Hahn U, Krummenauer F, Neuhann I
OcuNet GmbH & Co. KG, Friedrichstr. 47, 40217, Düsseldorf, Deutschland.
Ophthalmologe. 2012 Jun;109(6):575-82. doi: 10.1007/s00347-012-2577-0.
This systematic literature review, including 7 publications released since 2000, provides references for outcome indicators of cataract surgery for quality management initiatives. The reported relative numbers of cases achieving visual rehabilitation and refractive accuracy were determined and compared. With one exception the success rates did not represent benchmarks defined as best possible outcome but describe the results of data collected in a population during routine clinical practice. A best corrected visual acuity (BCVA) of ≥ 0.5 was achieved in 84-93% of all patients and in 95-99% of patients without preoperative visually impairing comorbidities. A refractive accuracy (absolute deviation of target refraction from spherical equivalent) of ≤ 1 D was reported in 72-97% of the patients. The success rates of these well established outcome indicator levels were high. Differences between operators were more distinguishable and the clinical relevance higher with less liberal indicator levels. A BCVA ≥ 1 was realized in 30-47% of all patients and in 52-62% of patients without visually impairing comorbidities. A total of 45-80% of the patients showed a refractive accuracy of ≤ 0.5 D. Exogenous factors not influencable by the surgeon have a relevant impact on the success rates. The literature review confirms the strong association of visually impairing comorbidities and BCVA outcome. Based on literature methodological problems of quality management systems for cataract surgery are discussed. While voluntary initiatives have the ability to solve these difficulties appropriate concepts for mandatory procedures are currently lacking.
这项系统的文献综述纳入了2000年以来发表的7篇文献，为质量管理举措中的白内障手术结局指标提供了参考。研究确定并比较了报告的实现视觉康复和屈光准确性的病例相对数量。除了一项研究外，成功率并非代表定义为最佳可能结局的基准，而是描述了在常规临床实践中人群收集的数据结果。所有患者中有84%-93%实现了≥0.5的最佳矫正视力（BCVA），术前无视力损害合并症的患者中有95%-99%实现了该视力。72%-97%的患者报告屈光准确性（目标屈光度与等效球镜的绝对偏差）≤1D。这些既定结局指标水平的成功率很高。手术医生之间的差异在指标水平较严格时更易区分，临床相关性也更高。所有患者中有30%-47%实现了BCVA≥1，术前无视力损害合并症的患者中有52%-62%实现了该视力。共有45%-80%的患者屈光准确性≤0.5D。外科医生无法影响的外部因素对成功率有显著影响。文献综述证实了视力损害合并症与BCVA结局之间的密切关联。基于文献讨论了白内障手术质量管理系统的方法学问题。虽然自愿性举措有能力解决这些困难，但目前缺乏适用于强制性程序的适当概念。
