First day review after uncomplicated phacoemulsification: is it necessary?
OBJECTIVE
To determine whether first day follow-up is necessary after routine uncomplicated phacoemulsification cataract surgery.


METHODS
Data collected prospectively at day 1 postoperative review.


RESULTS
In 510 consecutive cases, serious complications occurred in 8 (1.6%) (wound leak [4], corneal abrasion [2], iris prolapse [1], hyphema [1]). Intraocular pressure (IOP) >30 mmHg was found in 26 (5.1%) and was strongly associated with a diagnosis of pre-existing glaucoma or ocular hypertension (odds ratio [OR] 7.7). Symptoms of headache or ocular discomfort occurred in 40 (7.8%), mostly in association with raised IOP, and were also associated with pre-existing glaucoma or ocular hypertension (OR 4.7). Central corneal edema was found in 61 (12.0%). In the absence of corneal edema, IOP was >30 mmHg in only two cases (0.39%).


CONCLUSIONS
Few sight-threatening complications were detected on the morning after an uncomplicated procedure. First day follow-up may be safely omitted if adequate patient counseling is undertaken and there is provision of adequate access to eye services. Review prior to discharge on the day of surgery would provide an opportunity to detect these few surgical complications and for counseling. A diagnosis of glaucoma or ocular hypertension is a risk factor for significantly raised next day IOP and these patients are more likely to experience postoperative discomfort. They may benefit from prophylactic treatment.
Alwitry
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Department of Ophthalmology, Eye/ENT Centre, Queens Medical Centre, Nottingham NG7 2UH, UK. AmarAlwitry@aol.com
Rotchford
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Gardner
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D000359:Aftercare / Q000458:organization & administration*; D000368:Aged; D000556:Ambulatory Surgical Procedures; D005260:Female; D005901:Glaucoma / Q000150:complications; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology*; D008297:Male; D009798:Ocular Hypertension / Q000150:complications; D018918:Phacoemulsification; D011182:Postoperative Care / Q000379:methods; D011446:Prospective Studies; D013997:Time Factors