Outcome of 1000 consecutive clinic- and hospital-based cataract surgeries in a Danish county

Purpose: To evaluate the homogeneity and quality of cataract surgery in a Danish county. Setting: Four private eye clinics and the Department of Ophthalmology, Hillerod Hospital, Frederiksborg County, Denmark. Methods: This prospective study comprised 1013 consecutive cases of age-related cataract; 48% of the surgeries were performed in the hospital and 52%, at 1 of 4 clinics. Demographic and clinical data were recorded on standardized data sheets at referral, surgery and final refraction. Main outcome measures were change in best corrected visual acuity (BCVA), refractive power at final refraction, surgery-related complications, and waiting time for surgery and final refraction. Results: The hospital group had greater dispersion of age (P < .001) and higher frequency of general health problems (P < .005) and glaucoma (P < .01) than the clinic group. Fifty-four percent of surgeries were by phacoemulsification and 46% by extracapsular cataract extraction (ECCE). In general, phacoemulsification was prevalent at the hospital and ECCE at the clinics. No difference was found between groups in visual acuity at final refraction. Of all patients, 87.1% attained a BCVA of 0.5 or better and of the best cases, 96.2%. Zonule or capsule rupture with or without vitreous loss occurred more often in the hospital group (P < .05), while the incidence of postoperative complications was identical in the 2 groups. One case of retinal detachment was found. Time from referral to final refraction was shorter at clinics, while waiting time from surgery to final refraction was shorter at the hospital (P < .001). Conclusion: Dividing cataract surgery between hospital and private clinics seems to be a satisfactory model for meeting the increasing demand for cataract surgery.