A Simple Pre-Operative Nuclear Classification Score (SPONCS) for Grading Cataract Hardness in Clinical Studies.
cataract
classification
grading
nuclear color
phacoemulsification
Journal
Journal of clinical medicine
ISSN: 2077-0383
Titre abrégé: J Clin Med
Pays: Switzerland
ID NLM: 101606588
Informations de publication
Date de publication:
29 Oct 2020
29 Oct 2020
Historique:
received:
25
09
2020
revised:
19
10
2020
accepted:
26
10
2020
entrez:
3
11
2020
pubmed:
4
11
2020
medline:
4
11
2020
Statut:
epublish
Résumé
The aim of this study was to evaluate whether a simplified pre-operative nuclear classification score (SPONCS) was valid, both for clinical trials and real-world settings. Cataract classification was based on posterior nuclear color: 0 (clear), 1 (subcapsular/posterior cataract with clear nucleus), 2 (mild "green nucleus" with plus sign for yellow reflection of the posterior cortex), 3 (medium "yellow nucleus" with plus sign for brown/red posterior cortex reflection), 4 (advanced with 4 being "red/brown nucleus" and 4+ white nucleus), and 5 (hypermature/Morgagnian nucleus). Inter- and intra-observer validity was assessed by 30 Ophthalmologists for 15 cataract cases. The reliability of the cataract grading score in a surgical setting was evaluated. Correlation of nuclear scores was compared with phacoemulsification cumulative dissipated energy (CDE) in 596 patients. Analysis of mean intra-observer Cohen kappa agreement was 0.55 with an inter-observer score of 0.54 for the first assessment and 0.49 for the repeat assessment one week later. When evaluating results by nuclear color alone, there was a substantial agreement for both the intra-observer (0.70) and inter-observer parameters: 0.70 for the first test, and 0.66 on repetition with randomization of the cases after a week. CDE levels were found to be significantly different between all SPONCS score groups (p < 0.001), with a lower CDE related to a lower SPONCS score. A strong correlation was found between the SPONCS score and CDE (Spearman's rho = 0.8, p < 0.001). This method of grading cataract hardness is both simple and repeatable. This system can be easily incorporated in randomized controlled trials to lower bias and confounding effects regarding nuclear density along with application in the clinical setting.
Sections du résumé
BACKGROUND
BACKGROUND
The aim of this study was to evaluate whether a simplified pre-operative nuclear classification score (SPONCS) was valid, both for clinical trials and real-world settings.
METHODS
METHODS
Cataract classification was based on posterior nuclear color: 0 (clear), 1 (subcapsular/posterior cataract with clear nucleus), 2 (mild "green nucleus" with plus sign for yellow reflection of the posterior cortex), 3 (medium "yellow nucleus" with plus sign for brown/red posterior cortex reflection), 4 (advanced with 4 being "red/brown nucleus" and 4+ white nucleus), and 5 (hypermature/Morgagnian nucleus). Inter- and intra-observer validity was assessed by 30 Ophthalmologists for 15 cataract cases. The reliability of the cataract grading score in a surgical setting was evaluated. Correlation of nuclear scores was compared with phacoemulsification cumulative dissipated energy (CDE) in 596 patients.
RESULTS
RESULTS
Analysis of mean intra-observer Cohen kappa agreement was 0.55 with an inter-observer score of 0.54 for the first assessment and 0.49 for the repeat assessment one week later. When evaluating results by nuclear color alone, there was a substantial agreement for both the intra-observer (0.70) and inter-observer parameters: 0.70 for the first test, and 0.66 on repetition with randomization of the cases after a week. CDE levels were found to be significantly different between all SPONCS score groups (p < 0.001), with a lower CDE related to a lower SPONCS score. A strong correlation was found between the SPONCS score and CDE (Spearman's rho = 0.8, p < 0.001).
CONCLUSION
CONCLUSIONS
This method of grading cataract hardness is both simple and repeatable. This system can be easily incorporated in randomized controlled trials to lower bias and confounding effects regarding nuclear density along with application in the clinical setting.
Identifiants
pubmed: 33138221
pii: jcm9113503
doi: 10.3390/jcm9113503
pmc: PMC7694099
pii:
doi:
Types de publication
Journal Article
Langues
eng
Déclaration de conflit d'intérêts
The authors declare no conflict of interest.
Références
Int Ophthalmol. 1986 Dec;9(4):207-25
pubmed: 3793374
Ophthalmic Res. 2017;57(4):247-251
pubmed: 28288454
IEEE Trans Biomed Eng. 2015 Nov;62(11):2693-701
pubmed: 26080373
Arch Ophthalmol. 1988 Mar;106(3):330-4
pubmed: 3345149
Ophthalmic Epidemiol. 2002 Apr;9(2):83-95
pubmed: 11821974
Arch Ophthalmol. 1993 Jun;111(6):831-6
pubmed: 8512486
Curr Opin Ophthalmol. 2019 Jan;30(1):13-18
pubmed: 30489359
Ophthalmic Res. 1990;22 Suppl 1:46-50
pubmed: 2388751
PLoS One. 2017 Mar 17;12(3):e0168606
pubmed: 28306716
Can J Ophthalmol. 2017 Aug;52(4):331-337
pubmed: 28774512
Curr Opin Ophthalmol. 2012 Jan;23(1):3-6
pubmed: 22134364
J Cataract Refract Surg. 2003 Jan;29(1):138-45
pubmed: 12551681
PLoS One. 2020 Oct 12;15(10):e0240350
pubmed: 33044993
Can J Ophthalmol. 2019 Dec;54(6):727-734
pubmed: 31836107
Biometrics. 1977 Mar;33(1):159-74
pubmed: 843571
Int J Ophthalmol. 2018 Sep 18;11(9):1555-1561
pubmed: 30225234