Factors affecting cataract surgery complications and their effect on the postoperative outcome

Objective: To identify factors associated with the development of complications during or after cataract surgery and to determine the effect of complications on improvements in visual acuity and visual function. Design: Longitudinal study. Participants: A total of 4335 patients at 17 hospitals in the Spanish National Health Service undergoing cataract removal by phacoemulsification. Methods: Clinical data were collected before the intervention and 6 weeks postoperatively. All patients were mailed the Visual Function Index (VF-14) and additional questions concerning their ocular disease, preoperatively and 3 months after surgery. Logistic regression models were used to identify factors associated with the presence of complications, and general linear models to study the effect of complications on changes in visual acuity and VF-14 scores. Results: Some type of perioperative complication was found in 10.35% of patients and postoperative complications in 26.63%. Age, visual acuity greater than 0.3, moderate or high technical complexity, and the presence of perioperative complications, such as posterior capsular rupture or vitreous hemorrhage, were most strongly associated with the development of postoperative complications. Patients who had either perioperative or postoperative complications had lower levels of preoperative and postoperative visual acuity levels and visual function, and less improvement was seen for these parameters. Conclusions: We identified factors associated with the development of surgery-related complications and showed that the presence of complications is associated with poorer postoperative visual acuity and function. These findings are useful for health care management, clinical decision making, and providing patients and clinicians with realistic expectations.