TY - JOUR
T1 - A Randomized Controlled Trial Comparing Outcomes of Cataract Surgery in Nanophthalmos With and Without Prophylactic Sclerostomy
AU - Rajendrababu, Sharmila
AU - Babu, Naresh
AU - Sinha, Sapna
AU - Balakrishnan, Vijayakumar
AU - Vardhan, Ashok
AU - Puthuran, George Varghese
AU - Ramulu, Pradeep Y.
N1 - Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2017/11
Y1 - 2017/11
N2 - Purpose To prospectively evaluate visual outcomes and complications during and after cataract surgery with or without prophylactic sclerostomy in nanophthalmic eyes with visually significant cataract. Study Design Randomized controlled trial. Methods Sixty nanophthalmic eyes of 60 patients with visually significant cataract were randomly assigned to cataract surgery alone (control group, n = 31) or cataract surgery with concomitant prophylactic sclerostomy (sclerostomy group, n = 29). Surgery was performed using phacoemulsification or manual small-incision cataract surgery (SICS) based on the LOCS III grading score. Group differences in intraoperative and postoperative complications were analyzed and risk factors assessed. Results Fewer complications were noted in eyes receiving sclerostomy (5/29, 17.2%) as compared to control group eyes (12/31, 38.7%), though differences were marginally significant (P =.065). Four control group, but no sclerostomy group, eyes developed postoperative uveal effusions (P =.04). In multivariable models, sclerostomy decreased the odds of an intraoperative or postoperative complication by 80% (odds ratio [OR] = 0.2, 95% confidence interval [CI] = 0.04–0.92, P =.039); SICS was associated with a significantly higher risk of complications as compared to phacoemulsification (OR = 5.95, 95% CI = 1.49–23.73, P =.012), while high preoperative intraocular pressure (OR = 4.54, 95% CI = 0.99–20.9, P =.052) and greater lens thickness (OR = 3.38, 95% CI = 0.88–12.91, P =.075) demonstrated a marginally significant association. Conclusions Cataract surgery in eyes with nanophthalmos is associated with a high risk for vision-threatening complications. Performing a simultaneous prophylactic sclerostomy with cataract surgery reduces complication rates, particularly uveal effusions. Cataract surgery at earlier stages by phacoemulsification may be more beneficial than undergoing manual SICS.
AB - Purpose To prospectively evaluate visual outcomes and complications during and after cataract surgery with or without prophylactic sclerostomy in nanophthalmic eyes with visually significant cataract. Study Design Randomized controlled trial. Methods Sixty nanophthalmic eyes of 60 patients with visually significant cataract were randomly assigned to cataract surgery alone (control group, n = 31) or cataract surgery with concomitant prophylactic sclerostomy (sclerostomy group, n = 29). Surgery was performed using phacoemulsification or manual small-incision cataract surgery (SICS) based on the LOCS III grading score. Group differences in intraoperative and postoperative complications were analyzed and risk factors assessed. Results Fewer complications were noted in eyes receiving sclerostomy (5/29, 17.2%) as compared to control group eyes (12/31, 38.7%), though differences were marginally significant (P =.065). Four control group, but no sclerostomy group, eyes developed postoperative uveal effusions (P =.04). In multivariable models, sclerostomy decreased the odds of an intraoperative or postoperative complication by 80% (odds ratio [OR] = 0.2, 95% confidence interval [CI] = 0.04–0.92, P =.039); SICS was associated with a significantly higher risk of complications as compared to phacoemulsification (OR = 5.95, 95% CI = 1.49–23.73, P =.012), while high preoperative intraocular pressure (OR = 4.54, 95% CI = 0.99–20.9, P =.052) and greater lens thickness (OR = 3.38, 95% CI = 0.88–12.91, P =.075) demonstrated a marginally significant association. Conclusions Cataract surgery in eyes with nanophthalmos is associated with a high risk for vision-threatening complications. Performing a simultaneous prophylactic sclerostomy with cataract surgery reduces complication rates, particularly uveal effusions. Cataract surgery at earlier stages by phacoemulsification may be more beneficial than undergoing manual SICS.
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U2 - 10.1016/j.ajo.2017.09.008
DO - 10.1016/j.ajo.2017.09.008
M3 - Article
C2 - 28911991
AN - SCOPUS:85030176703
SN - 0002-9394
VL - 183
SP - 125
EP - 133
JO - American journal of ophthalmology
JF - American journal of ophthalmology
ER -