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Deferral of first review after uneventful phacoemulsification cataract surgery until 2 weeks - Randomized controlled study
Abstract
To investigate the safety of deferring the ophthalmic review after uneventful phacoemulsification cataract surgery until 2 weeks after the procedure.
Waterford Regional Hospital, Waterford, Ireland.
After uneventful cataract surgery, 233 patients were randomized to have ophthalmic review 2 hours after the procedure and 2 weeks postoperatively (Group 1) or to forego any ophthalmic review before the 2-week postoperative visit in the outpatient department (Group 2).
Of the 115 patients randomized to Group 1, 25 (21.7%) had intraocular pressure (IOP) spikes of 30 mm Hg or greater and 2 (1.7%) had a corneal abrasion in the immediate postoperative period. Group 1 and Group 2 were statistically similar in terms of problems encountered in the first 2 postoperative weeks and anterior segment findings and visual acuity at the 2-week postoperative visit.
The results of this randomized controlled study indicate that the first ophthalmic review after uneventful cataract surgery can be safely deferred until 2 weeks postoperatively in patients in whom a transient IOP spike would not be deemed clinically deleterious. Such a policy will enhance the efficiency of day-surgery units.
... Cataracts are the leading cause of blindness affecting about 20 million people and remain an important socioeconomic and public health care problem worldwide with surgery as the only effective treatment, and the standard procedure being phacoemulsification with intraocular lens implantation [1][2][3][4][5][6][7][8][9][10][11]. ...
... Cataract surgery is a common day case procedure worldwide, performed 4.5 million times in 2016 on patients with cataracts in European Union member states [12]. With the growing age of the population, the demand for eye care and cataract surgery is expected to double within the next 20 years [1,2,4,5,8,9]. ...
... Therefore, the time and number of close postoperative follow-up visits could be adjusted to detect and manage early clinically relevant complications. Such a model can reduce clinical cost, distribute physician time, and improve well-being of the patient assuring recovery after surgery as well as enhance patient satisfaction as well [3][4][5][6][7][8]. ...
Background and Objectives: to evaluate whether a set of questions after a routine cataract surgery can predict unexpected findings and avoid an unnecessary follow-up visit. Materials and Methods: single-center, prospective, cohort study included 177 routine cataract surgery cases of two experienced surgeons between November 2019 and December 2020. Inclusion criteria included unremarkable postoperative day one follow-up examination. A set of seven questions regarding complaints with positive or negative answers was presented at the second follow-up visit (PV2)—one week (mean 8.34 ± 1.73 days) after the surgery. The outcome measures were the incidence of unexpected management changes (UMCs) at the PV2 visit (change or addition from a prescribed postoperative drop plan, extra procedures, an urgent referral to an ophthalmologist) and UMCs associations with the answers to a question set. Results: 81.4% of patients had no complaints about postoperative ocular status and answered with negative answers, 18.6% reported one or more complaint (positive answer): dissatisfaction with postoperative visual acuity (6.2%, 11 cases), eye pain (4.0%, 7 cases), increase in floaters after the surgery (4.0%, 7 cases), red eye (4.0%, 7 cases) and others. The prevalence of UMCs at PV2 was 1.7% (3 cases), of which 0.6% (1 case) was the prolonged antibiotic prescription due to conjunctivitis, 0.6% (1 case) was the addition of IOP lowering medication and 0.6% (1 case) was additional medication due to uveitis management. None of the complaints (positive answers) at PV2 were associated with the incidence of UMCs (p > 0.05). Conclusions: there were no associations of UMCs determined with positive answers to the questions. The prediction of UMCs incidence based on the positive answers was not obtained. Thus, we cannot exclude the necessity of a postoperative week one follow-up visit.
... A systematic literature search revealed 3 clinical RCTs evaluating the safety of omitting first-day postoperative review. 7,8,25 The 3 studies comprised 886 patients; 451 were randomized to deferral of postoperative review until 2 weeks and 435 were randomized to standard early postoperative review. In 2 studies, the early postoperative review was performed on the first postoperative day 7,8 ; in the third study, the early review was performed 2 hours after the surgical procedure. ...
... In 2 studies, the early postoperative review was performed on the first postoperative day 7,8 ; in the third study, the early review was performed 2 hours after the surgical procedure. 25 However, the term first-day review is used in all 3 studies. Seventeen observational studies that did not meet the inclusion criteria were detected. ...
... Seventeen observational studies that did not meet the inclusion criteria were detected. Characteristics of the included studies 7,8,25 are provided in Appendix 1 and the risk for bias assessment, in Appendix 2. Characteristics of the excluded studies 5,9,13,14,[26][27][28][29][30][31][32][33][34][35][36][37][38] are provided in Appendix e1 (available at: http://jcrsjournal.org). ...
Unlabelled:
We conducted a systematic review and metaanalysis to provide evidence-based recommendations on the value of early postoperative review. We identified 3 randomized controlled trials (RCTs) that compared patients seen on the first postoperative day with those reviewed at 2 weeks; the 3 studies comprised 886 patients. The risk for postoperative complications was lower when review was deferred 2 weeks because of early transient pressure spikes. There was no difference in the number of unscheduled visits during the first 2 weeks postoperatively or the visual acuity at follow-up. No safety was gained by reviewing patients on the first postoperative day, and we recommend that routine early postoperative control can be omitted in nonglaucomatous patients after uneventful surgery if symptomatic patients are seen by an ophthalmologist as needed.
Financial disclosure:
No author has a financial or proprietary interest in any material or method mentioned.
... Endophthalmitis after cataract surgery is rarely encountered on the first postoperative day; more often, it is seen on day 2 or 3 postoperatively (Tan et al. 2000;Mandal et al. 2004;Saeed et al. 2007). The patients will often experience significant pain, visual acuity will be reduced and typical findings on clinical examination include lid oedema, chemosis, conjunc- ...
... From 2007 onwards, the first postoperative examination was 1 week after surgery. There are reports supporting the hypothesis that omission of the first postoperative day review does not delay in the detection of PE (Tan et al. 2000;Mandal et al. 2004;Saeed et al. 2007 ...
... In our department, we have omitted the first postoperative day review, as some authors have suggested that the review can safely be postponed to 1-2 weeks after surgery (Tan et al. 2000;Saeed et al. 2007). The examination of the patients on day one is mainly to detect potentially serious complications such as iris prolapse and IOP spike. ...
Purpose: The main aim of the study was to assess whether omitting prophylactic postoperative topical antibiotics (chloramphenicol) influenced the risk of developing endophthalmitis after cataract surgery.
Methods: We conducted a retrospective study including all patients who had cataract surgery at our outpatient cataract unit between 2004 and 2011. Postoperative topical antibiotics (chloramphenicol) were omitted from 2007 onwards, as was the first postoperative day review. Patients with a diagnosis of endophthalmitis after cataract surgery were extracted, and the rate of postoperative endophthalmitis (PE) before and after changing these routines was compared. The diagnosis of PE was defined as severe intraocular inflammation requiring prompt vitreous sampling for culture.
Results: Seven thousand one hundred and twenty-three and 8131 cataract surgeries were performed in the following periods: January 2004 through December 2006 (period 1) and January 2007 through December 2010 (period 2), respectively. Five cases of PE were identified in period 1 (0.070%) and four patients in period 2 (0.049%). The median time between cataract surgery and onset of symptoms was 6 days in period 1 and 4.5 days in period 2. Median time for intervention was 7 and 5 days postsurgery, respectively.
Conclusion: We found no difference in the frequency of PE following cataract surgery when changing the postoperative topical medication from a mixture of corticosteroids and antibiotics to only corticosteroids.
... Notably, alternative follow-up schedules eliminating the early follow-up and suggesting a first postoperative examination at 1-2 weeks after surgery or no examination at all have been investigated. [22][23][24][25][26][27][28][29] Although, these schedules may be convenient for clinics in isolated rural areas or patients for whom access to the hospital is difficult, [22,23,26] our study was based on the recommendations of the American Academy of Ophthalmology suggesting that a first postoperative evaluation be performed within 24-48 hours from surgery. [2] This study has limitations. ...
... Notably, alternative follow-up schedules eliminating the early follow-up and suggesting a first postoperative examination at 1-2 weeks after surgery or no examination at all have been investigated. [22][23][24][25][26][27][28][29] Although, these schedules may be convenient for clinics in isolated rural areas or patients for whom access to the hospital is difficult, [22,23,26] our study was based on the recommendations of the American Academy of Ophthalmology suggesting that a first postoperative evaluation be performed within 24-48 hours from surgery. [2] This study has limitations. ...
Purpose
There is limited evidence to inform the optimal follow-up schedule after cataract surgery. This study aims to determine whether a standardized question set can predict unexpected management changes (UMCs) at the postoperative week one (POW1) timepoint.
Setting
Massachusetts Eye and Ear, Harvard Medical School.
Design
Prospective cohort study.
Methods
Two-hundred-and-fifty-four consecutive phacoemulsification cases having attended an examination between postoperative days 5–14. A set of 7 ‘Yes’ or ‘No’ questions were administered to all participants by a technician at the POW1 visit. Patient answers along with perioperative patient information were recorded and analyzed. Outcomes were the incidence of UMCs at POW1.
Results
The incidence of UMCs was zero in uneventful cataract cases with unremarkable history and normal postoperative day one exam if no positive answers were given with the question set demonstrating 100% sensitivity (p<0.0001). A test version with 5 questions was equally sensitive in detecting UMCs at POW1 after cataract surgery.
Conclusion
In routine cataract cases with no positive answers to the current set of clinical questions, a POW1 visit is unlikely to result in a management change. This result offers the opportunity for eye care providers to risk-stratify patients who have had cataract surgery and individualize follow-up.
... Procedures were performed using standard technique, [5] with review two weeks following an uneventful procedure [6]. Postoperative data included: post-operative complications; refractive status (auto-refraction, and best corrected subjective refraction performed by the patient's optometrist [four weeks post-operatively, and at least two weeks following removal of any corneal suture]). ...
... In order to measure mis-alignment of a toric intra-ocular lens (attributable to poor operative alignment and/or post-operative rotation of the implanted IOL), alignment must be assessed on at least two occasions post-operatively. In compliance with published protocol of this busy non-refractive cataract practice, [6] patients were reviewed 2 weeks post-operatively, without assessment of IOL alignment. Accordingly, we cannot comment on ZCT alignment in this series. ...
Aim:To identify challenges inherent in introducing a toric intraocular lens (IOL) to a non-refractive cataract practice, and evaluate residual astigmatism achieved and its impact on patient satisfaction.
Methods:Following introduction of a toric IOL to a cataract practice with all procedures undertaken by a single, non-refractive, surgeon (SB), pre-operative, intra-operative and post-operative data was analysed. Attenuation of anticipated post-operative astigmatism was examined, and subjectively perceived visual functioning was assessed using validated questionnaires.
Results:Median difference vector (DV, the induced astigmatic change [by magnitude and axis] that would enable the initial surgery to achieve intended target) was 0.93D; median anticipated DV with a non-toric IOL was 2.38D. One eye exhibited 0.75D residual astigmatism, compared to 3.8D anticipated residual astigmatism with a non-toric IOL. 100% of respondents reported satisfaction of ≥ 6/10, with 37.84% of respondents entirely satisfied (10/10). 17 patients (38.63%) reported no symptoms of dysphotopsia (dysphoptosia score 0/10), only 3 respondents (6.8%) reported a clinically meaningful level of dysphotopsia (≥ 4/10). Mean post-operative NEI VF-11 score was 0.54 (+/-0.83; scale 0 - 4).
Conclusion:Use of a toric IOL to manage astigmatism during cataract surgery results in less post-operative astigmatism than a non-toric IOL, resulting in avoidance of unacceptable post-operative astigmatism.
... Litteratursøgningen identificerede 3 randomiserede kliniske studier (155)(156)(157), der beskriver forekomsten af komplikationer hos patienter, der blev randomiseret til førstedags postoperativ kontrol eller til først at blive kontrolleret 2 uger postoperativt. I to af studierne blev den ene gruppe patienter undersøgt på den første postoperative dag, hvorimod den anden gruppe af patienter blev udskrevet fra hospitalet få timer efter operation uden laegelig undersøgelse (155;156). ...
... I to af studierne blev den ene gruppe patienter undersøgt på den første postoperative dag, hvorimod den anden gruppe af patienter blev udskrevet fra hospitalet få timer efter operation uden laegelig undersøgelse (155;156). I det sidste studium fandt den tidlige kontrol sted 2 timer efter operation mens den anden gruppe af patienter ikke fik en tidlig postoperativ laegekontrol (157). Alle patienter blev undersøgt 2 uger efter operation eller før ved behov. ...
... Control examination day after cataract extraction revealed corneal edema in 86.5% of patients (86% in DCCS and 85% in ICS) and 14% of patients in DCCS had 2 ad- (17). On the other side, it should be noted that in cases of uneventful phacoemulsification, telephone review can be safe, effective and acceptable first-day review method (19) and also postponed till two weeks postoperatively (20). Control examination 7 days after cataract surgery revealed that 25% of patients in DCCS and 18% of patients in ICS group still had corneal edema that needed topical treatment extension similar to results of previous research (20). ...
... On the other side, it should be noted that in cases of uneventful phacoemulsification, telephone review can be safe, effective and acceptable first-day review method (19) and also postponed till two weeks postoperatively (20). Control examination 7 days after cataract surgery revealed that 25% of patients in DCCS and 18% of patients in ICS group still had corneal edema that needed topical treatment extension similar to results of previous research (20). Seventeen patients in DCCS and 14 in ICS group were removed on additional control examination 14 days postoperatively. ...
Purpose:
To evaluate safety and efficacy of day care cataract surgery in developing country.
Patients and Methods:
This prospective study included 200 patients planned for cataract surgery during October and November 2012 divided in to two groups, day care cataract surgery (DCCS) and inpatient cataract surgery (ICS), with same number of male and female patients right and left eyes. All patients had same operative conditions and postoperative follow up.
Results:
The average age of patients in this study was 68.4 ± 7.47 years. Visual acuity before cataract extraction was 0.1754 where 44.5% of patients had severe visual impairment and another 23% had complicated cataract. Posterior capsule rupture was noted in 4.5% of cases. The main risk factors in both groups were: higher age, female gender, left side, complicated cataract, higher dioptric power of IOL and ECCE. Regular control opthalmologic examinations 30, 90 and 180 days after the cataract extraction did not reveal signs bullous keratopathy, wound dehiscence, cystoid macular edema and endophtalmitis in any of patients. Postoperative visual acuity 180 days after the operation in DCCS was 0.920 ± 0.154 and 0.928 ± 0.144 in ICS. Visual acuity less than 0.5 was noted in 4.5% due to posterior eye segment changes. Patients in DCCS group had 30 control examinations more and 95 days of hospitalization less than ICS with 16.5% cost reduction.
Conclusion:
The concept of day care cataract surgery is equally safe and more cost effective than inpatient cataract surgery.
... Postoperative Data Patients were reviewed 2 weeks postoperatively, consistent with the unit's protocol. 19 The uncorrected distance visual acuity (UDVA) and CDVA were recorded at this visit. In addition, the ophthalmologist evaluated patient-reported symptoms or problems. ...
... In the Bland-Altman plots, the variance in all eyes, average eyes, and long eyes was stable and positive and negative differences occur randomly moving across from left to right (ie, with increasing mean absolute error) (Figure 2, A, C, and D). The Bland-Altman plot for short eyes suggests that an increasing mean absolute error (0.7 or above) is associated with a mean difference in absolute error that is always negative in association with personalized IOL constants (Figure 2, B); however, this group had a small number of eyes (19), with only 4 having a mean absolute error of 0.7 or above. Figure 3 shows the cumulative percentage of eyes (y axis) that achieved less than or equal to a given error of prediction. ...
... As per the National Programme of Control of Blindness, Vision 2020: Right to Sight, the recommended postoperative follow-up visit schedule is a first follow-up on the first postoperative day by the surgeon (mandatory), a second follow-up between day 7 and day 10, and a third follow-up (with refractive correction) between day 30 and day 45 [21]. Saeed et al [22] and Tinley et al [23] concluded that postoperative follow-up visits can be safely deferred up to 2 weeks after cataract surgery, thereby enhancing the efficiency of day care units. Meltzer et al [24] performed a study using data from the PRECOG (Prospective Review of Early Cataract Outcomes and Grading) trial and reported that visual acuity immediately after cataract surgery was highly correlated with visual acuity after 40 days, suggesting that for the purposes of quality assessment, follow-up of all patients is not needed. ...
Background:
Routine examination after cataract surgery, including a refraction test 4 to 6 weeks after surgery, is mandatory in most hospitals. In recent years, there has been growing interest in exploring alternative approaches to postoperative follow-up in cataract surgery patients due to the increasing number of cataract surgeries being performed, the limited availability of health care resources, and the need to optimize the use of health care services.
Objective:
We aim to compare postoperative visual outcomes after a day 0 examination in patients with 2 follow‑ups, one on day 7 and other on day 30, and patients with a single ophthalmic follow‑up between days 25 to 30.
Methods:
A prospective, quantitative, experimental control study will be carried out in Reiyukai Eiko Masunaga Eye Hospital, located in Banepa, Kavrepalanchok, Nepal. All patients undergoing cataract surgery meeting the inclusion and exclusion criteria irrespective of the type of surgery (small-incision cataract surgery or phacoemulsification) will be included in the study. The patients will be randomly assigned to 1 of 2 groups. Patients in group 1 will be examined on day 1, day 7, and day 30, whereas patients in group 2 will be examined on day 1 and once between days 25 to 30. The minimum clinically important difference (MCID) in our study will be set according to the improvement in the Snellen visual acuity chart.
Results:
The study is expected to be completed within 6 to 8 months from the start of the project. Data analysis and report writing will be carried out in a 2-month period. Best-corrected visual acuity will be compared between the 2 groups to determine if the MCID is achieved. The cost-effectiveness of the new approach will also be analyzed.
Conclusions:
We aim to conclude that we can safely defer the 1-week postoperative follow-up visit in patients undergoing uncomplicated cataract surgery and that, moreover, we can reduce the patient load at the hospital and decrease patient expenses by decreasing the frequency of hospital visits.
International registered report identifier (irrid):
PRR1-10.2196/48616.
... However, time until first review following routine, uneventful cataract surgery varies according to surgeon preference, but has been reported to occur most frequently either on the same day as the operation or on the following day, 3 although there have been some reports suggesting that initial postoperative care may be safely deferred out to 2 weeks. 4,5 Nevertheless, the AAO preferred practice patterns recommend that patients who underwent an uncomplicated surgery with a low-risk for postoperative complications should be evaluated in the first 48 hours following surgery. 2 Although this provides the physician with helpful guidance when scheduling initial postoperative care, little is known regarding patient preference in the matter. ...
Purpose
To evaluate patient preferences in regards to the timing of the initial postoperative examination after undergoing cataract surgery.
Methods
A retrospective, consecutive case series analysis from a single private practice institution was performed using a standardized phone survey on patients who underwent cataract surgery. Subjects were classified into one of two possible study groups according to the timing of their initial postoperative cataract surgery examination: Group A received the initial postoperative cataract surgery examination on the same day as the surgery, whereas Group B received the initial postoperative cataract surgery examination on the day following the operation.
Results
There were 80 subjects contacted for the phone survey of which 70 (35 in each study group) completed the survey and therefore were included in the analysis. Group A subjects responded favorably in regards to preference and realizing reduced time and cost savings compared to Group B (p < 0.0001 for both). There were no subjects in Group A who would have preferred next-day initial postoperative care, whereas 31.4% of subjects in Group B would have preferred same-day care if given the opportunity.
Conclusion
Patients undergoing cataract surgery both prefer and report time and cost savings with same-day initial postoperative care compared to next-day initial postoperative care. Patient preferences regarding their postoperative care should be one of the many factors that a surgeon ought to take into consideration when providing follow-up care after cataract surgery.
... A single surgeon performed all surgeries, while with multiple surgeons we would probably have had a wider palette of postoperative results. Another limitation was the short-term follow-up of the study groups, although several studies showed that 4 weeks after uneventful cataract surgery is enough time for follow-ups, as the visual outcome at the end of 1 month is optimal and the postoperative complications usually occur in the first 2 weeks [48,49]. ...
The aim of this study was to evaluate the influence of phacoemulsification cataract surgery on the state of the corneal endothelium in diabetic versus non-diabetic patients. We compared the corneal cell morphology in 48 diabetics with good glycemic control and 72 non-diabetic patients before and after uneventful phacoemulsification. Corneal cell density, central corneal thickness, and hexagonality were measured preoperatively and post-surgery (at 1 and 4 weeks) by specular microscopy. The effect of age, gender, axial length, and anterior chamber depth on the parameters of the corneal endothelium were evaluated. We noticed a drop in the endothelial density in both groups postoperatively: a mean endothelial cell loss of 472.7 ± 369.1 in the diabetic group was recorded versus 165.7 ± 214.6 mean loss in the non-diabetic group after the first week. A significant increase in central corneal thickness was also noticed in both groups one week after phacoemulsification, but no statistical significance after 4 weeks in the diabetic group. In terms of cell hexagonality, statistically significant differences were noticed after 4 weeks in both groups. Overall, a significant difference between diabetic and non-diabetic population was noticed in terms of corneal endothelial cell loss after uneventful phacoemulsification cataract surgery. Routine specular microscopy and HbA1c evaluation is recommended before cataract surgery, while intraoperative precautions and high monitorisation in terms of pacho power intensity and ultrasound energy, along with a proper application of the dispersive viscoelastic substances are essential to reduce the risk of endothelial damage.
... 7,8 Patient's first follow-up visit to the health care facility can be safely prolonged up to two weeks. 15 In the current study convenient day postoperative follow-up was comparable to the conventional first day followup in terms of safety. Our results are supported by the work of Ahmed and co-authors. ...
Objectives:
To compare safety and number of post-operative visits of patients in convenient day versus conventional first day follow-up after phacoemulsification.
Methods:
This observational cohort study was conducted in Department of ophthalmology, Sahiwal Medical College, Sahiwal from November 2019 to August 2020. There were 600 patients who underwent uncomplicated phacoemulsification with intraocular lens implantation. Patients were allocated into two groups. Group-I comprised of patients with convenient day follow-up during the first post-operative week. Group-II comprised of the patients with conventional first day follow-up. Rate of complications, number of visits during the first month and final visual acuity were recorded.
Results:
In Group-I post-operative complications were noted in 12.67% cases on first follow up visit and in 2.67% cases on first month follow up visit. In Group-II post-operative complication were noted in 22 % cases on first follow up visit and in 4% cases on first month follow up visit. Common postoperative complications were corneal oedema, anterior segment intraocular inflammation, residual lens matter in anterior chamber and intraocular lens subluxation. There was no difference in presenting and postoperative visual acuity between the two groups. Mean follow-up visits were 2.23 ± 0.42 in Group-I and 3.55 ± 0.50 in Group-II.
Conclusion:
Convenient day follow-up is as safe as conventional first day follow-up. Convenient day follow-up significantly reduces the number of post-operative visits. This would translate into cost reduction both for the patients and the health care facility.
... 20 It might be possible to covert some postoperative visits to telemedicine or to defer them altogether without compromising patient safety. 21,22 There are insufficient real-world data to assess how the aforementioned various strategies might increase throughput and potentially help diminish the backlog. Production would have to increase beyond previous throughput levels to catch up on the backlog. ...
Purpose:
To forecast the volume of cataract surgery in Medicare beneficiaries in the United States in 2020 and to estimate the surgical backlog that may be created due to COVID-19.
Design:
Epidemiologic modeling METHODS:: Baseline trends in cataract surgery among Medicare beneficiaries were assessed by querying the Medicare Part B Provider Utilization National Summary data. It was assumed that once the surgical deferment is over, there will be a ramp-up period; this was modeled using a stochastic Monte Carlo simulation. Total surgical backlog 2 years post-suspension was estimated. Sensitivity analyses were used to test model assumptions.
Results:
Assuming cataract surgeries were to resume in May 2020, it would take 4 months under an optimistic scenario to revert to 90% of the expected pre-COVID forecasted volume. At 2-years post-suspension, the resulting backlog would be between 1.1 and 1.6 million cases. Sensitivity analyses revealed that a substantial surgical backlog would remain despite potentially lower surgical demand in the future.
Conclusions:
Suspension of elective cataract surgical care during the COVID-19 surge might have a lasting impact on ophthalmology, and will likely result in a cataract surgical patient backlog. This data may aid physicians, payers, and policymakers in planning for post-pandemic recovery.
... There has been 1 smaller study in the United Kingdom of 50 patients evaluating the use of a phone call as an effective means of assessing symptoms in place of the United Kingdom's standard postoperative week 2 visit, and several studies in the United Kingdom and Singapore evaluating alternative methods to an in person assessment for the postoperative day 1 visit. 7,[13][14][15][16][17][18][19] Our study is the first to provide evidence of an optimized cataract surgery follow-up schedule in line with the 2016 AAO Preferred Practice Pattern, which recommends a first visit 24 to 48 hours after surgery. Therefore, the current study addresses a novel research question with broad implications and area for further study. ...
Purpose:
To ascertain the incidence of unexpected management changes at the postoperative week 1 visit in asymptomatic patients who have had an uncomplicated cataract surgery and a routine postoperative day 1 examination.
Design:
Retrospective observational study.
Methods:
A retrospective chart review was conducted of all cases of cataract extraction by phacoemulsification with intraocular lens insertion performed by the Comprehensive Ophthalmology Service at Massachusetts Eye and Ear between January 1, 2014 and December 31, 2014. The preoperative consultation, operative report, and postoperative day 1 and week 1 (postoperative days 5-14) visits were reviewed. Cases with intraoperative complications, as well as clinical findings at postoperative day 1 requiring close follow-up, were excluded. The main outcome measure was incidence of unexpected management changes at the postoperative week 1 visit after cataract surgery, defined as an unanticipated change in postoperative drops, additional procedures, or urgent referral to a specialty service.
Results:
Overall, 1938 surgical cases of 1471 patients were reviewed, and 1510 cases (77.9%) underwent uncomplicated phacoemulsification with intraocular lens implantation with a routine postoperative day 1 examination. Of these 1510 cases, 238 (15.8%) reported symptoms at the postoperative week 1 visit, including flashes, floaters, redness, pain, or decreased vision, which warranted an examination. In total, 1272 cases were asymptomatic, and only 11 of these cases (0.9%) had an unexpected management change at postoperative week 1. Eight of 11 patients were asymptomatic steroid responders requiring alteration of their postoperative drops. Two of these patients had an intraocular pressure >30 mm Hg.
Conclusions:
Unexpected management changes at the postoperative week 1 timepoint after cataract surgery are rare in asymptomatic patients who have had uncomplicated cataract surgery and a routine postoperative day 1 examination. Limited data are available to outline an optimal postoperative regimen after cataract surgery. The results of this study suggest that postoperative week 1 examinations could potentially be performed on an as-needed basis in the appropriate subgroup of patients after cataract surgery.
... A summary of prospective studies looking into the optimal timing of the first postphacoemulsification review and their outcome is shown in Table 4 [5,[15][16][17][18][19]. The majority of the NDR were conducted by doctors, while in one study, SDR was conducted by a nurse with a pen torch. ...
Purpose . To study whether nurse led same-day review (SDR) after uneventful phacoemulsification can replace next-day review (NDR) in terms of safety and efficacy. Setting . Patients are recruited from an ophthalmology outpatient clinic in Hong Kong. Design . A prospective, randomized crossover study conducted from November 2012 to 2014. Methods . Inclusion criteria include cataract surgery naïve patients undergoing phacoemulsification under local anaesthesia. All patients were seen by our ophthalmic nurse 2 hours after surgery. Before undergoing phacoemulsification of the first eye, patients were randomized to be reviewed on day 1 or 7 after surgery. Surgeons and reviewing doctors were blinded to patient allocation. For the patients’ second eye surgery, group allocation will cross over. Primary outcome measures include visual improvement and patient satisfaction questionnaire. Other measures include cataract characteristics, surgical details, and complications. Statistical tests include paired t -test, Wilcoxon signed rank test, and Chi-square test. Results . 164 eyes from 82 patients were available. Visual improvement, satisfaction, and complications were comparable between both groups. Conclusions . A nurse led SDR can replace NDR in uneventful phacoemulsification in terms of safety and efficacy. Patient satisfaction is also comparable in the setting of Asian culture and when transportation is not a major concern.
... 57 j No. 6 j 2561 III grader; one trained examiner performed MP measurements before and after cataract surgery, thereby eliminating interexaminer bias and variability; dietary and serum carotenoid assessment was performed to control for any variability in MP measurement attributable to these parameters; and the fellow eye was used as a control (i.e., in the absence of cataract surgery). Limitations of this study include its small sample size and a large number of potential study patients who were ultimately unable to participate due to the need for an accompanying person for transport purposes (because of the need to pharmacologically dilate the pupils at the study visits, a measure that would not be part of routine clinical evaluation of an eye before or after cataract surgery at the IOES 36 ). ...
Purpose:
To investigate the effect of cataract (and cataract surgery) on macular pigment (MP) measurements using the Heidelberg Spectralis HRA+OCT MultiColor device.
Methods:
Thirty-six patients (age, 54-87 years) scheduled for cataract surgery at the Institute of Eye Surgery, Ireland, were enrolled in this study. Cataracts were graded using the Lens Opacities Classification System (LOCS) III, and surgery was performed using standard phacoemulsification technique with implantation of a Tecnis ZCB00 or Tecnis ZCT intraocular lens. Macular pigment was measured before and after cataract surgery in the operated (study) eye and in the fellow (control) eye.
Results:
In the study eye, there was statistically significant disagreement in measures of MP taken before and after surgery. At all eccentricities, and also for MP volume, the postsurgery measurements were significantly (P < 0.05) greater, ranging from an average 16% greater at 1.72° to an average 35% greater at 0.23° eccentricity. Eyes exhibiting large disagreement between pre- and postsurgery measurements at a given eccentricity also generally exhibited substantial disagreement at other eccentricities. Overall severity of cataract contributed to greater disagreement between pre- and postoperative measures of MP, as did grade of nuclear opalescence, nuclear color, and posterior subcapsular cataract. In control eyes, there was no statistically significant disagreement in terms of measures of MP taken before and after cataract surgery (P > 0.05 for all; 1-sample t-test).
Conclusions:
Macular pigment measurements using the Spectralis are affected by cataract. Accordingly, we recommend that cataract be graded when measuring MP with a device that utilizes dual-wavelength fundus autofluorescence and propose the employment of a correction factor to compensate for cataract when measuring MP.
... Phacoemulsification and recent advances in cataract surgery techniques lead to improved postoperative outcomes, as well as to reduced intra-and postoperative complications [2,3]. Therefore, there is a tendency in discharging patients on the same day of surgery, without first day postoperative review3456, which is considered to be an increasing issue due to economic reasons. Nevertheless , routine review on the first day postoperatively has several advantages, such as the early detection of complications, reassurance for the patient and training of staff [3]. ...
Our purpose was to examine the value of the first postoperative day review after uneventful phacoemulsification cataract surgery.
291 patients who underwent uneventful phacoemulsification were randomized into two groups (ClinicalTrials.gov Identifier: NCT01247155): i) Next day review (NDR group, n = 146) and ii) No next day review (NNDR group, n = 145). The rate of complications, percentage of patients seeking non-scheduled medical consultation up to postoperative day 14, presence of any inflammation-related sign and best corrected visual acuity (BCVA) on postoperative day 28 were analyzed.
In the NDR group, 5.5% of patients developed a postoperative complication, whereas the respective rate was 6.2% in the NNDR group. The difference was not statistically significant (p = 0.791). The most frequent complications were: elevated intraocular pressure, allergy to postoperative treatment, corneal abrasion, punctuate epitheliopathy, iris prolapse and postoperative hyphema, whose rates did not differ between the two groups. The rate of patients seeking non-scheduled medical consultation up to postoperative day 14, presence of any inflammation-related sign, as well as BCVA on day 28 did not exhibit any significant differences between the study groups.
First postoperative day review could be omitted in cases of uneventful cataract surgery.
... Postoperative Data Patients were reviewed 2 weeks postoperatively, consistent with the unit's protocol. 19 The uncorrected distance visual acuity (UDVA) and CDVA were recorded at this visit. In addition, the ophthalmologist evaluated patient-reported symptoms or problems. ...
To quantify the effect on refractive outcomes after cataract surgery of personalization of Haigis intraocular lens (IOL) constants for a given surgeon-IOL combination.
Institute of Eye Surgery and Institute of Vision Research, Whitfield Clinic, Butlerstown North, Waterford, Ireland.
Personalization of Haigis IOL constants was performed using a series of 248 suitable eyes after biometry by partial coherence interferometry (IOLMaster) and IOL prediction based on optimized IOL constants derived from pooled data from the User Group for Laser Interference Biometry web site. A mean error of prediction and a mean absolute error were then calculated using the personalized IOL constants and compared with those derived using optimized IOL constants, allowing evaluation and quantification of the maximum realizable refractive benefits (if any) of personalization.
There was no statistically significant difference between personalized and optimized Haigis IOL constants in absolute error or the proportion of eyes within +/-1.00 diopters (D), +/-0.50 D, or +/-0.25 D of the target postoperative refraction in all eyes, short eyes (axial length [AL] <22 mm; n = 19), average eyes (AL > or =22 mm and <24.5 mm; n = 149), or long eyes (AL >24.5 mm; n = 46) (all P>.05, McNemar test). Ten eyes with a short AL had a smaller absolute error (by > or =0.30 D) in association with personalized IOL constants.
Personalized Haigis IOL constants showed marginal, but statistically nonsignificant, refractive advantages over optimized Haigis IOL constants, but only in eyes with a short AL. FINANCIAL DISCLAIMER: No author has a financial or proprietary interest in any material or method mentioned.
Introduction
We sought to streamline cataract surgery post-operative care when COVID-19 hit by discontinuing the 1-day post-operative visit. We wanted to know if this change was safe and beneficial to our patients by reducing patients’ time and transportation burden, opening appointment slots allowing providers to see more patients and reducing greenhouse gas emissions. By minimising intraoperative use of dispersive viscoelastic, increasing irrigation/aspiration time at the end of the surgery and using intraocular pressure (IOP) lowering medications such as carbachol, brimonidine and acetazolamide routinely, we posit that post-operative day 1 IOP spikes can be avoided, thereby eliminating the need for the 1 st post-operative day visit. We also sought to show the positive environmental impact of eliminating that 1 st day.
Methods
We retrospectively reviewed cataract surgeries performed before COVID-19 to determine the incidence of serious pathology discovered at the post-operative day 1 visit. Subsequently, we examined all the cataract surgeries performed in 2023 by our practice.
Results
One hundred and ninety-three cataract surgeries performed before COVID-19 and 832 performed in 2023 were reviewed. We found that the post-operative day 1 visit after cataract surgery is unnecessary in most routine uncomplicated cases.
Conclusion
By eliminating hundreds of post-operative day 1 visits for a busy rural practice annually, patients, their friends and relatives are spared an extra trip to the office (that can be 100 km each way), the office schedule is open to accommodate more patients, and the patients’ carbon footprint of travel to the office is reduced.
Introduction
Nous avons cherché à rationaliser les soins postopératoires de la chirurgie de la cataracte lors de l’arrivée de la Covid en supprimant la visite postopératoire d’un jour. Nous voulions savoir si ce changement était sécuritaire et bénéfique pour nos patients en réduisant le temps et la charge de transport des patients, en ouvrant des créneaux de rendez-vous permettant aux prestataires de voir plus de patients et en réduisant les émissions de gaz à effet de serre. En minimisant l’utilisation peropératoire de viscoélastique dispersif, en augmentant le temps d’irrigation/aspiration à la fin de l’opération et en utilisant systématiquement des médicaments abaissant la PIO, tels que le carbachol, la brimonidine et l’acétazolamide, nous pensons que les PIO postopératoire du premier jour peuvent être évitées, éliminant ainsi la nécessité d’une première visite de jour postopératoire. Nous avons également cherché à démontrer l’impact environnemental positif de l’élimination de ce premier jour.
Méthodes
Nous avons examiné rétrospectivement opérations de la cataracte réalisées avant la Covid afin de déterminer l’incidence des pathologies graves découvertes lors de la visite postopératoire du premier jour. Par la suite, nous avons examiné toutes les opérations de la cataracte réalisées en 2023 par notre cabinet.
Résultats
193 opérations de la cataracte réalisées avant la Covid et 832 réalisées en 2023 ont été examinées. Nous avons constaté que la visite postopératoire du premier jour après la chirurgie de la cataracte n’est pas nécessaire dans la plupart des cas de routine sans complications.
Conclusion
En éliminant des centaines de visites postopératoires du premier jour dans une région rural, les patients, leurs amis et leurs proches n’ont pas à SE rendre au cabinet (ce qui peut représenter des centaines de kilomètres aller-retour). L’emploi du temps du cabinet est libéré pour accueillir davantage de patients et l’empreinte carbone des patients liée à leur déplacement au cabinet est réduite.
Purpose:
To compare incidences and reasons for unplanned extra visits after phacoemulsification surgery in two unselected clinical populations with different postoperative treatment protocols.
Design:
Retrospective cohort study.
Methods:
We reviewed medical records of 1000 patients that underwent cataract surgery at two adjacent clinics in Sweden. At each clinic, 500 consecutive surgeries were included. Preoperatively recorded comorbidities were registered. One clinic used a non-steroidal anti-inflammatory drug (NSAID) in combination with steroids as postoperative treatment, the other used steroids in monotherapy. Main outcome was the number of patients that returned within 6 months after surgery for at least one unplanned visit. Reasons for unplanned visits were secondary outcomes.
Results:
Among patients receiving combined treatment 84 cases (16.8%) returned for at least 1 extra visit, compared with 63 cases (12.6%) in the group treated with steroids only (RR = 1.33 [95% CI 0.99-1.80, p = 0.061]). No significant differences were found regarding any underlying reasons for the visits, including cystoid macular oedema (CME). We found increased risks for CME in patients with diabetes mellitus (RR = 3.83 [95% CI 1.18-12.41, p = 0.016]) and patients with epiretinal membrane (ERM) (RR = 10.76 [95% CI 3.14-36.89, p < 0.0001]).
Conclusions:
Postoperative anti-inflammatory treatment with NSAID in combination with steroids did not reduce need for unplanned postoperative visits or incidence of visually disturbing CME after cataract surgery compared with steroids alone. Patient groups with elevated risks for CME are of interest in future research regarding benefits and optimal use of NSAID treatment after cataract surgery.
Purpose
To compare the postoperative outcomes and management of uncomplicated cataract surgery seen on postoperative day 0 (POD0) versus postoperative day one (POD1).
Methods
A retrospective cohort study of patients who followed up within 0-14 days of their uncomplicated surgery (current procedural terminology code 66984) from December 2018 to March 2020. Those who had perioperative complications, those who had combined glaucoma filtering surgery as well as other minimally invasive glaucoma surgery (MIGS) procedures, and those who did not complete their first two follow-up visits within 14 days of their surgery were excluded. Visual acuity (VA), intraocular pressure (IOP), post-operative interventions, and complications of the first and second postoperative visits were collected.
Results
Of the 665 participants studied, the mean (standard deviation) age was 68 (11) years old and 60% were female (n=304) with a mean (SD) pre-op logarithm of the minimum angle of resolution (logMAR) VA of 0.715 (0.625). About one-third (32%) of patients were seen on POD0. Compared to POD1, a higher percent of patients with glaucoma were seen POD0 (23% vs 14%; p = 0.008). The mean VA on POD0 was 0.840 (0.653), which was significantly worse than the mean VA of 0.539 (0.599) on POD1 (p<0.0001). There was no significant difference in VA by the second post-op visit. IOP did not significantly differ between POD0 and POD1 groups at the first post-operative visit. The most common changes in the post-operative drop regimen were related to IOP and inflammation control. The rate of interventions did not significantly differ between groups (p>0.1). Patients who received intervention on POD0 were not seen significantly sooner at the next follow-up visit compared to those seen on POD0 without undergoing an intervention. The incidence of an IOP spike greater than 30mmHg on POD0 or POD1 was not significantly different between patients with and without underlying glaucoma (overall p = 0.2020; with glaucoma p= 0.1238; without glaucoma p=0.999). Those with a history of glaucoma were not more likely to receive intervention to lower IOP on POD0 versus those seen on POD1 (p = 0.999).
Conclusion
It can be difficult to evaluate patients the day after their uncomplicated cataract surgery, and it is difficult to predict which patients may have post-operative complications. Our study shows no significant changes in management for patients seen on POD0 compared to POD1. Surgeons can expect significantly better visual acuity on POD1, but otherwise, post-operative outcomes were similar between patients seen on POD0 and those seen on POD1. Surgeons may offer the option of a POD0 visit for patients who underwent uncomplicated cataract surgery.
The climate crisis is threatening the health of current and future generations and represents a particular challenge for healthcare systems. To address man-made climate change, comprehensive adaptation and mitigation strategies are crucial. Medicine and ophthalmology offer various opportunities to reduce the CO2 (carbon dioxide) footprint - these should be implemented and politically encouraged. Data-driven sustainability tools may provide options to evaluate the environmental footprint and to initiate optimization strategies. Life cycle assessments are an approach to systemically measure the environmental footprint and may facilitate sustainable decisions processes. The German health system needs to develop quantifiable and holistic strategies to reduce CO2; sustainability might become a future performance indicator. This article discusses examples of adaptation to the climate crisis and mitigation in ophthalmology and beyond.
Purpose:
The aim of this study was to compare the postoperative visual outcome after a Day 0 examination in patients with two follow-ups, one between Day 3 to Day 7 and other between Day 25 to Day 30 to those with a single ophthalmic follow-up directly after 25-30 Days and to assess the safety of deferral of the first follow-up visit at 1 week.
Methods:
Randomized Controlled Trial was conducted at a tertiary eye care hospital, with 848 patients enrolled for the study. Patients meeting the inclusion criteria were selected. Their pre-operative and post-operative data was collected and the patients were divided into groups based on the type of cataract surgery and the postoperative follow-up protocol through randomization.
Results:
No significant difference was observed in the postoperative visual outcome in patients that underwent postoperative review at Day 3-7 and Day 25-30 as opposed to those that followed up directly at Day 25-30 after a mandatory Day 0 examination for all patients.
Conclusion:
In patients with no preexisting ocular or systemic comorbidity undergoing an uneventful cataract surgery, the postoperative follow-up visit can be safely deferred until 4 weeks, without any impact on the postoperative visual outcome, thereby conserving the available resources which can be deviated towards better eye care services.
Purpose
To evaluate safety perspectives when the standard routine after cataract surgery is no planned postoperative visit.
Setting
Eye Clinic, Sunderby Hospital, Luleå, Norrbotten County, Sweden.
Design
Prospective case series.
Methods
All cataract surgery cases during a 1-year period were included. The study group had the standard routine at the clinic, that is, no planned postoperative visit for patients without comorbidity and uneventful surgery. For the control group, patients who had surgery during 1 month of the 1-year period were chosen. All these patients had a planned postoperative visit. All surgeons involved were experienced. The outcome measures were any planned postoperative visit, any complication and/or adverse event, postoperative corrected distance visual acuity (CDVA), and any postoperative control/contact initiated by the patient.
Results
The study comprised 1249 patients (1115 in the study group and 134 in the control group). No significant differences in demographics, postoperative CDVA, frequency of planned visits because of ocular comorbidity, or postoperative patient-initiated contacts were found between the 2 groups. Of the 1249 patients, 9% (117 patients) initiated a postoperative contact, of whom 26% (30 patients) also had a scheduled visit. The reasons for the patient-initiated contacts were visual disturbance, redness and/or chafing, pain, and anxiety. An evaluation of all medical records 2 years postoperatively found no reports of missed adverse events.
Conclusions
It was possible to refrain from planned postoperative visits for patients having uncomplicated cataract surgery. However, preoperatively, patients with comorbidities should be provided with individual planning of their postoperative follow-up. Preoperative counseling is important, and the clinic must have resources to answer questions from patients and be prepared for additional unplanned postoperative visits.
To investigate subjectively reported outcomes following cataract surgery and the relationships between such outcomes in the context of falling thresholds for cataract surgery.
Large, private, non-refractive cataract practice, Institute of Eye Surgery, Whitfield Clinic, Waterford, Ireland METHODS: Pre-operative, intra-operative and post-operative data of 2552 eyes undergoing phacoemulsification and implantation of the Tecnis(R) ZCB00 1-piece intraocular lens (IOL) by a single surgeon between July 2009 and October 2013 was analysed. Patients without visually consequential ocular co-morbidity completed two validated questionnaires, designed to assess subjectively perceived visual functioning and identify symptoms of dysphotopsia following cataract surgery.
54.8 % of questionnaire respondents were entirely satisfied (satisfaction 10/10) post-operatively, with 83.7 % reporting satisfaction of ≥7/10. Satisfaction was positively associated with patient age and negatively associated with spectacle dependence, dysphotopsia, and function related to vision (NEI VF-11) score. The mean (±standard deviation[SD]) dysphotopsia score was 1.36 (±1.9; scale 0-10), with 40 % of respondents reporting no dysphotopsia symptoms and 9.8 % reporting clinically meaningful dysphotopsia. The mean (±SD) National Eye Institute visual function-11 (NEI VF-11) score was 0.33 (±0.53; scale 0-4) and reduced function related to vision was associated with increasing severity of dysphotopsia symptoms. When linear regression was applied, 17.5 % of the variation in functionality was attributable to symptoms of dysphotopsia.
Dysphotopsia is an important determinant of a patient having difficulty with vision-related tasks following cataract surgery, and patient satisfaction is positively associated with patient age and negatively associated with spectacle in dependence, dysphotopsia and function related to the vision (NEI VF-11) score.
Purpose:
The purpose of this paper is to determine the safety of substituting the first day post-operative review after routine cataract surgery (phacoemulsification) with a telephone survey.
Design/methodology/approach:
Prospective non-randomised cohort study. A standardised questionnaire of five common ocular symptoms (general condition, vision, eye pain, headache, nausea or vomiting) was administered by a trained nurse on the first post-operative day. The patients were reviewed in clinic two to 14 days later. Patient charts were retrospectively reviewed for complications (endophthalmitis, raised intra-ocular pressure, wound leaks and uveitis) requiring deviation from standard treatment.
Findings:
Over 13 months, 256 eyes of 238 patients underwent uncomplicated phacoemulsification by four consultant surgeons. Only one patient reported poor general condition, blurred vision and eye pain. She was subsequently found to have corneal oedema and raised intra-ocular pressure when recalled for an earlier review. Best corrected visual acuity better than 20/40 was achieved in 80.5 per cent of patients. There were no other post-operative complications noted from medical records review.
Research limitations/implications:
Non-randomised nature, skewed surgical expertise, lack of a control group and patient experience data. In all, 22 patients (9.2 per cent) were also uncontactable for the telephone interview.
Practical implications:
A nurse-administered telephone survey seemed to be a safe and effective alternative to first day post-operative review after routine phacoemulsification. The survey also enabled the detection of serious post-operative complications. The first day post-operative hospital visit may be safely substituted in a selected patient population with greater patient convenience achieved and liberation of clinic resources.
Originality/value:
This is the first study which utilises a standardised questionnaire as a form of post-operative review in an Asian population.
Purpose of review:
The purpose of this study is to provide a summary of current trends and recent developments in postoperative care after cataract surgery.
Recent findings:
There is new evidence challenging the routine use of a protective eye shield after uncomplicated cataract surgery. Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective in decreasing the risk of cystoid macular edema (CME) in high-risk eyes, but must be used with caution in patients with prior corneal disease. Pre-existing ocular comorbidities can have significant effects on postoperative outcomes. Management of postoperative visual expectations can be challenging in patients receiving newer advanced technology intraocular lenses (IOLs).
Summary:
Key practices such as restrictions on activities, prophylactic regimens against infection and inflammation, appropriate follow-up with adjustments for individual risk factors and management of complications, and continuing care until visual rehabilitation is complete are advised to optimize visual outcome for patients after cataract surgery.
IntroductionIn France in 2009, newly operated patients after cataract surgery are usually seen by their surgeon the day after surgery (D1). The value of this day-after visit has been undergoing reassessment for some years, but this visit remains in widespread use in France. The aim of this study was to assess whether this visit changes patient management.Patients and methodsOne hundred three consecutive patients (106 eyes) undergoing cataract surgery by phacoemulsification were prospectively treated in our department (82% were outpatients). All intraoperative events were noted. The day after surgery, we monitored ocular tension, the anterior segment, and the fundus. Every change in the postoperative prescription compared with a standard prescription was noted.ResultsIntraoperative complications occurred in eight cases. On D1, six patients had ocular hypertension that exceeded 24 mmHg, 14 had a corneal edema, six had corneal erosion, two had a Seidel, one had an anterior subluxation of the IOL, and one had retinal detachment. In 26 cases (24.5%), the prescription was changed compared to our standard prescription.DiscussionSeveral studies have shown that the day-after-surgery visit was not mandatory. The main objective of this visit is to check for ocular hypertension. More rarely, it can detect a Seidel in front of the wound, incorrect position of the IOL, retinal detachment, or other complications that may require surgery.Conclusion
The day-after-surgery visit remains necessary after phacoemulsification because complications, sometimes unpredictable, can occur and compromise the result of surgery. This visit also has an educational value (to reiterate to the patients the symptoms that would require an emergency visit).
Methods Personalization of Haigis IOL constants was performed using a series of 248 suitable eyes after biometry by partial coherence interferometry (IOLMaster) and IOL prediction based on optimized IOL constants derived from pooled data from the User Group for Laser Interference Biometry web site. A mean error of prediction and a mean absolute error were then calculated using the personalized IOL constants and compared with those derived using optimized IOL constants, allowing evaluation and quantification of the maximum realizable refractive benefits (if any) of personalization. Results There was no statistically significant difference between personalized and optimized Haigis IOL constants in absolute error or the proportion of eyes within ±1.00 diopters (D), ±0.50 D, or ±0.25 D of the target postoperative refraction in all eyes, short eyes (axial length [AL] < 22 >mm; n = 19), average eyes (AL ≥22 mm and < 24.5 mm; n = 149), or long eyes (AL >24.5 mm; n = 46) (all P>.05, McNemar test). Ten eyes with a short AL had a smaller absolute error (by ≥0.30 D) in association with personalized IOL constants. Conclusion Personalized Haigis IOL constants showed marginal, but statistically nonsignificant, refractive advantages over optimized Haigis IOL constants, but only in eyes with a short AL.
We compared bimanual microincision cataract surgery (MICS) and standard coaxial phacoemulsification (CAP) in terms of uncorrected visual acuity (UCVA) recorded 1 h and 2 weeks postoperatively.
This was a prospective, nonrandomised comparative study. All MICS procedures were performed by one surgeon (MGM), and all CAP procedures were performed by another surgeon (SB). Eyes with visually consequential ocular morbidity were excluded. The primary outcome measure was UCVA recorded 1 h postoperatively.
One hundred eyes underwent MICS and CAP (50 eyes in each group). The treatment groups did not differ significantly in terms of preoperative mean best corrected visual acuity (6/24 +/- 4.3 lines and 6/20 +/- 4.4 lines in the MICS and the CAP groups, respectively; P = 0.65). Also, there was no significant difference in terms of postoperative UCVA at 1 h or at 2 weeks (mean +/- standard deviation UCVA 1 h postoperatively: MICS: 6/36 +/- 5.7 lines; CAP: 6/30 +/- 4.7 lines; P = 0.80; UCVA 2 weeks postoperatively: MICS: 6/10 +/- 1.9 lines; CAP: 6/10 +/- 2.2 lines; P = 0.90). However, nine eyes (18%) and one eye (2%) achieved a UCVA of C6/12 at 1 h following MICS and CAP, respectively, and this difference was statistically significant (P = 0.02).
Mean UCVA at 1 h and at 2 weeks following cataract surgery was not significantly different between eyes undergoing MICS and CAP. However, a greater proportion of patients achieved a UCVA of C6/12 following MICS when compared with CAP.
To report the value of dual biometry in the detection of biometry errors.
Study 1: retrospective study of 224 consecutive cataract operations. The intraocular lens power calculation was based on immersion biometry. Study 2: immersion biometry was compared with optical coherence biometry (OCB) in terms of axial length, anterior chamber depth, keratometry readings and the recommended lens power to achieve emmetropia. Study 3: prospective study of 61 consecutive cataract operations. Both immersion and OCB were performed, but lens power calculation was based on the latter.
Study 1: 115 (86%), 101 (75.4%), 90 (67.2%) and 50 (37.3%) of postoperative spherical equivalents were within +/-1.5 dioptres (D), +/-1.25 D, +/-1 D and +/-0.5 D of the target, respectively. Study 2: excellent agreement between axial length readings, anterior chamber depth readings and keratometry readings by immersion biometry and OCB was observed (reflected in a mean bias of -0.065 mm, -0.048 mm and +0.1803 D, respectively, in association with OCB). Agreement between the lens power recommended by each technique to achieve emmetropia was poor (mean bias of +1.16 D in association with OCB), but improved following appropriate modification of lens constants in the Accutome A-scan software (mean bias with OCB = -0.4 D). Study 3: 37 (92.5%) and 23 (57.5%) of operated eyes achieved a postoperative refraction within +/-1 D and +/-0.5 D of target, respectively.
Systematic errors in biometry can exist, in the presence of acceptable postoperative refractive results. Dual biometry allows each biometric parameter to be scrutinized in isolation, and identify sources of error that may otherwise go undetected.
In France in 2009, newly operated patients after cataract surgery are usually seen by their surgeon the day after surgery (D1). The value of this day-after visit has been undergoing reassessment for some years, but this visit remains in widespread use in France. The aim of this study was to assess whether this visit changes patient management.
One hundred three consecutive patients (106 eyes) undergoing cataract surgery by phacoemulsification were prospectively treated in our department (82% were outpatients). All intraoperative events were noted. The day after surgery, we monitored ocular tension, the anterior segment, and the fundus. Every change in the postoperative prescription compared with a standard prescription was noted.
Intraoperative complications occurred in eight cases. On D1, six patients had ocular hypertension that exceeded 24 mmHg, 14 had a corneal edema, six had corneal erosion, two had a Seidel, one had an anterior subluxation of the IOL, and one had retinal detachment. In 26 cases (24.5%), the prescription was changed compared to our standard prescription.
Several studies have shown that the day-after-surgery visit was not mandatory. The main objective of this visit is to check for ocular hypertension. More rarely, it can detect a Seidel in front of the wound, incorrect position of the IOL, retinal detachment, or other complications that may require surgery.
The day-after-surgery visit remains necessary after phacoemulsification because complications, sometimes unpredictable, can occur and compromise the result of surgery. This visit also has an educational value (to reiterate to the patients the symptoms that would require an emergency visit).
The increase in the number of operating rooms nationwide in the United States may reflect preferences of patients for scheduling of outpatient surgery. Yet, little is known of the importance that patients place on scheduling convenience and flexibility.
Fifty cataract surgery patients seen by a surgeon at his main office during a 6-mo period responded to a marketing survey. All the patients had Medicare insurance and supplemental insurance permitting surgery at any facility. A telephone questionnaire included four vignettes describing different choices in the scheduling of cataract surgery. Respondents were asked how far they would be willing to travel for one option instead of another. For example, "Your surgery will be on Thursday in three weeks at 2 pm. You can drink water until 9 am. You arrive at 10 am, because your surgery might start early. If you travel farther, you would arrive at 8 am for 9 am surgery."
The median (50th percentile) additional travel time was 60 min (lower 95% confidence bound >or=52 min) for each of four options: to receive care on a day chosen by the patient instead of assigned by the physician, to receive care at a single site instead of both the surgeon's office and a surgery center at a different location, to combine the examination and the surgery into a single visit instead of two visits, and to have surgery in the morning instead of the afternoon.
The patients of this ophthalmologist placed a high value on convenience and flexibility in scheduling their surgery. In general, this would be achievable only if many operating rooms were available each morning.
To determine the clinical intervention rate during routine review after uncomplicated phacoemulsification.
A review of case notes in 651 consecutive cases of uncomplicated phacoemulsification from 1994 (< or = 5.5 mm self sealing wound) was performed. The intervention rate at scheduled routine review visits and at unscheduled visits to the eye casualty service in the first 120 postoperative days was recorded. Interventions were defined as departures from predetermined postoperative care protocols.
Clinical interventions were reported in 2.8% (95% confidence interval 1.5 to 4.1%) of (n = 1652) routine follow up visits. Many of these interventions were avoidable or trivial; 90% of patients had no postoperative intervention at any visit. 7.3% of patients made unscheduled visits to the emergency service. The intervention rate in this group was 50% (35.9 to 64.1%).
The intervention rate in routine clinical review after uncomplicated modern cataract surgery is low. Alternatives to conventional postoperative review, including shared care with non-ophthalmologists and improved perioperative patient education with an open channel for self referral, should be evaluated.
To determine whether the first day review is essential in management of patients following uncomplicated phacoemulsification with intraocular lens implantation. Patients are routinely seen on the day following surgery. This can produce logistical problems in patient attendance that can necessitate an overnight stay. If the first day review were abandoned this would lead to an increased uptake of day case surgery and a reduction in health care costs.
A retrospective cohort study was performed on all cases of uncomplicated phacoemulsification with intraocular lens implant surgery over a 6 month period. Slit lamp examination findings on the first post-operative day were reviewed. Visual acuity, corneal clarity, anterior chamber activity, intraocular pressure and configuration of the pupil were recorded. Any cases that failed to meet predetermined criteria underwent full case-note review. The subsequent management of these patients was analysed.
Of the 201 cases of uncomplicated surgery, 74 cases (37%) failed to meet the study criteria and underwent review. Of these only 12 (6%) had their management altered as a result of the first day post-operative findings. This was entirely due to raised intraocular pressure. Visual acuity, corneal oedema and activity in the anterior chamber all improved on subsequent follow-up.
The first day review of uncomplicated phacoemulsification with lens implant surgery provides the opportunity to treat raised intraocular pressure. A prospective randomised study is needed to identify means to prevent the post-operative intraocular pressure rise before we are able to consider abandoning the first review.
To compare two organisational models of management for patients with cataract referred to a peripheral ophthalmic clinic who underwent day-surgery at a main eye hospital.
Patients were randomised into two groups. The experimental group (n = 25) received pre-operative assessment by a trained ophthalmic nurse at the peripheral clinic immediately following diagnosis of cataract and diary-booking for surgery. The control group (n = 24) received a separate appointment for pre-operative assessment at the main hospital. For all patients, the first review appointment (3 or 5 days post-operatively) and all subsequent review was at the peripheral clinic. Outcome measures included: visual acuity, subjective visual function (VF-14), anxiety and depression (HADS), semi-structured interviews to ascertain patient satisfaction, and a cost-benefit analysis.
There were no significant differences at any time between the experimental and control groups with respect to visual acuity, subjective visual function or anxiety and depression. The experimental model was found to be more cost-effective and provided a less fragmented means of care delivery. The majority of patients in both groups expressed satisfaction with their care but, overall, the experimental model was preferred.
Nurse-led pre-operative assessment of patients with cataract at a peripheral ophthalmic clinic is safe, cost-effective and is preferred by patients.
To assess the necessity for first post-operative day review in determining the need for post-operative intervention in patients who had uncomplicated phacoemulsification surgery.
A retrospective study was carried out to review the first post-operative day findings in patients who underwent uncomplicated phacoemulsification surgery by a single surgeon between January 1997 and March 1998. The findings analysed were wound integrity, corneal clarity, anterior chamber activity, intraocular pressure and the intraocular lens status. The need for medical or surgical intervention was also analysed. Those eyes that had coexisting ocular pathology such as glaucoma, ocular hypertension, uveitis, trauma or previous intraocular surgery were excluded from the study. Fisher's exact test was used to compare the difference between the groups.
Seventy-one eyes of 71 patients who underwent an uncomplicated phacoemulsification procedure were included in the study. Intraocular pressure of 30 mmHg or greater was found in 7 eyes (10%), all of which also had corneal oedema. These patients received acetazolamide SR 250 mg twice daily for 3 days. Another 21 eyes (30%) had corneal oedema for which no specific treatment was given. The intraocular pressure had returned to baseline and corneal oedema resolved by the first clinic follow-up in 1-2 weeks. None of the 71 patients needed surgical intervention in the post-operative period.
First post-operative day review is necessary as it gives an opportunity to manage the post-operative rise in intraocular pressure.
To determine the postoperative morbidity on day 1 after uncomplicated phacoemulsification.
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.
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.
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.
To establish the rate of complications detected on the first postoperative day and therefore the need for evaluation on that day.
Hinchingbrooke Hospital, Huntingdon, England.
Complications detected on the first day after phacoemulsification cataract surgery were retrospectively reviewed over 8 months. Ophthalmic nurse practitioners performed the 1 day postoperative examination and kept a log of patients seen, recording complications detected and whether referral to a physician was required. All patients had had routine phacoemulsification with intraocular lens implantation without anterior vitrectomy or trabeculectomy, as identified from the log book and cross-checked with operating theater records. Notes were reviewed if a complication or referral was recorded. Most cases were performed under local anesthesia as day cases using a temporal corneal approach. Sections were routinely left unsutured unless enlarged or closure was not satisfactory at the conclusion of surgery.
The review yielded 392 patients. Six (1.53%) had intraocular pressure (> or = 30 mm Hg) requiring treatment, 1 (0.26%) had painless iris prolapse, 11 (2.81%) had corneal abrasions, and 7 (1.78%) were given a more intensive steroid regime. No cases of fibrinous uveitis were recorded.
Potentially sight-threatening complications present on the first postoperative day, albeit infrequently. With our current practice and case mix, the need for this review persists. It is possible to reduce the demand on physician time by using appropriately trained nonmedical practitioners.
To determine the value of routine review on the first post-operative day following phacoemulsification cataract surgery.
A prospective study was performed of 238 consecutive patients who underwent phacoemulsification cataract surgery. Local anaesthesia was used for 97% of patients and surgery was performed as a day-case procedure for 93% of patients. The findings at the first day post-operative review were analysed separately for patients who had undergone uncomplicated surgery and patients who had suffered an intraoperative complication. Four patients were excluded because of incomplete data collection.
A total of 227 patients underwent uncomplicated phacoemulsification cataract surgery. Thirteen (5.7%, 95% confidence interval (CI) 3.1-9.6%) of these were found to have post-operative complications at their first day review which comprised corneal oedema (4.4%, 95% CI 2.1-8.0%), raised intraocular pressure > or = 30 mmHg (1.3%, 95% CI 0.3-3.8%), hyphaema (0.9%, 95% CI 0.1-3.1%), corneal abrasion (0.4%, 95% CI 0.0-2.4%) and anterior uveitis (0.4%, 95% CI 0.0-2.4%). These findings led to the standard post-operative management being altered for 5 (2.2%) patients. Intraoperative complications occurred in 7 (2.9%) patients during phacoemulsification cataract surgery. Five (71%) of these patients had post-operative complications at their first day review.
Routine review on the first post-operative day following uncomplicated phacoemulsification cataract surgery could safely be withdrawn. A single post-operative review at 1-2 weeks after surgery would then be required, supplemented by patient-initiated post-operative review in the interim.
Cataract surgery is increasing in Australia and represents a significant burden on limited health resources. This study examines the frequency and outcomes of cataract surgery for patients who were hospitalized overnight compared with those treated as day surgery cases.
Medical records of 671 consecutive admissions for cataract surgery at the Royal Victorian Eye and Ear Hospital were reviewed. Data analysed included demographic features, insurance status, length of hospitalization, ophthalmic conditions, medical conditions, social problems and planned surgical technique. Ophthalmic and anaesthetic complications, active ophthalmic and medical interventions were also studied.
Of the 671 patient admissions for cataract during the study period, 226 (33.4%) were hospitalized overnight. Factors significantly associated with overnight hospitalization in univariate analyses include older age, female sex, country residence, Veterans' Affairs insurance, monocular vision status, pre-existing ischaemic heart disease, pre-existing asthma/chronic obstructive lung disease, absence of carer, transportation problems, planned extra-capsular cataract extraction technique, ophthalmic complications and active ophthalmic and/or medical interventions. After adjusting for possible confounding factors using backwards stepwise multivariate logistic regression models all except pre-existing ischaemic heart disease and ophthalmic complications were significantly associated with overnight admission for cataract surgery. In total, 14 cases (2.1%) needed active ophthalmic and/or medical interventions, 13 overnight cases and one day case.
These data suggest that many patients who are hospitalized overnight for cataract surgery could be safely treated as day cases. Such a shift in the pattern of care for cataract surgery could provide a significant potential for health care savings.
The aim of this study was to compare clinical and perceived health outcomes and cost between ambulatory and inpatient cataract surgery. An unmasked randomised clinical trial was undertaken. Cataract surgery patients of three public hospitals in Barcelona (Spain) who met inclusion criteria for ambulatory surgery were randomly assigned to two groups: outpatient hospital and inpatient hospital. Primary outcome measures were early and late postoperative surgical complications and visual acuity. Secondary outcome measures were perceived visual function, overall perceived health status, and costs. A total of 464 outpatients and 471 inpatients were analysed. No statistically significant differences were observed between the two groups in visual acuity (P =.48), nor for the other clinical and perceived health outcome measures, except for early postoperative complications. Outpatients presented at least one complication in the first 24 h after surgery more frequently than inpatients (64 vs. 43; RR 1.6, 95% CI 1.1, 2.4), but 4 months after surgery the differences in complications rates between groups disappeared. The cost of surgery was lower for outpatients than for inpatients (1001 vs. 1218 Euros; P <.001). Ambulatory cataract surgery was more cost-effective than inpatient surgery. Despite the higher risk of early complications in the outpatient hospital group, these differences may not be clinically relevant because the 4-month postoperative outcomes were not affected.
To determine whether postoperative evaluation of routine phacoemulsification can be safely and effectively performed on the day of surgery and 4 days postoperatively and evaluate the incidence and management of early intraocular pressure (IOP) elevations 3 to 7 hours postoperatively in patients with or without glaucoma.
Community-based hospital.
This retrospective series comprised 465 consecutive patients who had phacoemulsification and intraocular lens implantation. All patients had postoperative follow-up on the day of surgery (3 to 7 hours postoperatively) and at 4 days. Patients were classified into 2 groups: nonglaucoma (NG), 396 patients; and glaucoma (GL), 69 patients. The main outcome measures were the incidence and management of postoperative complications including IOP spikes, wound leaks, uveitis, and endophthalmitis.
Three to 7 hours postoperatively, 73 NG (18.4%) and 32 GL (46.4%) patients had IOP elevations greater than 28 mm Hg, a significant change from baseline (P <.0001). Fourteen NG (3.6%) and 13 GL (18.8%) patients had IOP elevations greater than 40 mm Hg (P <.0001). Significant IOP elevations were effectively managed with a paracentesis with or without short-term antiglaucoma medications on the day of surgery, with 75 NG (18.9%) and 39 GL (56.5%) patients requiring IOP intervention. There were no IOP elevations greater than 21 mm Hg on the next day or at 4 days. There were no complications that were missed at the same-day evaluation that may have been identified at the 1-day postoperative visit.
The results indicate that after routine phacoemulsification, patients can be safely and effectively reviewed on the day of surgery and 4 days postoperatively to identify and manage early postoperative IOP spikes. A significant number of patients, particularly those with preexisting glaucoma, had potentially harmful IOP spikes 3 to 7 hours postoperatively.
The purpose of this study was to perform a reference case, cost-utility analysis of initial cataract surgery using the current literature on cataract outcomes and complications.
Computer-based econometric modeling.
Visual acuity data of patients treated and observed over a 4-month postoperative period was obtained from the US National Cataract Patient Outcomes Research Team (PORT). The results from this prospective study were combined with other studies that investigated the complication rates of cataract surgery to complete the cohort of patients and outcomes. These synthesized data were incorporated with time-tradeoff utility values, decision analysis, and econometric modeling to account for the time value of money.
The number of quality-adjusted life-years (QALYs) gained was calculated for the study group undergoing cataract extraction in the first eye when the vision was the same in both eyes. This was divided into the cost of the procedure to find the year 2000 nominal US dollars spent per quality-adjusted life-year (2020/QALY gained for this procedure.
Initial cataract surgery seems to be highly cost-effective compared with procedures across multiple medical specialties. This information, incorporating patient preferences into evidenced-based medicine, will play an increasingly important role in the evaluation of health care in the future.
To compare the incidence and the spectrum of postoperative complications detected when the intraocular pressure (IOP) is reviewed 4 to 6 hours or the day after uneventful phacoemulsification cataract extraction and intraocular lens (IOL) implantation.
Royal Free Hospital, London, United Kingdom.
The study cohort consisted of 141 patients who had uneventful phacoemulsification and IOL implantation under regional (peribulbar/topical) or general anesthesia. Postoperative evaluation of the patients was performed by an ophthalmologist using a standard form at 4 to 6 hours or 24 hours.
The mean IOP at 4 to 6 hours and 24 hours was 22.85 mm Hg +/- 9.56 (SD) and 19.44 +/- 7.04 mm Hg, respectively. The IOP was more likely to be greater than 30 mm Hg when measured on the same day, resulting in a significantly higher intervention rate than on the first day (P =.037). The best corrected visual acuity was significantly better at 24 hours than at the same-day review (P <.001). There was no significant difference in the extent of anterior chamber activity, patient comfort, or state of the wound between the same- or next-day follow-up. All patients attended a follow-up appointment 3 weeks after surgery, had an IOP of 21 mm Hg or less, and were subsequently discharged.
The results indicate that moderate IOP spikes (<40 mm Hg) can be left untreated if they are not associated with corneal edema or patient discomfort as they decline spontaneously. Before they are discharged, patients with compromised optic discs or predisposed to retinal or optic nerve pathology should be carefully evaluated the day after surgery to treat IOP elevations.
To determine the pattern of intraocular pressure (IOP) change postoperatively and its bearing on the timing of postoperative review.
Ophthalmology department of a district general hospital, Northamptonshire, England.
One hundred eyes of 100 consecutive patients having uneventful phacoemulsification were included in this study. The IOP was measured preoperatively and 2 hours, 1 day, and 1 week postoperatively. The IOP readings were statistically analyzed using the Fisher exact probability test.
From 1 week before surgery, there was a mean rise in IOP of 8.14 mm Hg 2 hours after surgery followed by a mean fall of 5.18 mm Hg at 24 hours (next-day review). The mean fall in IOP at 1 week was 2.94 mm Hg. Ten percent of patients had an IOP greater than or equal to 35 mm Hg 2 hours postoperatively and required oral IOP-lowering agents. All patients had an IOP lower than 35 mm Hg at the next-day review. At 1 day, 18.6% of patients had a higher IOP than at 2 hours; however, the mean IOP was 21.39 mm Hg.
The results show it is safe to review patients 2 hours after uneventful phacoemulsification and omit the next-day review. This enhances patient acceptance of true day-case cataract surgery as it eliminates the need for an inpatient stay and transport on the following day. It also improves utilization of hospital resources. A larger study will help confirm the conclusions of this study.
To examine the safety implications of omitting first day clinical review following phacoemulsification cataract surgery.
362 patients were randomly assigned to "same day discharge" (SDD) or "next day review" (NDR). All patients were reviewed approximately 2 weeks after surgery.
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 chi(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).
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.
Raised intraocular pressure (IOP) still holds pride of place as the principal risk factor for developing glaucoma. The detrimental effects of chronically elevated IOP on the optic disc are well known. However, the clinical significance of acutely raised IOP is less certain. Transient acute elevations of intraocular pressure (IOP spikes) occur following many surgical and laser procedures. Cataract extraction, glaucoma surgery, pars plana vitrectomy with fluid air exchange, Nd-YAG capsulotomy, or peripheral iridotomy, and laser trabeculoplasty all have been reported to be associated with variable IOP spikes in the early postoperative period. There is considerable diversity of opinion concerning how these IOP spikes should best be managed. We have reviewed the nature and quality of the available experimental and clinical data relating to IOP spikes and we offer some broad, general guidelines for their clinical management.
To assess whether telephone review on the first day after uneventful phacoemulsification is as effective as postoperative review in a hospital or the patients' home by nursing staff.
Sunderland Eye Infirmary, Sunderland, United Kingdom.
This prospective study comprised 3 arms, each of which consisted of 100 patients who had uneventful phacoemulsification with intraocular lens implantation. Patients received the same postoperative medications and were given a questionnaire regarding their opinions on the method of postoperative review. The method of review was different for each arm as follows: (1) home review by a nurse, (2) return to the hospital for review by a nurse, and (3) telephone review by a nurse. Statistical analysis of relative frequencies was done; exact testing was applied throughout to test for differences in proportions and, where applicable, to construct 95% confidence intervals.
There were no significant differences between the 3 groups in the degree to which patients understood the instructions and questions. The telephone group was significantly less reassured than the home-visit group, but there was no significant difference in the degree of reassurance between the telephone and hospital-visit groups. Seventy percent of patients in the telephone group listed telephone review as their preferred method of postoperative review.
In cases of uneventful phacoemulsification, telephone review is safe, effective, and acceptable and is a reasonable alternative to other first-day review methods.
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Day care cataract sur-gery versus in-patient surgery for age-related cataract. Co-chrane Database Syst Rev 2005, issue 1:CD004242. Abstract available online at
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Cataract Surgery Guide-lines The Royal College of Ophthalmologists
- Royal College
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