Office-Based Lens Surgeries No Riskier Than Those Performed in Surgical Centers

Office-based lens surgeries, whether for cataract extraction or refractive improvement, have a similar rate of adverse events to modern cataract surgeries performed in ambulatory surgery centers, according to findings published in the Journal of Cataract and Refractive Surgery. The study shows patients who underwent office-based procedures had approximately the same rates of unplanned anterior vitrectomy and endophthalmitis as most reported findings from cataract surgeries conducted in conventional settings.

Researchers conducted a retrospective study to evaluate the rate of adverse events following office-based lens surgeries performed across multiple private practices in the United States, compared with the literature-reported safety profile of modern cataract procedures performed in operating rooms.

The investigators included case records for all consecutive patients who underwent office-based lens surgeries for visually significant cataract, refractive lens exchange, or phakic intraocular lens implantation between 2020 and 2022 at 36 participating sites across the United States. Primary postoperative outcome measures included assessments of intra- and postoperative complications such as the incidence of unplanned vitrectomy, iritis, corneal edema, and endophthalmitis. The researchers also evaluated the frequency of patients requiring a return to the operating room (OR) or referral to a retina surgeon and the frequency of patients requiring hospitalization or calling emergency services for any reason.

They found that many office-based lens surgeries resulted in postoperative complications at the same, or lower, rates than the literature shows with regard to conventional operating facilities. Endophthalmitis in the office-based patients was 0.028%, lower than the 0.1% and 0.056% associated with procedures performed in conventional operating rooms. Toxic anterior segment syndrome (TASS) was 0.022% in office-based procedures, compared with 0.33% for patients undergoing OR-based cataract surgery.

The study also found office-based lens surgeries resulted in rates of corneal edema (0.027%) and unplanned anterior vitrectomy (0.177%) similar to OR-surgery data. While 0.067% of patients needed to return to the OR, 0.011% of patients were referred to the hospital.

The study shows that, by 2050, the number of cataract patients annually is expected to grow to 50 million, compared to the 2020 estimate of 38 million per year, demonstrating the importance of office-based surgery and its benefits.

“Meeting this growing need without unduly burdening surgeons or the surgical infrastructure will make the adoption of efficient, cost-effective approaches to cataract surgery imperative,” the researchers noted. “Our experience with more than 18,000 cases from 36 sites performed in the office demonstrated that office-based lens surgery can be performed safely, with adverse event rates similar to or lower than those in the published literature.”

Study limitations include possible confounding of data due to the unavailability of detailed information on systemic and ocular comorbidities, preoperative laboratory evaluations, and postoperative visual outcomes for analysis; and due to the lack of evaluating the type of anesthesia used by the surgeons in patients undergoing office-based lens surgery.

Disclosure: Multiple study authors declared affiliations with the biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 

Correction: An earlier published version of this article incorrectly used the term “in-office procedures” in place of “office-based surgeries.” Office-based lens surgery centers are nationally accredited operating rooms located within a practice, rather than an ambulatory surgery center. They are not to be confused with in-office procedure rooms.