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Graefe's Archive for Clinical and Experimental Ophthalmology
Published in: Graefe's Archive for Clinical and Experimental Ophthalmology 5/2019

Open Access 01-05-2019 | Review Article

Do we need day-1 postoperative follow-up after cataract surgery?

Authors: Andrzej Grzybowski, Piotr Kanclerz

Published in: Graefe's Archive for Clinical and Experimental Ophthalmology | Issue 5/2019

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Abstract

Purpose

The aim of our study was to evaluate the current nature and frequency of complications present on the first postoperative day (POD1) and to verify whether the completion of a follow-up visit at this time is justified after standard phacoemulsification cataract surgery (PCS).

Methods

We used the PubMed literature database to identify relevant studies using the following keywords: postoperative, follow-up visit, complications, outcome, intraocular pressure, IOP, intraocular pressure spikes, IOP spikes, wound leakage, wound dehiscence, intraocular lens, IOL, dislocation, exchange, phacoemulsification, cataract surgery, and cataract extraction.

Results

We collected and analyzed 45 articles published between 1994 and 2017. The most common complications after PCS include corneal edema, postoperative uveitis, intraocular pressure (IOP) elevation, cystoid macular edema, and posterior capsule opacification. The IOP typically peaks at 3 to 7 h after surgery; however, none of the assessed treatment regimens were sufficient to protect glaucomatous eyes from IOP spikes. The majority of postoperative complications do not require early surgical intervention. Alternatives to POD1 follow-up after PCS include a nurse-administered telephone questionnaire, shared care with non-ophthalmologists, and seeing the patients at a low threshold in cases of complaints.

Conclusions

The current literature does not support the concept of a POD1 follow-up after uneventful PCS in patients without posterior synechiae or chronic/recurrent uveitis and operated on by experienced surgeons. When eliminating the POD1, visit individuals should receive topically a potent steroid (preferably prednisolone or dexamethasone). Applying a combination of topical dorzolamide/timolol and brinzolamide postoperatively in patients with glaucoma would be recommended, particularly in eyes with preexisting optic nerve damage. Eliminating the routine POD1 follow-up could result in significant health care savings without an increased risk to the patient.

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Metadata
Title
Do we need day-1 postoperative follow-up after cataract surgery?
Authors
Andrzej Grzybowski
Piotr Kanclerz
Publication date
01-05-2019
Publisher
Springer Berlin Heidelberg
Published in
Graefe's Archive for Clinical and Experimental Ophthalmology / Issue 5/2019
Print ISSN: 0721-832X
Electronic ISSN: 1435-702X
DOI
https://doi.org/10.1007/s00417-018-04210-0

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