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Notable Patient Outcomes

Recent outcomes reflect Moran’s dedication to providing exceptional care while fulfilling its teaching role as part of an academic medical center. Moran’s cataract surgery and endophthalmitis complication rates include cases performed with fellows or residents, or both.

Moran researchers have also published some of the most influential studies about cataract surgery techniques, safety, and intraoperative complications.*

These complication rates for cataract surgery** and endophthalmitis, a potentially blinding infection of the tissues or fluids inside the eye following surgery or ophthalmic injections are among the lowest when compared to known national and international benchmarks.

Cataract Surgery Complications

Data collected in 2020 shows cataract surgery complications were rare, occurring in only 35 of 3,378 surgeries.

· 1.03% with complications

· 98.97% complications free

Cataract Surgery Complications by Type

Of the 35 cataract extraction procedures with complications:

· 20 - Capsular Breakage (Vitreous Loss)

· 7 - Capsular Breakage

· 3 - Zonular Dehiscence (Vitreous Loss)

· 3 - Zonular Dehiscence

· 1 - Anterior Capsular Tear

· 1 - Lens Damage

Cataract Surgery-Induced Endophthalmitis

There were no cases of culture-positive endophthalmitis following uncomplicated cataract surgery in 2020. One possible case investigated in a complicated cataract surgery procedure returned with a negative culture. It was atypical in that it occurred more than five weeks after surgery. Visual outcome was excellent, improving from 20/150 best corrected, to 20/30 uncorrected. This results in an incidence of 0.018% for cataract surgery in 2020.***

All-Specialties Endophthalmitis Data

Surgery-Induced Endophthalmitis

Total 5,551 surgeries (4 cases: 1 positive culture, 3 negative)

· 0.07% surgery-induced endophthalmitis

· 99.93% endophthalmitis free cases

Injection-Induced Endophthalmitis

Total 8,690 intravitreal injections (10 cases: 5 infectious endophthalmitis, 5 non-infectious endophthalmitis)

· 0.11% Injection-induced endophthalmitis

· 99.89% endophthalmitis free cases

Comprehensive Data Collection

Casting a wide net, Moran’s QI group and division representatives, University of Utah Health Infection Prevention Department, and others review every potential case of endophthalmitis in the U of U Health hospital system. The team reviews all ocular specimens submitted for culture, all patients receiving intraocular antibiotics, and all cases coded as endophthalmitis.

Because Moran is part of a large referral hospital system, there were numerous “external” cases of endophthalmitis, not related to Moran’s facility, reviewed in 2020.

Moran’s review of 255 total potential endophthalmitis cases in 2020 detected 8 positive external referral cases, including 1 with post-operative endophthalmitis, 1 with indolent endophthalmitis, and 6 with endogenous endophthalmitis. There were 4 external cases of traumatic endophthalmitis.

Of the 4 internal Moran post-operative cases reviewed, 3 came back with negative cultures. Because of the possibility of falsenegative culture results, Moran includes negative cultures in final complication rate totals for comprehensive data analysis. The 1 positive culture surgery-induced endophthalmitis case occurred following a vitreoretinal procedure.

By seeking cases from numerous sources and locations, Moran is rigorous in including not only potential surgical complications, but also traumatic and endogenous cases.

Footnotes

* Among the studies: “Cataract Surgery Complications in 1 Year at an Academic Institution.” MF Pingree, AS Crandall, RJ Olson. Journal of Cataract & Refractive Surgery.1999 May;25(5):705-8.

**Available benchmark data includes a reported 2020 cataract surgery intraoperative complication rate by Cleveland Clinic Cole Eye Institute of 0.85%. Massachusetts Eye and Ear reported a 2019 cataract surgery intraoperative complication rate of 1.6%; comparable 2020 data from the institution was not available at time of printing.

***Multiple studies in the U.S., Europe, and Asia, put the incidence of post-cataract-surgery endophthalmitis from 0.03% to 0.07%, with the mean at about 1 in 1,500.

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