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Published on: July 7, 2023
Complications of phacoemulsification on the first postoperative day: can follow-up be safely changed?
E N Herbert1, H Gibbons, J Bell
1Hinchingbrooke Hospital, Huntingdon, England.
Insights
Routine postoperative evaluations after cataract surgery detect few complications. Ophthalmic nurse practitioners can effectively manage these 1-day post-surgery assessments, reducing physician workload.
Area of Science:
- Ophthalmology
- Surgical Outcomes
- Patient Care
Background:
- Cataract surgery, specifically phacoemulsification with intraocular lens implantation, is a common procedure.
- Postoperative assessment is crucial for early detection of complications.
Purpose of the Study:
- To determine the incidence of complications on the first postoperative day after cataract surgery.
- To evaluate the necessity of a 1-day postoperative examination.
Main Methods:
- Retrospective review of 392 patients undergoing routine phacoemulsification.
- Ophthalmic nurse practitioners conducted 1-day postoperative examinations.
- Complications and referrals were logged and analyzed.
Main Results:
- A low rate of complications was observed: 1.53% with elevated intraocular pressure, 0.26% with iris prolapse, 2.81% with corneal abrasions, and 1.78% requiring intensified steroid treatment.
- No cases of fibrinous uveitis were recorded.
Conclusions:
- Potentially sight-threatening complications are infrequent but can occur on the first postoperative day.
- The 1-day postoperative review remains necessary for the current patient population.
- Trained non-medical practitioners can efficiently manage these assessments, reducing physician burden.
Purpose:
To establish the rate of complications detected on the first postoperative day and therefore the need for evaluation on that day.
Setting:
Hinchingbrooke Hospital, Huntingdon, England.
Methods:
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.
Results:
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.
Conclusions:
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.
