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Incidence of nonarteritic ischemic optic neuropathy following topical clear corneal cataract surgery: survey and meta-analysis

Published:August 09, 2019DOI:https://doi.org/10.1016/j.jcjo.2019.06.006

      ABSTRACT

      Objective

      We estimate the incidence and characteristics of post-cataract-surgery nonarteritic ischemic optic neuropathy (PCNAION) after topical clear corneal cataract extraction (CCCE) in Canada.

      Design

      Canada-wide internet survey and meta-analysis

      Participants

      All certified Canadian ophthalmologists in the Canadian Ophthalmological Society directory, or belonging to a provincial ophthalmology internet group.

      Methods

      Identical surveys were distributed to 5 regions in Canada. CCCE surgeons were asked to estimate the number of CCCE they had performed in their career, and the number of PCNAION events that occurred within 1 year after CCCE. The results were analyzed using a random effects meta-analysis of proportions for rare events.

      Results

      The estimated survey response rate was 18%–32%. The 182 survey respondents performed a total of 1 499 694 CCCE with 107 events of PCNAION. Twenty-six percent of surgeons had at least one patient with PCNAION. Meta-analysis revealed a pooled estimate incidence of 2.8 PCNAION events (95% confidence interval 1.6–4.7) per 100 000 cataract procedures during the year after cataract surgery. Seventy-seven percent (82/107) of the PCNAION cases occurred within 3 weeks of surgery, and 7 patients had bilateral PCNAION.

      Conclusions

      PCNAION is a rare complication after topical CCCE. Its incidence is important to estimate for patient care and epidemiologic reasons.

      Résumé

      Objectif

      Il s'agit d'une estimation de l'incidence et d'une description des caractéristiques de la neuropathie optique ischémique non artéritique secondaire à une chirurgie de la cataracte (NOINACC) après extraction de la cataracte en cornée claire (ECCC) sous anesthésie topique au Canada.

      Nature

      Sondage sur Internet à l’échelle du Canada, suivi d'une méta-analyse.

      Participants

      Tous les ophtalmologistes certifiés de la Société canadienne d'ophtalmologie ou appartenant à un groupe provincial d'ophtalmologie sur Internet.

      Méthodes

      Des questionnaires identiques ont été distribués dans 5 régions du Canada. On a demandé aux chirurgiens d'estimer le nombre d'ECCC qu'ils ont réalisées pendant leur carrière, et le nombre de NOINACC survenues dans l'année suivant l'ECCC. Les résultats ont été analysés au moyen d'une méta-analyse à effets aléatoires de la proportion d’événements rares.

      Résultats

      Le taux estimatif de réponse au questionnaire oscille entre 18 % et 32 %. Les 182 répondants ont réalisé un total de 1 499 694 ECCC, dont 107 ont été suivies d'une NOINACC. Vingt-six pour cent des chirurgiens ont eu au moins un patient chez lequel il s'est produit une NOINACC. La méta-analyse a fait ressortir une estimation du taux d'incidence colligé de 2,8 NOINACC (intervalle de confiance à 95 %: 1,6–4,7) par 100 000 chirurgies de la cataracte au cours de l'année suivant l'intervention. Soixante-dix-sept pour cent (82/107) des NOINACC sont survenues dans les 3 semaines suivant la chirurgie, et 7 patients ont subi une NOINACC bilatérale.

      Conclusions

      La NOINACC est une complication rare de l'ECCC sous anesthésie topique. Il est important de connaître son incidence pour mieux évaluer les soins aux patients et pour en cerner l’épidémiologie.
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      References

        • Harvard Health Publishing
        Considering cataract surgery? What you should know.
        2018
        • Stein J.
        Serious adverse events after cataract surgery.
        Curr Opin Ophthalmol. 2012; 23: 219-225
        • National Institute for Health and Care Excellence
        Cataracts in adults: management.
        NICE Guideline NG77 Cataracts in adults: management. 2017
        https://www.nice.org.uk/guidance/ng77
        Date accessed: August 1, 2018
        • McCulley T.
        Ischemic optic neuropathy and cataract extraction: what do I need to know.
        Oman J Ophthalmol. 2012; 5: 141-143
        • Moradi A.
        • Kanagalingam S.
        • Diener-West M.
        • Miller N.R.
        Post-cataract surgery optic neuropathy: prevalence, incidence, temporal relationship, and fellow eye involvement.
        Am J Ophthalmol. 2017; 175: 183-193
        • McCulley T.J.
        • Lam B.Y.
        • Feuer W.J.
        Editorial: nonarteritic anterior ischemic optic neuropathy and intraocular surgery.
        Am J Opthalmol. 2017; 175: xv-xvi
        • Canadian Medical Association
        Ophthalmology Profile.
        2018
        • Beck R.W.
        • Servais G.E.
        • Hayreh S.S.
        Anterior ischemic optic neuropathy. IX. Cup-to-disc ratio and its role in pathogenesis.
        Ophthalmology. 1987; 94: 1503-1508
        • Fan W.
        • Yan Z.
        Factors affecting response rates of the web survey: a systematic review.
        Comput Hum Behav. 2010; 26: 132-139
        • Rao S.R.
        • Graubard B.I.
        • Schmid C.H.
        • et al.
        Meta-analysis of survey data: application to health services research.
        Health Serv Outcomes Res Methodol. 2008; 8: 98-114
        • Ma Y.
        • Chu H.
        • Mazumdar M.
        Meta-analysis of proportions of rare events-a comparison of exact likelihood methods with robust variance estimation.
        Commun Stat Simul Cormput. 2016; 45: 3036-3052
        • Nyaga V.N.
        • Arbyn M.
        • Aerts M.
        METAPROP_ONE: Stata module to perform fixed and random effects meta-analysis of proportions.
        2017 (revised)
        • Micieli J.A.
        • Buys Y.M.
        Proportion of medical-only versus surgical ophthalmology practices: associations and trends.
        Can J Ophthalmol. 2016; 51: 161-167
        • Ali A.A.
        • Hallingham S.
        • Buys Y.
        Workforce supply of eye care providers in Canada: optometrists, ophthalmologists, and subspecialty ophthalmologists.
        Can J Ophthalmol. 2015; 50: 422-428
        • Hunter J.P.
        • Saratzis A.
        • Sutton A.J.
        • Boucher R.H.
        • Sayers R.D.
        • Bown M.J.
        In meta-analyses of proportion studies, funnel plots were found to be an inaccurate method of assessing publication bias.
        J Clin Epidemiol. 2014; 67: 897-903
        • Statistics Canada
        Canada at a Glance.
        2018
        • Ong-Tone L.
        Practice patterns of Canadian Ophthalmological Society members in cataract surgery - 2017 survey.
        Can J Ophthalmol. 2018; 53: 1
        • Saskatchewan Health Authority & Lindsay Ong-Tone
        COS Survey Results.
        2018
        • Fryrear A.
        What's a good survey response rate?.
        2015
        • Hattenhauer M.G.
        • Leavitt J.A.
        • Hodge D.O.
        • Grill R.
        • Gray D.T.
        Incidence of nonarteritic anterior ischemic optic neuropathy.
        Am J Ophthalmol. 1997; 123: 103-107
        • Lee M.S.
        • Grossman D.
        • Arnold A.C.
        • Sloan F.A.
        Incidence of nonarteritic anterior ischemic optic neuropathy: increased risk among diabetic patients.
        Ophthalmology. 2011; 118: 959-963
        • Lee J.Y.
        • Park K.A.
        • Oh S.Y.
        Prevalence and incidence of non-arteritic anterior ischaemic optic neuropathy in South Korea: a nationwide population-based study.
        Br J Ophthalmol. 2018; 102: 936-941
        • Erie J.
        Rising cataract surgery rates: demand and supply.
        Ophthalmology. 2014; 121: 2-4
        • Lam B.L.
        • Jabaly-Habib H.
        • Al-Sheikh N.
        • Pezda M.
        • Guirgis M.F.
        • Feuer W.J.
        Risk of non-arteritic anterior ischaemic optic neuropathy (NAION) after cataract extraction in the fellow eye of patients with prior unilateral NAION.
        Br J Ophthalmol. 2007; 91: 585-587
        • Aptel F.
        • Khayi H.
        • Pépin J.L.
        • et al.
        Association of nonarteritic ischemic optic neuropathy with obstructive sleep apnea syndrome: consequences for obstructive sleep apnea screening and treatment.
        JAMA Opthalmol. 2015; 133: 797-804
        • Cestari D.M.
        • Arnold A.
        Does nocturnal hypotension play a causal role in nonarteritic anterior ischemic optic neuropathy?.
        J Neuroophthalmol. 2016; 36: 329-333
        • Lee A.G.
        • Biousse V.
        Should steroids be offered to patients with nonarteritic anterior ischemic optic neuropathy.
        J Neuroophthalmol. 2010; 30: 193-198
        • Kinori M.
        • Ben-Bassat I.
        • Wasserzug Y.
        • Chetrit A.
        • Huna-Baron R.
        Visual outcome of mega-dose intravenous corticosteroid treatment in non-arteritic anterior ischemic optic neuropathy - retrospective analysis.
        BMC Ophthalmol. 2014; 14: 62
        • Pakravan M.
        • Esfandiari H.
        • Hassanpour K.
        • Razavi S.
        • Pakravan P.
        The effect of combined systemic erythropoietin and steroid on non-arteritic anterior ischemic optic neuropathy: a prospective study.
        Curr Eye Res. 2017; 42: 1079-1084
        • Johnson L.N.
        • Guy M.E.
        • Krohel G.B.
        • Madsen R.W.
        Levodopa may improve vision loss in recent-onset, nonarteritic anterior ischemic optic neuropathy.
        Ophthalmology. 2000; 107: 521-526
        • Rootman D.B.
        • Gill H.S.
        • Margolin E.A.
        Intravitreal bevacizumab for the treatment of nonarteritic anterior ischemic optic neuropathy: a prospective trial.
        Eye (Lond). 2013; 27: 538-544
        • IONDT Research Group
        Ischemic optic neuropathy decompression trial, twenty-four month update.
        JAMA Ophthalmol. 2000; 118: 793-797
        • Neuro-ophthalmology Research Disease Investigator Consortium
        Phase 2/3, Randomized, Double-Masked, Sham-Controlled Trial of QPI-1007 in Acute NAION.
        2018 (ClinicalTrials.gov(updated))