Aim: To study the incidence of endophthalmitis following cataract surgery over a 10 year period, and to examine ways in which this may be related to changes in surgical technique. Methods: All cases of endophthalmitis occurring over a 10 year period within a single ophthalmic unit in the United Kingdom were reviewed, and possible risk factors identified. Results: During the study period, as the technique of extracapsular cataract surgery was replaced by phacoemulsification, there was a commensurate reduction in the incidence of endophthalmitis. Injectable IOLs were associated with the lowest risk of postoperative endophthalmitis (0.028%). Conclusions: Injectable intraocular lenses do not make contact with the ocular surface and this may result in the observed lower rate of endophthalmitis. This, and the ease with which they can be inserted through small incisions, support their use as the first line method of lens insertion.
One hundred and twenty-four eyes with a rhegmatogenous retinal detachment, considered to be at high risk of failure if treated conventionally, underwent vitrectomy and internal tamponade, with or without scleral buckling, as the primary procedure. The retina was reattached in 64.5% of eyes after one operation, 75.0% after two, and in 83% of eyes after more than two operations, with no difference in the success rate between those eyes which underwent vitrectomy alone, and those that received adjunctive scleral buckling; duration of surgery was significantly shorter, however, in the former group. Twenty percent of eyes redetached in association with proliferative vitreoretinopathy, and 20% of phakic eyes developed posterior subcapsular lens opacities after surgery. Vitrectomy is now an established method in the management of selected cases of rhegmatogenous retinal detachments.
Aims: To examine the safety implications of omitting first day clinical review following phacoemulsification cataract surgery. Methods: 362 patients were randomly assigned to ''same day discharge'' (SDD) or ''next day review'' (NDR). All patients were reviewed approximately 2 weeks after surgery. Results: Of the 174 patients randomised to NDR, 14 (8.0%) were treated for raised intraocular pressure (25-48 mm Hg) on the first postoperative day. Four received increased topical steroids for uveitis (two) and corneal oedema (two). One patient was treated for a significant wound leak. 12 (6.9%) required additional reviews before 2 week follow up for treatment of the following complications: drop toxicity (six), raised intraocular pressure (five), and corneal abrasion (one). Of the 188 randomised to SDD, six (3.2%) returned to the department before the planned review for reassurance of patients' concerns regarding eye symptoms (three), drop toxicity (one) and follow up of previously raised intraocular pressure (one). There were two cases of iris prolapse in the SDD group. In one case, the complication was anticipated and early review had been arranged. Postoperative acuities of 6/12 or better were achieved in 83% of both SDD and NDR patients (p = 0.96 by x 2 test). Postoperative quality of life scores at 4 months indicating ''no or hardly any concern about vision'' (VCM1 questionnaire index ,1.0) were achieved in 67% SDD and 72.5% NDR (p = 0.26). Conclusion: The intention to discharge patients on the day of surgery, with planned postoperative review at 2 weeks, was associated with a low frequency of serious ocular complications. Differences in the proportions achieving a good visual outcome between the two groups, based on 2 week visual acuity and 4 month quality of life, were not significant.
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