ◽

Basal Cell Nevus Syndrome ◽

Patient Âgé

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Researchers examine the influence of hospital surgery volume, procedure type, and patient age on surgical risk

PsycEXTRA Dataset ◽

10.1037/e556652006-011 ◽

2002 ◽

Keyword(s):

Patient Age ◽

Surgical Risk ◽

Patient Âgé ◽

Procedure Type

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Gestion orthopédique d’une ankylose de l’ATM chez l’enfant

Revue d Orthopédie Dento-Faciale ◽

10.1051/odf/2020041 ◽

2020 ◽

Vol 54 (4) ◽

pp. 407-418

Author(s):

Pamela Villalon-Pooley ◽

Camila Hernandez-Veliz ◽

Maria Fernanda Pinto-Chavez ◽

Pierre Bourdiol

Keyword(s):

Patient Age ◽

Patient Âgé

Parmi les fractures cranio-faciales, celles affectant le condyle mandibulaire font partie des fractures les plus souvent rencontrées chez le patient en âge pédiatrique. L’évolution sans traitement peut produire une ankylose temporo-mandibulaire entraînant troubles fonctionnels et asymétrie de la croissance cranio-faciale. Le traitement traditionnellement chirurgical est d’un pronostic généralement réservé. Dans cet article est présenté le cas d’un patient, âgé de quatre ans, atteint d’ankylose fibreuse de l’articulation temporo-mandibulaire gauche, suite probable d’une fracture du col du condyle non-diagnostiquée. La libération fonctionnelle de la fibro-ankylose articulaire a été l’objectif de la première étape thérapeutique. Celle-ci a été suivie, à l’âge de sept ans, d’une distraction articulaire obtenue au moyen de butées occlusales controlatérales disposées côté droit. Ceci a produit un ajustement de la croissance dento-alvéolaire assurant à la fois un rattrapage du déficit de croissance unilatéral de départ et une néoformation condylienne par remodelage de l’articulation temporo-mandibulaire gauche. Quatre années après la mise en route de la phase orthopédique initiale, la fonction articulaire restaurée et l’équilibre facial obtenu restent stables chez ce jeune patient

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Hemmkörperentwicklung bei Hämophilie-Patienten nach Präparate wechsel

Hämostaseologie ◽

10.1055/s-0037-1619773 ◽

2012 ◽

Vol 32 (S 01) ◽

pp. S39-S42 ◽

Cited By ~ 1

Author(s):

S. Kocher ◽

G. Asmelash ◽

V. Makki ◽

S. Müller ◽

S. Krekeler ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Observational Study ◽

Retrospective Observational Study ◽

Frequent Change ◽

Patient Age ◽

Treatment Regimens ◽

Patient Âgé ◽

The Relationship ◽

Observation Period

SummaryThe retrospective observational study surveys the relationship between development of inhibitors in the treatment of haemophilia patients and risk factors such as changing FVIII products. A total of 119 patients were included in this study, 198 changes of FVIII products were evaluated. Results: During the observation period of 12 months none of the patients developed an inhibitor, which was temporally associated with a change of FVIII products. A frequent change of FVIII products didn’t lead to an increase in inhibitor risk. The change between plasmatic and recombinant preparations could not be confirmed as a risk factor. Furthermore, no correlation between treatment regimens, severity, patient age and comorbidities of the patients could be found.

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Hämophilie-Zentrum Bonn 1980 – 2009

Hämostaseologie ◽

10.1055/s-0037-1619741 ◽

2011 ◽

Vol 31 (S 01) ◽

pp. S4-S10 ◽

Cited By ~ 2

Author(s):

I. Besmens ◽

H.-H. Brackmann ◽

J. Oldenburg

Keyword(s):

Young Patients ◽

Severe Form ◽

Coagulation Disorder ◽

Care Providers ◽

Long Distance ◽

Patient Age ◽

Patient Âgé ◽

Number Of Patients ◽

Clotting Disorder ◽

Regional Character

SummaryThe Bonn Haemophilia Care Center provides patient care on a superregional level. The centre’s large service area is, in part, due to the introduction of haemophilia home treatment and related to this the individualized prophylaxis in children and adults by Egli and Brack-mann in Bonn in the early 1970s, that represented a milestone in German haemophilia therapy. Epidemiologic patient data from the two selected time points, 1980 and 2009, are evaluated to illustrate the change in the composition of the patient clientele. In 1980 a total of 639 patients were treated at the Bonn Haemophilia Center. 529 patients exhibited a severe form and 110 a non-severe form of the respective clotting disorder. In 2009 the Bonn Haemophilia Center took care for a total of 837 patients. There were 445 patients who suffered from a severe form of the considered clotting disorder while 392 showed a non-severe course. The number of less severely affected patients has increased significantly in 2009. Patients in 1980 were predominantly suffering from a severe form and most had to travel more than 150 km from their homes to the treatment center. In 2009 the number of patients living a medium-long distance from the care provider has significantly increased while the number of patients living more than 150km from the center has decreased. Comparing 2009 to 1980 a growth of the center’s regional character becomes apparent, especially when patient age and severity of the coagulation disorder are taken into consideration. The regional character was more strongly pronounced with milder disease severity and lower patient age. Due to the existence of well established primary haemophilia care in CCCs in Germany, the trend for the recent years is that the proportion of young patients that choose haemophilia care providers closer to their homes is increasing.

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