This Issue at a Glance

Abstract

Zetterberg et al (p. 364) investigated case mix in relation to capsule complication and surgeons’ operation volume and determined a composite risk score for capsule complications. They retrospectively analyzed data from Swedish patients who underwent cataract surgery between 2007 and 2016 and used the 2016 cohort of 118 534 cases to calculate risk factors for capsule complications. Variables significantly associated with capsule complications were preoperative best-corrected visual acuity ≤ 0.1, pseudoexfoliation, use of Trypan blue, mechanical pupil dilation, and iris hooks at the rhexis margin. The composite risk score was 3.09 ± 6.40 for patients with capsule complication and 1.28 ± 1.66 for uncomplicated procedures. High-volume cataract surgeons (≥ 500 procedures yearly) had significantly lower mean composite case mix score compared with low/medium-volume cataract surgeons. The authors conclude that case mix may contribute to the decrease in capsule complications from 2007 to 2016 and the lower complication rate of high-volume cataract surgeons. In a prospective cross-sectional study, Dart et al (p. 372) assessed whether a panel of serum pemphigoid autoantibody tests could be used to confirm an immunopathologic diagnosis of mucous membrane pemphigoid (MMP) in direct immunofluorescent negative (DIF–) MMP patients. The proportions of serum pemphigoid autoantibodies detected in DIF+ MMP patients was higher at 22 of 49 patients (44.9%) compared with DIF– MMP at 6 of 24 patients (25%). Ocular-only MMP serum reactivity was not significantly different compared with controls for any test or test combination, whereas DIF– multisite ocular MMP differed for 1 ELISA and 3 of 7 test combinations. Individual test sensitivity was low for the entire MMP cohort, and disease activity was strongly associated with positive serologic findings. The researchers conclude that pemphigoid serum autoantibody tests did not provide immunopathologic evidence of MMP in ocular-only MMP patients but showed limited value in DIF– multisite ocular MMP patients. In a retrospective cohort study, Medeiros et al (p. 383) assessed whether deep learning estimates of retinal nerve fiber layer (RNFL) thickness from fundus photographs can also detect progressive glaucomatous changes over time. Using a test sample of 33 466 pairs of fundus photographs and spectral-domain (SD) OCT images collected from 1147 eyes of 717 patients, the researchers found a significant correlation between change over time in estimated and observed RNFL thickness. RNFL estimations showed a receiver operating characteristic (ROC) curve area of 0.86 to discriminate progressors from nonprogressors. For detecting fast progressors with rates faster than –2 μm/year, the area under the ROC curve was 0.96. The intraclass correlation coefficient for photographs obtained at the same visit was 0.946, with a coefficient of variation of 3.2%. The authors conclude that a deep learning algorithm could accurately estimate objective RNFL thickness measurements from fundus photographs and could potentially be used to track glaucoma progression. Achiron et al (p. 410) examined the effect of blue-light filtering (BLF) intraocular lenses (IOLs) on the prevention of neovascular age-related macular degeneration (nAMD) after cataract surgery. The retrospective registry-based cohort study included 11 397 eyes of 11 397 patients, with 5425 eyes (47.6%) using the BLF IOL, and 5972 eyes (52.4%) using the non-BLF IOL. During follow-up, 88 cases of new-onset nAMD were recorded in the BLF group and 76 in the non-BLF group. The nAMD-free survival was similar between the groups, and the use of a BLF IOL was not predictive of nAMD development. Clinical outcomes at one year for best corrected visual acuity, foveal thickness, the number of intravitreal injections, and treatment interval were comparable between both IOLs. The researchers conclude that the use of a BLF IOL resulted in no apparent advantage over a non-BLF IOL in nAMD incidence, progression, or clinical outcomes related to nAMD severity. Iftikhar et al (p. 463) conducted a retrospective, longitudinal study to examine the incidence, characteristics, and economic burden of orbital floor fractures in the United States. There were an estimated 350 379 Emergency Department (ED) visits in the US with a primary diagnosis of orbital floor fracture between 2006 and 2017, and the incidence increased by 47% over the study period, from 7.7 to 11.3 per 100 000 population. Orbital floor fractures were most likely to occur in young men (46%) and the most common cause was assault (43%). The second most common cause was falls (26%), which was most frequent in patients aged ≥ 65 years and more than doubled during the study period. The total inflation-adjusted ED charges over the study period exceeded $2 billion, with the mean charge per visit increasing 48% from $5881 to $8728. The authors suggest that orbital floor fractures are becoming an increasingly common and costly injury in the United States.