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Bahadur G, Macdonald L, Lin S, Boxrud C, Crew R. Advantages of eliminating the cataract surgery post-operative day 1 appointment in a rural practice. CANADIAN JOURNAL OF RURAL MEDICINE 2024; 29:173-176. [PMID: 39520066 DOI: 10.4103/cjrm.cjrm_14_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 06/19/2024] [Indexed: 11/16/2024]
Abstract
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 1st post-operative day visit. We also sought to show the positive environmental impact of eliminating that 1st 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. MTHODES 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. RSULTATS 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.
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Affiliation(s)
- Gavin Bahadur
- Stein Eye Center Santa Monica, Stein Eye Institute, University of California, Los Angeles, California
| | | | - Shawn Lin
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, California
| | - Cynthia Boxrud
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, California
| | - Ralph Crew
- Crew and Boss Eye Associates, Los Angeles, California
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Parajuli S, Dhakhwa P, Adhikary R. Deferring Postoperative Follow‑Up Visits up to 4 Weeks After Uneventful Cataract Surgery in a Tertiary Level Eye Hospital: Protocol for a Prospective, Quantitative, Experimental Control Study. JMIR Res Protoc 2023; 12:e48616. [PMID: 37651180 PMCID: PMC10502588 DOI: 10.2196/48616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 09/01/2023] Open
Abstract
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.
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Rush SW, Huseman S, Rush RB. Timing of the Initial Postoperative Care After Cataract Surgery: A Patient's Perspective. Clin Ophthalmol 2023; 17:1475-1479. [PMID: 37256196 PMCID: PMC10226547 DOI: 10.2147/opth.s413602] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/22/2023] [Indexed: 06/01/2023] Open
Abstract
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.
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Affiliation(s)
- Sloan W Rush
- Panhandle Eye Group, Amarillo, TX, USA
- Department of Surgery, Texas Tech University Health Science Center, Amarillo, TX, USA
| | - Samuel Huseman
- Panhandle Eye Group, Amarillo, TX, USA
- Department of Surgery, Texas Tech University Health Science Center, Amarillo, TX, USA
| | - Ryan B Rush
- Department of Surgery, Texas Tech University Health Science Center, Amarillo, TX, USA
- Southwest Retina Specialists, Amarillo, TX, USA
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Gärdin J, Johansson B. Incidence of unplanned visits after cataract surgery in two large cohorts with different anti-inflammatory treatment protocols. Acta Ophthalmol 2023; 101:310-318. [PMID: 36200168 DOI: 10.1111/aos.15265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 09/08/2022] [Accepted: 09/24/2022] [Indexed: 11/29/2022]
Abstract
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.
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Grants
- 2020 Anders & Solveig Bergman Foundation, Linköping, Research
- 2019 Karin Sandqvist Foundation, Stockholm, Travel
- RÖ-937430 County council of Östergötland, Linköping, Research
- SC-2018-00231-41 County council of Östergötland, Linköping, Research
- SC-2017-00202-37 County council of Östergötland, Linköping, Research
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Affiliation(s)
- Jan Gärdin
- Department of Ophthalmology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Björn Johansson
- Department of Ophthalmology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Evaluation of the Corneal Endothelium Following Cataract Surgery in Diabetic and Non-Diabetic Patients. Diagnostics (Basel) 2023; 13:diagnostics13061115. [PMID: 36980422 PMCID: PMC10047116 DOI: 10.3390/diagnostics13061115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/09/2023] [Accepted: 03/14/2023] [Indexed: 03/17/2023] Open
Abstract
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.
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[Position Paper and Recommendations for Action for Ecologically Sustainable Ophthalmology - Statement of the German Society of Ophthalmology (DOG) and the German Professional Association of Ophthalmologists (BVA)]. Klin Monbl Augenheilkd 2023; 240:198-217. [PMID: 36812927 DOI: 10.1055/a-2015-1562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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[Position paper and recommendations for action for ecologically sustainable ophthalmology : Statement of the German Society of Ophthalmology (DOG) and the German Professional Association of Ophthalmologists (BVA)]. DIE OPHTHALMOLOGIE 2023; 120:52-68. [PMID: 36625883 PMCID: PMC9838365 DOI: 10.1007/s00347-022-01792-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 06/17/2023]
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Patel V, Freedman RL, Das S, Mansoor S, Parekh H, Ridha F. Post-operative Day Zero Versus Day One Follow-Up for Uncomplicated Cataract Surgery. Cureus 2022; 14:e29286. [PMID: 36277527 PMCID: PMC9578331 DOI: 10.7759/cureus.29286] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2022] [Indexed: 12/03/2022] Open
Abstract
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.
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Birtel J, Heimann H, Hoerauf H, Helbig H, Schulz C, Holz FG, Geerling G. [Sustainability in ophthalmology : Adaptation to the climate crisis and mitigation]. Ophthalmologe 2022; 119:567-576. [PMID: 35451609 PMCID: PMC9024069 DOI: 10.1007/s00347-022-01608-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 11/26/2022]
Abstract
Die Klimakrise bedroht die Gesundheit heutiger und künftiger Generationen und stellt das Gesundheitssystem vor besondere Herausforderungen. Zur Anpassung an den anthropogene Klimawandel sind umfängliche Adaptationsstrategien und eine Mitigation des Klimawandels notwendig. In der Medizin sowie in der Augenheilkunde gibt es vielfältige Möglichkeiten zur Reduktion des CO2(Kohlendioxid)-Fußabdrucks, die es zu ergreifen gilt, die ordnungspolitisch gefördert und eingefordert werden sollten. Das aufkommende Feld der datengesteuerten Nachhaltigkeit kann Werkzeuge liefern, um den ökologischen Fußabdruck der eigenen Tätigkeit zu evaluieren sowie Optimierungen zu initiieren. Lebenszyklusanalysen können Instrumente für systematische Ökobilanzen sein und nachhaltige Produkt- und Praxisentscheidungen ermöglichen. Das deutsche Gesundheitssystem sollte eine quantifizierbare und holistische Strategie zur CO2-Reduktion entwickeln; Nachhaltigkeit könnte zukünftig ein Leistungsindikator sein. Dieser Artikel diskutiert mit augenärztlicher Perspektive Beispiele zur Adaptation an die Klimakrise und zur Mitigation; dies schließt kleine Maßnahmen, die jeder Einzelne umsetzen kann, als auch größere, strukturelle Ansätze ein.
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Affiliation(s)
- Johannes Birtel
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, Großbritannien.
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Großbritannien.
- Klinik für Augenheilkunde, Universitätsklinikum Bonn, Bonn, Deutschland.
| | - Heinrich Heimann
- St. Paul's Eye Unit, Royal Liverpool University Hospitals Foundation Trust, Liverpool, Großbritannien
| | - Hans Hoerauf
- Augenklinik der Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Horst Helbig
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Christian Schulz
- Deutsche Allianz Klimawandel und Gesundheit, Berlin, Deutschland
- Klinik für Anästhesiologie und Intensivmedizin, Technische Universität München, München, Deutschland
| | - Frank G Holz
- Klinik für Augenheilkunde, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Gerd Geerling
- Klinik für Augenheilkunde, Heinrich-Heine-Universität, Düsseldorf, Deutschland
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Can a Set of Questions after Routine Cataract Surgery Predict Unexpected Findings and Avoid an Unnecessary Follow-Up Visit? Medicina (B Aires) 2021; 57:medicina57111144. [PMID: 34833362 PMCID: PMC8620108 DOI: 10.3390/medicina57111144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/12/2021] [Accepted: 10/19/2021] [Indexed: 11/17/2022] Open
Abstract
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.
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Kamal Z, Jamil AZ, Khokhar HS, Huma F. Comparison of safety and number of post-operative visits of patients in convenient day versus conventional first day follow-up after phacoemulsification. Pak J Med Sci 2021; 37:1440-1444. [PMID: 34475927 PMCID: PMC8377886 DOI: 10.12669/pjms.37.5.4121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/26/2021] [Accepted: 05/05/2021] [Indexed: 11/15/2022] Open
Abstract
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.
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Affiliation(s)
- Zahid Kamal
- Zahid Kamal, MBBS, FRCS(Ed), FCPS, FRVEEH, MCPS (HPE). Professor of Ophthalmology, Sahiwal Medical College, Sahiwal, Pakistan
| | - Ahmad Zeeshan Jamil
- Ahmad Zeeshan Jamil, MBBS, MCPS, FCPS, FRCS, FCPS (VRO). Associate Professor of Ophthalmology, Sahiwal Medical College, Sahiwal, Pakistan
| | - Hira Shuja Khokhar
- Hira Shuja Khokhar, MBBS. Post Graduate Trainee, Department of Ophthalmology, Unit 1, Mayo Hospital Lahore, Pakistan
| | - Farah Huma
- Farah Huma, MBBS. Post Graduate Trainee, Department of Ophthalmology, Unit 1, Mayo Hospital Lahore, Pakistan
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Deshpande R, Vora U, Mangiraj V, Dole K, Deshpande M. Can the postoperative follow-up visit be deferred up to four weeks after an uneventful cataract surgery? - A randomized controlled trial. Indian J Ophthalmol 2021; 69:1409-1413. [PMID: 34011710 PMCID: PMC8302296 DOI: 10.4103/ijo.ijo_2390_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Rahul Deshpande
- Department of Oculoplasty and Ocular Oncology, PBMA's H.V. Desai Eye Hospital, Pune, Maharashtra, India
| | - Ushma Vora
- Department of General Ophthalmology, PBMA's H.V. Desai Eye Hospital, Pune, Maharashtra, India
| | - Varsha Mangiraj
- Department of General Ophthalmology, PBMA's H.V. Desai Eye Hospital, Pune, Maharashtra, India
| | - Kuldeep Dole
- Department of Community Ophthalmology, PBMA's H.V. Desai Eye Hospital, Pune, Maharashtra, India
| | - Madan Deshpande
- Department of General Ophthalmology, PBMA's H.V. Desai Eye Hospital, Pune, Maharashtra, India
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Abstract
Suspension of elective surgical care during COVID-19 will result in a large backlog of cataract surgeries in Medicare beneficiaries. It is necessary to start planning proactively to reduce 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 postsuspension 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-year postsuspension, 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. These data may aid physicians, payers, and policymakers in planning for postpandemic recovery.
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Westborg I, Mönestam E. Optimizing number of postoperative visits after cataract surgery: Safety perspective. J Cataract Refract Surg 2019; 43:1184-1189. [PMID: 28991615 DOI: 10.1016/j.jcrs.2017.06.042] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 06/27/2017] [Accepted: 06/30/2017] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- Inger Westborg
- From the Department of Clinical Sciences/Ophthalmology, Faculty of Medicine, Umeå University, Umeå, Sweden.
| | - Eva Mönestam
- From the Department of Clinical Sciences/Ophthalmology, Faculty of Medicine, Umeå University, Umeå, Sweden
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Moustafa GA, Borkar DS, Borboli-Gerogiannis S, Greenstein SH, Lorch AC, Vasan RA, Kloek CE. Optimization of cataract surgery follow-up: A standard set of questions can predict unexpected management changes at postoperative week one. PLoS One 2019; 14:e0221243. [PMID: 31536500 PMCID: PMC6752806 DOI: 10.1371/journal.pone.0221243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 08/02/2019] [Indexed: 11/25/2022] Open
Abstract
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.
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Affiliation(s)
- Giannis A. Moustafa
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Durga S. Borkar
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States of America
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania, United States of America
| | - Sheila Borboli-Gerogiannis
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Scott H. Greenstein
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Alice C. Lorch
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ryan A. Vasan
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Carolyn E. Kloek
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States of America
- Dean McGee Eye Institute, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, United States of America
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Incidence of Management Changes at the Postoperative Week 1 Visit after Cataract Surgery: Results from the Perioperative Care for IntraOcular Lens Study. Am J Ophthalmol 2019; 199:94-100. [PMID: 30339795 DOI: 10.1016/j.ajo.2018.10.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 10/07/2018] [Accepted: 10/09/2018] [Indexed: 01/06/2023]
Abstract
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.
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Refractive Errors & Refractive Surgery Preferred Practice Pattern®. Ophthalmology 2018; 125:P1-P104. [DOI: 10.1016/j.ophtha.2017.10.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 10/02/2017] [Indexed: 11/19/2022] Open
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Eloranta H, Falck A. Is an ophthalmic check-up needed after uneventful cataract surgery? A large retrospective comparative cohort study of Finnish patients. Acta Ophthalmol 2017; 95:665-670. [PMID: 28133952 DOI: 10.1111/aos.13373] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 11/24/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate retrospectively the potential benefit of a routine 1-month ophthalmic check-up after cataract surgery, and the potential harm after terminating this practice and only organizing a check-up for those patients anticipated to need such. METHODS In 2006, cataract patients of the Oulu University Hospital Eye Clinic were advised to have a check-up at an ophthalmologist 1 month after uneventful surgery, while in 2009, no check-up was regarded necessary. The consecutive first 1000 cataract surgery visits in both 2006 and 2009 are included in this study. Data on intra- and postoperative complications, ocular comorbidity, planned and unplanned postoperative out-patient visits, nights in the hospital and phone calls were gathered until 2014. In both time periods, a hospital check-up was provided for patients experiencing complications or symptoms. RESULTS There were 31 complications identified during or immediately after cataract surgery in 2006, and 23 in 2009. Fifty-eight (2006) and 27 patients (2009) were assigned an out-patient visit to the hospital. Additional 42 (2006) and 39 patients (2009) contacted the hospital because of symptoms, five (2006) and three (2009) with a referral. Medical or surgical intervention was needed by a third. Long-term complications other than secondary cataract were rare in both groups. Problems attributable to the lack of a 1-month check-up were not found in the later patient group during 5 years of follow-up. CONCLUSION According to this study, ophthalmic check-up arranged at 1 month after uneventful cataract surgery is unnecessary. However, the 5-10% of patients with intraoperative problems or ocular comorbidities that could interfere with recovery, or postoperative symptoms, should be seen at low threshold.
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Affiliation(s)
- Hannakaisa Eloranta
- Department of Ophthalmology; PEDEGO Research Unit and Medical Research Center; Oulu University and Oulu University Hospital; Oulu Finland
| | - Aura Falck
- Department of Ophthalmology; PEDEGO Research Unit and Medical Research Center; Oulu University and Oulu University Hospital; Oulu Finland
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Randomized Crossover Study Showing Nurse-Led Same Day Review Replacing Next Day Review in Uneventful Phacoemulsification to Be Safe and Efficacious. J Ophthalmol 2017; 2017:1261698. [PMID: 28465832 PMCID: PMC5390629 DOI: 10.1155/2017/1261698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 02/05/2017] [Indexed: 11/18/2022] Open
Abstract
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.
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Kessel L, Andresen J, Erngaard D, Flesner P, Tendal B, Hjortdal J. Safety of deferring review after uneventful cataract surgery until 2 weeks postoperatively. J Cataract Refract Surg 2017; 41:2755-64. [PMID: 26796457 DOI: 10.1016/j.jcrs.2015.11.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Accepted: 05/28/2015] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Line Kessel
- From the Department of Ophthalmology (Kessel), Copenhagen University Hospital Glostrup, Glostrup, the Danish Health and Medicines Authorities (Kessel, Tendal) and the Nordic Cochrane Center (Tendal), Rigshospitalet, Copenhagen, the Skanderborg Eye Clinic (Andresen), Skanderborg, the Department of Ophthalmology (Erngaard), Næstved Hospital, Næstved, the Odense Eye Clinic (Flesner), Odense, and the Department of Ophthalmology (Hjortdal), Aarhus University Hospital NBG, Aarhus, Denmark.
| | - Jens Andresen
- From the Department of Ophthalmology (Kessel), Copenhagen University Hospital Glostrup, Glostrup, the Danish Health and Medicines Authorities (Kessel, Tendal) and the Nordic Cochrane Center (Tendal), Rigshospitalet, Copenhagen, the Skanderborg Eye Clinic (Andresen), Skanderborg, the Department of Ophthalmology (Erngaard), Næstved Hospital, Næstved, the Odense Eye Clinic (Flesner), Odense, and the Department of Ophthalmology (Hjortdal), Aarhus University Hospital NBG, Aarhus, Denmark
| | - Ditte Erngaard
- From the Department of Ophthalmology (Kessel), Copenhagen University Hospital Glostrup, Glostrup, the Danish Health and Medicines Authorities (Kessel, Tendal) and the Nordic Cochrane Center (Tendal), Rigshospitalet, Copenhagen, the Skanderborg Eye Clinic (Andresen), Skanderborg, the Department of Ophthalmology (Erngaard), Næstved Hospital, Næstved, the Odense Eye Clinic (Flesner), Odense, and the Department of Ophthalmology (Hjortdal), Aarhus University Hospital NBG, Aarhus, Denmark
| | - Per Flesner
- From the Department of Ophthalmology (Kessel), Copenhagen University Hospital Glostrup, Glostrup, the Danish Health and Medicines Authorities (Kessel, Tendal) and the Nordic Cochrane Center (Tendal), Rigshospitalet, Copenhagen, the Skanderborg Eye Clinic (Andresen), Skanderborg, the Department of Ophthalmology (Erngaard), Næstved Hospital, Næstved, the Odense Eye Clinic (Flesner), Odense, and the Department of Ophthalmology (Hjortdal), Aarhus University Hospital NBG, Aarhus, Denmark
| | - Britta Tendal
- From the Department of Ophthalmology (Kessel), Copenhagen University Hospital Glostrup, Glostrup, the Danish Health and Medicines Authorities (Kessel, Tendal) and the Nordic Cochrane Center (Tendal), Rigshospitalet, Copenhagen, the Skanderborg Eye Clinic (Andresen), Skanderborg, the Department of Ophthalmology (Erngaard), Næstved Hospital, Næstved, the Odense Eye Clinic (Flesner), Odense, and the Department of Ophthalmology (Hjortdal), Aarhus University Hospital NBG, Aarhus, Denmark
| | - Jesper Hjortdal
- From the Department of Ophthalmology (Kessel), Copenhagen University Hospital Glostrup, Glostrup, the Danish Health and Medicines Authorities (Kessel, Tendal) and the Nordic Cochrane Center (Tendal), Rigshospitalet, Copenhagen, the Skanderborg Eye Clinic (Andresen), Skanderborg, the Department of Ophthalmology (Erngaard), Næstved Hospital, Næstved, the Odense Eye Clinic (Flesner), Odense, and the Department of Ophthalmology (Hjortdal), Aarhus University Hospital NBG, Aarhus, Denmark
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Kirwan C, Nolan JM, Stack J, Dooley I, Moore J, Moore TC, Beatty S. Introduction of a Toric Intraocular Lens to a Non-Refractive Cataract Practice: Challenges and Outcomes. INTERNATIONAL JOURNAL OF OPHTHALMOLOGY AND CLINICAL RESEARCH 2016; 3. [PMID: 27830188 DOI: 10.23937/2378-346x/1410056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
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.
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Affiliation(s)
- Clare Kirwan
- Biomedical Science Research Institute, University of Ulster, Coleraine, Northern Ireland; Institute of Eye Surgery, and Institute of Vision Research, Whitfield Clinic, Cork Road, Waterford, Ireland; Macular Pigment Research Group, Waterford Institute of Technology, Waterford, Ireland
| | - John M Nolan
- Macular Pigment Research Group, Waterford Institute of Technology, Waterford, Ireland
| | - Jim Stack
- Macular Pigment Research Group, Waterford Institute of Technology, Waterford, Ireland
| | - Ian Dooley
- University College Hospital Limerick, Ireland
| | - Johnny Moore
- Biomedical Science Research Institute, University of Ulster, Coleraine, Northern Ireland
| | - Tara Cb Moore
- Biomedical Science Research Institute, University of Ulster, Coleraine, Northern Ireland
| | - Stephen Beatty
- Institute of Eye Surgery, and Institute of Vision Research, Whitfield Clinic, Cork Road, Waterford, Ireland; Macular Pigment Research Group, Waterford Institute of Technology, Waterford, Ireland
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Determinants of patient satisfaction and function related to vision following cataract surgery in eyes with no visually consequential ocular co-morbidity. Graefes Arch Clin Exp Ophthalmol 2015; 253:1735-44. [PMID: 25968132 DOI: 10.1007/s00417-015-3038-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 04/23/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To investigate subjectively reported outcomes following cataract surgery and the relationships between such outcomes in the context of falling thresholds for cataract surgery. SETTING 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. RESULTS 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. CONCLUSION 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.
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Tan P, Foo FY, Teoh SC, Wong HT. Evaluation of the use of a nurse-administered telephone questionnaire for post-operative cataract surgery review. Int J Health Care Qual Assur 2014; 27:347-54. [PMID: 25076608 DOI: 10.1108/ijhcqa-11-2012-0120] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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Abstract
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.
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Affiliation(s)
- Emir Cabric
- Public Health Care Institution Doboj-Jug, Matuzici, Matuzici, Bosnia and Herzegovina
| | - Jasmin Zvornicanin
- Eye Clinic, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina
- Corresponding author: Jasmin Zvornicanin, MD. Eye Clinic University Clinical Center Tuzla. Trnovac b.b., 75000 Tuzla, Bosnia and Herzegovina. Phone: +387 61 134 874; Fax: +387 35 250 474. E-mail:
| | - Vahid Jusufovic
- Eye Clinic, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina
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Råen M, Sandvik GF, Drolsum L. Endophthalmitis following cataract surgery: the role of prophylactic postoperative chloramphenicol eye drops. Acta Ophthalmol 2013; 91:118-22. [PMID: 22151787 DOI: 10.1111/j.1755-3768.2011.02324.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
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.
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Affiliation(s)
- Marianne Råen
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.
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Chatziralli IP, Sergentanis TN, Kanonidou E, Papazisis L. First postoperative day review after uneventful phacoemulsification cataract surgery: is it necessary? BMC Res Notes 2012; 5:333. [PMID: 22738668 PMCID: PMC3403973 DOI: 10.1186/1756-0500-5-333] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Accepted: 06/27/2012] [Indexed: 11/10/2022] Open
Abstract
Background Our purpose was to examine the value of the first postoperative day review after uneventful phacoemulsification cataract surgery. Methods 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. Results 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. Conclusions First postoperative day review could be omitted in cases of uneventful cataract surgery.
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Charalampidou S, Cassidy L, Ng E, Loughman J, Nolan J, Stack J, Beatty S. Effect on refractive outcomes after cataract surgery of intraocular lens constant personalization using the Haigis formula. J Cataract Refract Surg 2010; 36:1081-9. [PMID: 20610083 DOI: 10.1016/j.jcrs.2009.12.050] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Revised: 12/22/2009] [Accepted: 12/23/2009] [Indexed: 11/30/2022]
Abstract
PURPOSE To quantify the effect on refractive outcomes after cataract surgery of personalization of Haigis intraocular lens (IOL) constants for a given surgeon-IOL combination. SETTING Institute of Eye Surgery and Institute of Vision Research, Whitfield Clinic, Butlerstown North, Waterford, Ireland. 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 > 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. 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. FINANCIAL DISCLAIMER: No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Sofia Charalampidou
- Institute of Eye Surgery and Institute of Vision Research, Whitfield Clinic, Waterford, Ireland.
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Charalampidou S, Dooley I, Molloy L, Beatty S. Value of dual biometry in the detection and investigation of error in the preoperative prediction of refractive status following cataract surgery. Clin Exp Ophthalmol 2010; 38:255-65. [PMID: 20447121 DOI: 10.1111/j.1442-9071.2010.02211.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE To report the value of dual biometry in the detection of biometry errors. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Sofia Charalampidou
- Department of Ophthalmology, Waterford Regional Hospital, Waterford, Ireland.
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Tilleul J, Tiberghien E, Renard G, Rohart C, Nghiem-Buffet S, Fajnkuchen F, Chaine G. [Value of first-day postoperative visit after cataract surgery]. J Fr Ophtalmol 2010; 33:111-6. [PMID: 20116884 DOI: 10.1016/j.jfo.2009.11.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Accepted: 10/13/2009] [Indexed: 11/26/2022]
Abstract
INTRODUCTION 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. PATIENTS AND METHODS 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. RESULTS 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. DISCUSSION 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. 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).
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Affiliation(s)
- J Tilleul
- Service d'Ophtalmologie, Hôpital Avicenne, Université Paris XIII, Bobigny, France.
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Dexter F, Birchansky L, Bernstein JM, Wachtel RE. Case Scheduling Preferences of One Surgeon's Cataract Surgery Patients. Anesth Analg 2009; 108:579-82. [DOI: 10.1213/ane.0b013e31818f1651] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Canadian Ophthalmological Society evidence-based clinical practice guidelines for cataract surgery in the adult eye. CANADIAN JOURNAL OF OPHTHALMOLOGY 2008. [DOI: 10.3129/i08-133] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Guide de pratique clinique factuelle de la Société canadienne d’ophtalmologie pour la chirurgie de la cataracte de l’œil adulte. CANADIAN JOURNAL OF OPHTHALMOLOGY 2008. [DOI: 10.1016/s0008-4182(08)80002-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Uncorrected visual acuity in the immediate postoperative period following uncomplicated cataract surgery: bimanual microincision cataract surgery versus standard coaxial phacoemulsification. Int Ophthalmol 2008; 29:393-400. [DOI: 10.1007/s10792-008-9255-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2008] [Accepted: 07/01/2008] [Indexed: 10/21/2022]
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Sharma V, Sharma S, Sharma SS, Paul S, Gupta B. Time of first review after phacoemulsification. J Cataract Refract Surg 2008; 34:343. [PMID: 18299045 DOI: 10.1016/j.jcrs.2007.10.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2007] [Accepted: 10/17/2007] [Indexed: 11/29/2022]
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Lindfield D, Horgan S. Time of first review after phacoemulsification. J Cataract Refract Surg 2008; 34:342; author reply 342-3. [PMID: 18299043 DOI: 10.1016/j.jcrs.2007.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2007] [Accepted: 10/03/2007] [Indexed: 11/27/2022]
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