Is visual outcome compromised when next day review is omitted after phacoemulsification surgery? A randomised control trial

Abstract

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.

Intraoperative use of intravitreal triamcinolone in uveitic eyes having cataract surgery: Pilot study

“…18,19 In addition, in our study, 89.5% of eyes achieved a postoperative visual acuity of 20/40 or better, which compares favorably with results in other studies of phacoemulsification in eyes with uveitis in which systemic corticosteroid therapy was used (73% with 20/30 or better 18 and 72% with 6/9 or better at last follow-up 19 ). This finding even compares well with results in some studies of eyes without uveitis, 20,21 in which approximately 80% of patients achieved a postoperative visual acuity of 20/40 or better.…”

Changes to the subscales of two vision-related quality of life questionnaires are proposed

“…The VCM1 has been used in several studies [23][24][25], but underwent only minor revision following the CFA. The one item was deleted because it was conceptually different from the other items.…”

Is the 1-day postoperative IOP check needed post uncomplicated phacoemulsification in patients with glaucoma and ocular hypertension?

“…1,[4][5][6][7] However, in patients with glaucoma or OHT, this approach was not advocated. 1,4 The AAO recommends a review within 24 h for all patients at risk of an IOP spike.…”

“…[1][2][3] It has been suggested that the 1-day postoperative intraocular pressure (IOP) check post routine uncomplicated phacoemulsification can be abandoned for a number of reasons. 1,[4][5][6][7] Some of these include the fact that new surgical complications are unlikely to be picked up on the first day, peak IOP may have already passed, economical constraints, improved postoperative outcomes and low complication rates. 1,4 However in patients with glaucoma or ocular hypertension (OHT), either this approach was not advocated, or it was recommended that prophylactic regimes against a raised IOP should be followed as investigated in other studies.…”