Aim To investigate effect of patient age, gender, comorbidities and surgeon on refractive outcomes following cataract surgery. Methods Study population: patients on UK national ophthalmic cataract database on cataract operations undertaken between 1 April 2010 and 31 August 2018. Variables examined included gender, age, diabetic retinopathy, glaucoma, high myopia, inherited retinal disease, optic nerve disease, uveitis, pseudoexfoliation, vitreous opacities, retinal pathology, cataract type, previous surgery and posterior capsular rupture. A multivariate normal cross-classified model was fitted to the refractive outcome using Markov Chain Monte Carlo (MCMC) methods with diffuse priors to approximate maximum likelihood estimation. A MCMC chain was generated with a burn-in of 5000 iterations and a monitoring chain of 50 000 iterations. Results 490 987 cataract operations were performed on 351 864 patients by 2567 surgeons. Myopic and astigmatic errors were associated with posterior capsule rupture (−0.38/+0.04×72), glaucoma (−0.10/+0.05×95), previous vitrectomy (−0.049/+0.03×66) and high myopia (−0.07/+0.03×57). Hyperopic and astigmatic errors were associated with diabetic retinopathy (+0.08/+0.03×104), pseudoexfoliation (+0.07/+0.01×158), male gender (+0.12/+0.05×91) and age (−0.01/+0.06×97 per increasing decade). Inherited retinal disease, optic nerve disease, previous trabeculectomy, uveitis, brunescent/white cataract had no significant impact on the error of the refractive outcome. The effect of patient gender and comorbidity was additive. Surgeons only accounted for 4% of the unexplained variance in refractive outcome. Conclusion Patient comorbidities and gender account for small but statistically significant differences in refractive outcome, which are additive. Surgeon effects are very small. Data may be obtained from a third party and are not publicly available. Data was provided by the National Ophthalmology Database at the Royal College of Ophthalmologists.

中文翻译：

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与患者合并症和性别相比，外科医生对白内障屈光结果的影响微乎其微：对 490 987 例病例的分析

目的 调查患者年龄、性别、合并症和外科医生对白内障手术后屈光结果的影响。方法 研究人群：英国国家眼科白内障数据库中 2010 年 4 月 1 日至 2018 年 8 月 31 日期间接受白内障手术的患者。检查的变量包括性别、年龄、糖尿病性视网膜病变、青光眼、高度近视、遗传性视网膜疾病、视神经疾病、葡萄膜炎、假性剥脱、玻璃体混浊、视网膜病理学、白内障类型、既往手术史和后囊膜破裂。使用具有扩散先验的马尔可夫链蒙特卡罗 (MCMC) 方法来近似最大似然估计，将多变量正态交叉分类模型拟合到屈光结果。通过 5000 次迭代的老化和 50000 次迭代的监控链生成 MCMC 链。结果2567名外科医生对351864例患者实施了490987例白内障手术。近视和散光误差与后囊膜破裂 (-0.38/+0.04×72)、青光眼 (-0.10/+0.05×95)、既往玻璃体切除术 (-0.049/+0.03×66) 和高度近视 (-0.07/+) 有关0.03×57)。远视和散光误差与糖尿病视网膜病变（+0.08/+0.03×104）、假性剥脱（+0.07/+0.01×158）、男性（+0.12/+0.05×91）和年龄（-0.01/+0.06×每增加十年 97 个）。遗传性视网膜疾病、视神经疾病、既往小梁切除术、葡萄膜炎、棕褐色/白色白内障对屈光结果的误差没有显着影响。患者性别和合并症的影响是相加的。外科医生仅占屈光结果无法解释的变异的 4%。结论 患者合并症和性别对屈光结果的影响虽小但具有统计学意义，且具有累加性。外科医生的影响很小。数据可能从第三方获得，并且不公开。数据由皇家眼科学院的国家眼科数据库提供。