Revisiting early postoperative follow-up after phacoemulsification.
OBJECTIVE
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.


METHODS
Community-based hospital.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Ahmed
Iqbal Ike K
II
Department of Ophthalmology, University of Toronto, Toronto, Ontario, Canada.
Kranemann
Christoph
C
Chipman
Mary
M
Malam
Faiz
F
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D007429:Intraocular Pressure; D019654:Lens Implantation, Intraocular; D009798:Ocular Hypertension / Q000175:diagnosis / Q000188:drug therapy; D018918:Phacoemulsification; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis / Q000188:drug therapy; D012189:Retrospective Studies; D013256:Steroids; D013997:Time Factors; D014606:Uveitis, Anterior / Q000175:diagnosis / Q000188:drug therapy; D014792:Visual Acuity; D014945:Wound Healing
D000893:Anti-Inflammatory Agents; D000959:Antihypertensive Agents; D013256:Steroids