A systematic review and meta-analysis are presented with the aim of assessing whether cataract surgery increases the risk of non-arteritic anterior ischaemic optic neuropathy (NAION) and identify potential predictors of risk. The search strategy components are outlined in detail. A total of nine studies were included within the narrative synthesis, with five of these contributing to the meta-analysis. The included studies involved 320 cases of post-cataract NAION, 1307 cases of spontaneous NAION from 1,587,691 cataract surgeries and 1,538,897 non-surgery controls. The combined unadjusted incidence for early post-cataract NAION was 99.9 per 100,000 per year; for delayed post-cataract NAION was 32.4 per 100,000 per year; and for spontaneous NAION was 8.9 per 100,000 per year. Patients diagnosed with post-cataract NAION were older compared to the spontaneous NAION group. No significant differences were identified in the baseline risk factors of the two groups. The authors conclude there is an increased risk of 4.6 times of NAION within the first year after cataract surgery. The peaks of onset occur within the first 72 hours and at six weeks. They reassure that the absolute risk remains low (1 in 1000-3100 surgeries). No risk factors other than older age were identified including previous diagnosis of spontaneous NAION in the fellow eye. It was felt by the authors that these findings did not require any extra information during the cataract surgery consent procedure.
A review of the risk of nonarteritic anterior ischaemic optic neuropathy post-cataract surgery
Reviewed by Lauren Hepworth
Nonarteritic anterior ischemic optic neuropathy after cataract surgery: a systematic review and meta-analysis.
CONTRIBUTOR
Lauren R Hepworth
University of Liverpool; Honorary Stroke Specialist Clinical Orthoptist, Northern Care Alliance NHS Foundation Trust; St Helen’s and Knowsley NHS Foundation Trust, UK.
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