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Importance: Patients and clinicians need to accurately assess the risks and benefits of pars plana vitrectomy for proliferative diabetic retinopathy, but clinical trial data may not reflect real-world experience., Objective: To prospectively audit the complications of vitrectomy for proliferative diabetic retinopathy and help establish benchmarks., Design, Setting, and Participants: Royal College of Ophthalmologists' National Ophthalmology Database study of 939 eyes of 834 patients undergoing primary vitrectomy for proliferative diabetic retinopathy at 16 different vitreoretinal units in the United Kingdom. Data were obtained for the period from January 2001 to November 2010., Interventions: Pars plana vitrectomy with or without delamination/segmentation., Main Outcomes and Measures: Descriptions of the primary procedures performed, intraoperative complication rate, and proportion of eyes undergoing further surgery. An exploratory analysis of visual outcome was undertaken, with visual success and visual loss defined as a gain or reduction of 0.3 logMAR or more, respectively (approximately 2 Snellen lines), 6 to 12 months after surgery., Results: Of 420 eyes (among 408 patients) that underwent vitrectomy without delamination, the intraoperative complication rate was 13.1% (95% CI, 10.2%-16.7% [55 of 420 eyes]), with 126 eyes (30.0%) requiring an intravitreal tamponade and 49 eyes (11.7%) undergoing further vitrectomy (median follow-up, 6.9 months); 17.9% of 127 phakic eyes developed cataracts within a year, with 63.6% achieving visual success and 8.2% visual loss. Of 519 eyes (among 463 patients) that underwent vitrectomy with delamination, the intraoperative complication rate was 30.4% (95% CI, 26.6%-34.5% [158 of 519 eyes]), with 299 eyes (57.6%) requiring an intravitreal tamponade and 78 eyes (15.0%) undergoing further vitrectomy (median follow-up, 7.1 months); 21.2% of 126 phakic eyes developed cataracts within a year, with 62.8% achieving visual success and 14.9% visual loss., Conclusions and Relevance: Diabetic vitrectomy has an appreciable complication rate, particularly if delamination or segmentation are required. Nonetheless, the data available on visual acuity suggest that a majority of patients achieve clinically meaningful gains in vision.

Importance: Aligning outcome measures for cataract surgery, one of the most frequently performed procedures globally, may facilitate international comparisons that can drive improvements in the outcomes most meaningful to patients., Objective: To propose a minimum standard set of outcome measures for cataract surgery that enables global comparisons., Design, Setting, and Participants: A working group of international experts in cataract outcomes and registries was convened, along with a patient advocate, to agree on a consensus of outcome measures for cataract surgery. In a modified Delphi process, the group met regularly between November 10, 2012, and November 21, 2013, to discuss which outcomes to include in a standard set. Included factors were based on extant literature, existing registries, and the experience of group members. Similarly, a series of consensus discussions were held to determine a set of risk factors to be gathered for each patient. The final shortlist was compiled into a standard set. Analysis was performed from November 22, 2013, to April 5, 2014., Main Outcomes and Measures: Development of a recommended standard set encompassing preoperative metrics including patient risk factors, intraoperative factors including surgical complications, and postoperative cataract surgery outcomes., Results: The recommended standard set encompasses all patients treated for cataracts by 1 of 4 surgical approaches (phacoemulsification, sutured manual extracapsular cataract extraction, sutureless manual extracapsular cataract extraction, or intracapsular cataract extraction). The recommended metrics to be recorded preoperatively include demographics, ocular history and comorbidities, preoperative visual acuity, and patient-reported visual function. The recommended outcomes were split into intraoperative and postoperative metrics. Intraoperative outcomes include capsule-related problems, dislocation of lens nucleus fragments into the vitreous, and other complications. Postoperative outcomes include visual acuity, refractive error, patient-reported visual function, and early and late complications of surgery. The suggested follow-up for collection of postoperative outcomes is up to 3 months., Conclusions and Relevance: A minimum standard set of outcome measures for cataract surgery is important for meaningful comparison across contexts. The proposed data set is a compromise between all useful data and the practicalities of data collection.

Follow-up ranging between 6 and 8 years of the survival of a cohort of 473 elderly nondiabetic subjects randomly selected from a small English town showed an age- and sex-adjusted association between nuclear cataract at the time of baseline examination and decreased survival (P = .002). Comparing those with and without nuclear cataract, the adjusted relative hazard for death was 1.52 (95% confidence interval, 1.15 to 1.99). This effect remained virtually unchanged when also adjusted for whether the subject reported ever having been a smoker.