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Aims-To determine the postoperative morbidity on day 1 after uncomplicated phacoemulsification. Methods-A prospective study was performed on 100 otherwise healthy eyes after uncomplicated phacoemulsification and lens implant. Patients were examined on the first postoperative day and any deviation from a set postoperative protocol was recorded. Results-Transient intraocular pressure rises of 30 mm Hg or greater were seen in three eyes. These all settled after a single dose of oral acetazolamide 250 mg. Conclusions-The results of this study reinforce the clinical impression that the need for day 1 routine follow up in this selected group of patients is questionable and probably unnecessary. (BrJ Ophthalmol 1996; 80: 148-150) With the advent of small incision modern microsurgical techniques, day-case cataract surgery has become increasingly popular. Economic forces dictate an increasing demand for day-case surgery.1In many ophthalmic units in the UK, patients are reviewed routinely in the hospital the day after day-case cataract surgery. In contrast with other authors,2 3 our experience is that many patients decline day-case surgery owing to difficulties in attending hospital the next day. Reasons commonly include inadequate transport facilities, difficulty parking in inner cities, distance from hospital, reliance on friends and relatives. The population group requiring cataract surgery is frequently affected by these problems and this results in a lower rate of day-case surgery.

Dilating the pupil did not adversely affect the clinical accuracy of the IOLMaster.

Purpose To report our experience of using Aqualase technology for cataract extraction. Methods In total, 33 patients (20 females; mean age 71.4 years) underwent cataract surgery using Aqualase through a 3.2-mm corneal incision. Grade of nucleus, nuclear removal technique, and intraoperative complications were noted. Clinical parameters from postoperative visits were collected. Results Aqualase is capable of removing cataracts up to nuclear sclerosis 2 þ (out of 4) with relative ease. Nuclei graded 2 þ or greater were technically more difficult and conversion to ultrasound phacoemulsification was required in one case. Two posterior capsule ruptures occurred: one during nucleus removal (contact with the tip while aspirating without Aqualase) and one unrelated to Aqualase during aspiration of cortex. Of 25 patients seen on the first postoperative day, 22 had a clear cornea. A total of 96% patients without preoperative comorbidity achieved 6/9 or better postoperatively. One patient had transient postoperative uveitis. Conclusions Removal of softer cataracts with Aqualase has the theoretical advantage over phacoemulsification, by carrying less risk to the posterior capsule, since the handpiece has a smooth polymer tip that has no mechanical motion inside the eye. However, the tip should not be considered entirely capsule-friendly, as rupture is possible with the foot-pedal in position two (aspiration only). Although certain adjustments to the technique are required, the method is similar enough to phacoemulsification to ensure a brief learning curve. With increasingly firm cataracts, Aqualase becomes less effective and ultrasound phacoemulsification is still superior for such cases, in our experience.

General anaesthesia for obstetric surgery has distinct characteristics that may contribute towards a higher risk of accidental awareness during general anaesthesia. The primary aim of this study was to investigate the incidence, experience and psychological implications of unintended conscious awareness during general anaesthesia in obstetric patients. From May 2017 to August 2018, 3115 consenting patients receiving general anaesthesia for obstetric surgery in 72 hospitals in England were recruited to the study. Patients received three repetitions of standardised questioning over 30 days, with responses indicating memories during general anaesthesia that were verified using interviews and record interrogation. A total of 12 patients had certain/ probable or possible awareness, an incidence of 1 in 256 (95%CI 149-500) for all obstetric surgery. The incidence was 1 in 212 (95%CI 122-417) for caesarean section surgery. Distressing experiences were reported by seven (58.3%) patients, paralysis by five (41.7%) and paralysis with pain by two (16.7%). Accidental awareness occurred during induction and emergence in nine (75%) of the patients who reported awareness. Factors associated with accidental awareness during general anaesthesia were: high BMI (25-30 kg.m -2 ); low BMI (<18.5 kg.m -2 ); out-of-hours surgery; and use of ketamine or thiopental for induction. Standardised psychological impact scores at 30 days were significantly higher in awareness patients (median (IQR [range]) 15 (2.7-52.0 [2-56]) than in patients without awareness 3 (1-9 [0-64]), p = 0.010. Four patients had a provisional diagnosis of post-traumatic stress disorder. We conclude that direct postoperative questioning reveals high rates of accidental awareness during general anaesthesia for obstetric surgery, which has implications for anaesthetic practice, consent and follow-up.

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Endothelial cell loss after cataract surgery is similar whether phacoemulsification or Aqualase is used. Aqualase can be considered to be as safe as phacoemulsification with regard to corneal trauma and is a useful alternative especially for soft cataracts.