Cataract Surgery Outcome in a Referral Center: Farabi Eye Hospital, Tehran; Study Protocol

Purpose: To report a study design for assessing the cataract surgery outcome Methods: We conducted the study in an eye hospital in which over 13,300 cataract extractions are performed annually. Sampling framework and recruitment included hospital records of patients who underwent age-related cataract extraction within the preceding 5 years that were sampled randomly for 470 patients. Phone recruitment was made and the surgical records were reviewed. Novel variables were ‘mature cataract rate’, ‘surgeon competence’, ‘surgically challenging eye’, ‘wound enlargement’ and ‘use of an injector to insert an intraocular lens’, ‘posterior capsule status’, ‘postoperative spectacle use’, and ‘unmet need’. Causal diagrams (to facilitate modeling), data mining (clustering and decision matrix), and outlier analysis were used. Results: Subjects were categorized as deceased, unavailable, or successfully contacted with the last subcategorized as participants or non-participants (declined or noncompliant), in a participants’ flow chart. The participation rate was 51%. Participants and non-participants were comparable regarding baseline and surgical characteristics. The causes of visual impairment were reviewed and a standardized diagnostic scheme was developed that included eight anatomic headings and 18 disease-specific subheadings. A reporting scheme was sketched. Conclusion: Despite shortcomings in the quality and availability of the hospital and surgical records and a relatively low participation rate compared to prospective data collection, this retrospective cross-sectional approach was practical for evaluating the quality of cataract surgery in a hospital in a developing country and the protocol is recommended as a guideline to manage such a project.