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Lim JS, Tan SS, Yeo YL, Hong M, Teo AWJ, Lee YF, Ting DSW, Aung T, Husain R. Replacing the postoperative week 1 visit after routine phacoemulsification with a telephone consult. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00096-6. [PMID: 38604239 DOI: 10.1016/j.jcjo.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/17/2024] [Accepted: 03/19/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE To assess the safety of replacing the postoperative week 1 (POW1) clinic visit with a nurse-conducted telephone call. DESIGN Retrospective observational study that included cases from January 2019 to June 2021. PARTICIPANTS Patients who had undergone uncomplicated phacoemulsification surgery with an unremarkable postoperative day 1 (POD1) examination. METHODS All patients were seen in clinic on POD1 by an ophthalmologist. They then had a telephone conversation with a nurse at POW1 and subsequently an in-person postoperative month 1 (POM1) clinic consultation with an ophthalmologist. Main outcome measure was the incidence of unexpected management changes related to cataract surgery within POM1. Data also were collected on the reasons for unscheduled patient-initiated visits, additional procedures or medications, and postoperative visual acuity worse than 6/12 at POM1. RESULTS Of the 20,475 patients, 541 patients (2.64%) had an unexpected management change within POM1. There were 565 patients (2.76%) who had self-initiated unscheduled visits between POD1 to POM1. There were 23 patients (0.11%) who required additional surgery within POM1 and 1 patient (0.005%) with endophthalmitis. The most common indication for additional surgical procedures was retained lens material (7 patients, 30.43%). Visual acuity was worse than 6/12 in 1,199 patients (6.22%), with the most common causes attributed to preexisting ocular conditions. CONCLUSIONS These results suggest that replacing the POW1 visit with a nurse-conducted telephone consult for patients who have undergone uncomplicated phacoemulsification surgery and had a normal POD1 consultation is safe.
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Affiliation(s)
- Jane S Lim
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
| | | | - Yi Lin Yeo
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
| | | | | | - Yi Fang Lee
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
| | - Daniel S W Ting
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
| | - Tin Aung
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
| | - Rahat Husain
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore.
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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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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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[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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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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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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Tognetto D, Brézin AP, Cummings AB, Malyugin BE, Evren Kemer O, Prieto I, Rejdak R, Teus MA, Törnblom R, Toro MD, Vinciguerra AL, Giglio R, De Giacinto C. Rethinking Elective Cataract Surgery Diagnostics, Assessments, and Tools after the COVID-19 Pandemic Experience and Beyond: Insights from the EUROCOVCAT Group. Diagnostics (Basel) 2020; 10:E1035. [PMID: 33276612 PMCID: PMC7761628 DOI: 10.3390/diagnostics10121035] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/21/2020] [Accepted: 12/01/2020] [Indexed: 01/08/2023] Open
Abstract
The progressive deterioration of the visual function in patients on waiting lists for cataract surgery has a negative impact on their quality of life, especially in the elderly population. Patient waiting times for cataract surgeries in many healthcare settings have increased recently due to the prolonged stop or slowdown of elective cataract surgery as a result of coronavirus disease 19 (COVID-19). The aim of this review is to highlight the impact of such a "de-prioritization" of cataract surgery and to summarize some critical issues and useful hints on how to reorganize cataract pathways, with a special focus on perioperative diagnostic tools during the recovery phase and beyond. The experiences of a group of surgeons originating from nine different countries, named the European COVID-19 Cataract Group (EUROCOVCAT), have been combined with the literature and recommendations from scientific ophthalmic societies and healthcare institutions. Key considerations for elective cataract surgery should include the reduction of the number of unnecessary visits and examinations, adoption of precautionary measures, and implementation of telemedicine instruments. New strategies should be adopted to provide an adequate level of assistance and to guarantee safety conditions. Flexibility will be the watchword and regular updates would be necessary following scientific insights and the development of the pandemic.
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Affiliation(s)
- Daniele Tognetto
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34134 Trieste, Italy; (A.L.V.); (R.G.); (C.D.G.)
| | | | | | - Boris E. Malyugin
- S. Fyodorov Eye Microsurgery Federal State Institution, Russian Federation, 127486 Moscow, Russia;
| | - Ozlem Evren Kemer
- University of Health Sciences, Ankara City Hospital, 06800 Ankara, Turkey;
| | - Isabel Prieto
- Department of Ophthalmology, Fernando Fonseca Hospital, 2720-276 Amadora, Portugal;
| | - Robert Rejdak
- Department of General Ophthalmology, Medical University of Lublin, 20-079 Lublin, Poland;
| | - Miguel A. Teus
- Department of Ophthalmology, University of Alcalá, 28802 Madrid, Spain;
| | - Riikka Törnblom
- Department of Ophthalmology, TYKS Hospital, 20521 Turku, Finland;
| | - Mario D. Toro
- Department of General Ophthalmology, Medical University of Lublin, 20-079 Lublin, Poland;
- Faculty of Medical Sciences, Collegium Medicum, Cardinal Stefan Wyszyński University, 01-815 Warsaw, Poland
- Department of Ophthalmology, University Hospital of Zürich, University of Zürich, 8091 Zürich, Switzerland
| | - Alex L. Vinciguerra
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34134 Trieste, Italy; (A.L.V.); (R.G.); (C.D.G.)
| | - Rosa Giglio
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34134 Trieste, Italy; (A.L.V.); (R.G.); (C.D.G.)
| | - Chiara De Giacinto
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34134 Trieste, Italy; (A.L.V.); (R.G.); (C.D.G.)
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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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Karimi A, Lindfield D. Is a Day 1 postoperative review following ab interno Xen gel stent surgery for glaucoma needed? Clin Ophthalmol 2018; 12:2331-2335. [PMID: 30532518 PMCID: PMC6247944 DOI: 10.2147/opth.s181530] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose To assess whether a first day review is needed following Xen surgery in glaucoma patients. Patients and methods We performed a retrospective case note review of all Xen surgeries performed across four centers between August 2015 and May 2017. Intraocular pressure (IOP), number of medications, complications, and all further procedures were recorded. Results Two hundred and fifty-nine cases from 226 patients were analyzed, 78 of 259 cases (30.1%) had numerical hypotony (<6 mmHg) on Day 1, but 60 had resolved by Week 1. Zero cases of hypotony required intervention at Day 1. Two of 259 cases (0.8%) had transient IOP of ≥20 mmHg due to air bubble/iris blockage on Day 1 with one case (0.4%) requiring iris manipulation at the slit-lamp. One case (0.4%) required IOP lowering medications at Day 1. All other complications and interventions in our series occurred at 1 week or beyond. Day 1 IOP was not shown to be a reliable indicator for outcomes at Week 1 (r2=0.2155), Month 1 (r2=0.0574), or Month 12 (r2=0.1580). Conclusion The presence of significant complications requiring intervention at Day 1 was 0%. Only one case (0.4%) required topical IOP lowering medication and one case (0.4%) needed stent manipulation at Day 1. Day 1 IOP is not a reliable indicator of long-term outcomes in Xen surgeries. Removing Day 1 follow-up would have been safe in our series and it may be more effective to perform the first postoperative review of Xen surgery at Week 1.
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Affiliation(s)
- Ayesha Karimi
- Department of Ophthalmology, Royal Surrey County Hospital, Guildford, UK,
| | - Dan Lindfield
- Department of Ophthalmology, Royal Surrey County Hospital, Guildford, UK,
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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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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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Hoffman JJSL, Pelosini L. Telephone follow-up for cataract surgery: feasibility and patient satisfaction study. Int J Health Care Qual Assur 2016; 29:407-16. [PMID: 27142949 DOI: 10.1108/ijhcqa-08-2015-0096] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose - The purpose of this paper is to investigate the feasibility of telephone follow-up (TFU) after uncomplicated cataract surgery in low-risk patients and patient satisfaction with this alternative clinical pathway. Design/methodology/approach - Prospective, non-randomised cohort study. A ten-point subjective ophthalmic assessment questionnaire and a six-point patient satisfaction questionnaire were administered to patients following routine cataract surgery at two to three weeks post-procedure. All patients were offered a further clinic review if required. Exclusion criteria comprised ophthalmic co-morbidities, hearing/language impairment and high risk of post-operative complications. Patient notes were retrospectively reviewed over the study period to ensure no additional emergency attendances took place. Findings - Over three months, 50 eyes of 50 patients (mean age: 80; age range 60-91; 66 per cent second eye surgery) underwent uncomplicated phacoemulsification surgery received a TFU at 12-24 days (mean: 16 days) post-operatively. Subjective visual acuity was graded as good by 92 per cent of patients; 72 per cent patients reported no pain and 20 per cent reported mild occasional grittiness. Patient satisfaction was graded 8.9 out of 10; 81.6 per cent defined TFU as convenient and 75.5 per cent of patients preferred TFU to routine outpatient review. No additional visits were required. Research limitations/implications - Non-randomised with no control group; small sample size. One patient was unable to be contacted. Practical implications - Post-operative TFU can be suitably targeted to low-risk patients following uncomplicated cataract surgery. This study demonstrated a high patient satisfaction. A larger, randomised study is in progress to assess this further. Originality/value - This is the first study reporting TFU results and patient satisfaction to the usual alternative two-week outpatient review.
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Affiliation(s)
- Jeremy J S L Hoffman
- Department of Ophthalmology, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | - Lucia Pelosini
- Department of Ophthalmology, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
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Tsaousis KT, Panagiotou DZ, Kostopoulou E, Vlatsios V, Stampouli D. Corneal oedema after phacoemulsification in the early postoperative period: A qualitative comparative case-control study between diabetics and non-diabetics. Ann Med Surg (Lond) 2015; 5:67-71. [PMID: 26865977 PMCID: PMC4710706 DOI: 10.1016/j.amsu.2015.12.047] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 11/16/2015] [Accepted: 12/17/2015] [Indexed: 02/08/2023] Open
Abstract
Background The occurrence and severity of corneal oedema after phacoemulsification is dependent on the integrity of corneal endothelial cells. The function of these cells is affected by diabetes mellitus and consequently the behaviour of the cornea in diabetic patients is of special interest. Aim To compare the frequency of corneal oedema in two age-matched groups of diabetics and non diabetic patients that underwent cataract surgery in the Ophthalmology Department of Xanthi General Hospital in Greece. Methods A retrospective case control study was conducted in a retrospective fashion. Patients in the control and study groups were assessed regarding the severity of corneal oedema at three postoperative visits: days 1, 3–7, 10–14 after the operation. Ultrasound energy consumed during phacoemulsification was also a parameter of interest and possible correlations with the pre-existent cataract severity and the subsequent incidence of corneal oedema were investigated. Results The difference in the incidence of severe corneal oedema between the study and control group was statistically significant: (4.5% non diabetics vs 14.3% diabetics). The consumed ultrasound energy did not define final clinical outcome. Conclusions The existence of diabetes mellitus type 2 appears to be a significant risk factor for the development of persistent corneal oedema. The results of our study led to the modification of the algorithm for postoperative follow-up of patients of this remote area of Greece. Ultrasound energy is not the only defining factor for the development of corneal oedema. Persistent corneal oedema is more frequent in diabetic patients 2 weeks postoperatively. Modern Greek public health system requires modifications in clinical governance issues.
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Affiliation(s)
- Konstantinos T Tsaousis
- Department of Ophthalmology, General Hospital of Xanthi, Greece; 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Greece
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Immediate Sequential Bilateral Cataract Surgery: A Systematic Review and Meta-Analysis. J Ophthalmol 2015; 2015:912481. [PMID: 26351576 PMCID: PMC4553313 DOI: 10.1155/2015/912481] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 06/30/2015] [Accepted: 07/02/2015] [Indexed: 11/17/2022] Open
Abstract
The aim of the present systematic review was to examine the benefits and harms associated with immediate sequential bilateral cataract surgery (ISBCS) with specific emphasis on the rate of complications, postoperative anisometropia, and subjective visual function in order to formulate evidence-based national Danish guidelines for cataract surgery. A systematic literature review in PubMed, Embase, and Cochrane central databases identified three randomized controlled trials that compared outcome in patients randomized to ISBCS or bilateral cataract surgery on two different dates. Meta-analyses were performed using the Cochrane Review Manager software. The quality of the evidence was assessed using the GRADE method (Grading of Recommendation, Assessment, Development, and Evaluation). We did not find any difference in the risk of complications or visual outcome in patients randomized to ISBCS or surgery on two different dates. The quality of evidence was rated as low to very low. None of the studies reported the prevalence of postoperative anisometropia. In conclusion, we cannot provide evidence-based recommendations on the use of ISBCS due to the lack of high quality evidence. Therefore, the decision to perform ISBCS should be taken after careful discussion between the surgeon and the patient.
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Gupta A, Vernon SA. Is the 1-day postoperative IOP check needed post uncomplicated phacoemulsification in patients with glaucoma and ocular hypertension? Eye (Lond) 2015; 29:1299-307. [PMID: 25697456 DOI: 10.1038/eye.2014.331] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Accepted: 12/07/2014] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To determine whether the 1-day postoperative intraocular pressure (IOP) check following routine uncomplicated phacoemulsification is necessary in patients with pre-existing glaucoma and ocular hypertension (OHT), if acetazolamide prophylaxis is used. To investigate the practice of U.K. glaucoma specialists in IOP rise prophylaxis and follow-up regimes. PATIENTS AND METHODS The IOP 1-day postoperatively was analysed against the last recorded IOP before phacoemulsification in a cohort of patients with glaucoma or OHT who underwent uncomplicated phacoemulsification cataract surgery between December 2009 and September 2012, where it was routine practice to give acetazolamide postoperatively. U.K. and Eire Glaucoma Society members were surveyed via an online questionnaire to analyse practice among U.K. glaucoma specialists. RESULTS One hundred and seven eyes were studied: 99 with glaucoma and 8 with OHT. The mean IOP change was -0.8 mm Hg with only two eyes measuring >30 mm Hg postoperatively (2%). Both these eyes received 750 mg acetazolamide. Eighteen (17%) eyes had an IOP rise of at least 30%. In the survey of practice there were 65 respondents. Twenty-one (32%) respondents did not use IOP prophylaxis. Only 17 (26%) of respondents routinely reviewed their patients 1-day postoperatively. CONCLUSION Our prophylactic acetazolamide regime does not completely eliminate the risk of an IOP >30 mm Hg on day 1 post routine phacoemulsification in glaucoma/OHT patients. Patients with pre-existing glaucoma, despite acetazolamide prophylaxis, will require IOP management decisions on the first postoperative day after uncomplicated phacoemulsification surgery. U.K. expert practice is non-uniform with regard to IOP prophylaxis, and the 1-day review, and further discussion and formulation of consensus appears necessary.
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Affiliation(s)
- A Gupta
- Ophthalmology Department, Queen's Medical Centre, Nottingham, UK
| | - S A Vernon
- Ophthalmology Department, Queen's Medical Centre, Nottingham, UK
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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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Voyatzis G, Roberts HW, Keenan J, Rajan MS. Cambridgeshire cataract shared care model: community optometrist-delivered postoperative discharge scheme. Br J Ophthalmol 2014; 98:760-4. [DOI: 10.1136/bjophthalmol-2013-304636] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lundström M, Wendel E. Assessment of vision-related quality of life measures in ophthalmic conditions. Expert Rev Pharmacoecon Outcomes Res 2014; 6:691-724. [DOI: 10.1586/14737167.6.6.691] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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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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Yuen L, Do NH, Vu QL, Gupta S, Ambrosio E, Congdon N. Cataract surgical outcomes, visual function and quality of life in four rural districts in Vietnam. Clin Exp Ophthalmol 2011; 39:119-25. [DOI: 10.1111/j.1442-9071.2010.02427.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Van Vliet EJ, Bredenhoff E, Sermeus W, Kop LM, Sol JCA, Van Harten WH. Exploring the relation between process design and efficiency in high-volume cataract pathways from a lean thinking perspective. Int J Qual Health Care 2010; 23:83-93. [DOI: 10.1093/intqhc/mzq071] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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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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[Phacoemulsification: advantages of a consultation the day after surgery?]. J Fr Ophtalmol 2010; 33:169-73. [PMID: 20056296 DOI: 10.1016/j.jfo.2009.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Accepted: 10/21/2009] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Cataract surgery is the most frequent surgery in France. The D1 consultation limits the extension of ambulatory care to patients who can return on their own the day after sugery. We assessed the usefulness of this systematic D1 consultation in terms of therapeutic modifications. MATERIAL AND MéTHODE: Retrospective study of patients who underwent cataract surgery in a teaching hospital from february to july 2006. The major parameter was the modification of postsurgical treatment after the D1 consultation. RESULTS Of the 380 operated eyes studied, the patients included 145 men and 235 women, the mean age was 73.8 years (range, 43-92), 86% underwent conventional hospitalization, 70% had been operated by a senior surgeon, and 66% had no suture. At the D1 visit, 11 modifications (2.9%) were recorded: one case of athalamia, one Seidel-positive test, four cases of high IOP (>30mmHg), and five severe inflammations of the anterior segment. All the treatment changes were reported in the group of hospitalized patients, none were reported in the ambulatory patients. Of the 380 eyes studied, only one required sutures at D1, the other treatment changes were minor. CONCLUSIONS The low output of the D1 visit raises the problem of its relevance in terms of public health. In most of the English-speaking and Scandinavian countries, patients have only one postoperative visit at 1 month. Patients could receive written and oral recommendations and a hotline number to contact the surgical team, which could allow the D1 visit to be discontinued for standard patients with uncomplicated surgery.
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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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Lamoureux EL, Pesudovs K, Pallant JF, Rees G, Hassell JB, Caudle LE, Keeffe JE. An evaluation of the 10-item vision core measure 1 (VCM1) scale (the Core Module of the Vision-Related Quality of Life scale) using Rasch analysis. Ophthalmic Epidemiol 2008; 15:224-33. [PMID: 18780255 DOI: 10.1080/09286580802256559] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To assess and re-engineer the Vision Core Measure 1 (VCM1) questionnaire in low vision (LV) and cataract participants using Rasch analysis. METHODS 295 participants drawn from a low vision clinic and 181 from a cataract surgery waiting list completed the 10-item VCM1. Unidimensionality, item fit to the model, response category performance, differential item functioning (DIF) and targeting of items to patients were assessed. Category collapsing and item removal were considered to improve the questionnaire. RESULTS The initial fit of the VCM1 (combined populations) to the Rasch model showed lack of fit (chi2 = 83.3, df = 50, p = 0.002). There was evidence of DIF between the two populations which could not be resolved. Consequently, each population was assessed separately. Irrespective of the population, disordering of response category thresholds was evident. However, collapsing categories produced ordered thresholds and resulted in fit to the Rasch model for the LV (Total chi2 = 41.6, df = 30; p = 0.08) and cataract population (Total chi2 = 17.9, df = 20, p = 0.59). Overall, the VCM1 behaved as a unidimensional scale for each population and no item showed evidence of DIF. Item targeting to patients was however sub-optimal particularly for the cataract population. CONCLUSION The VCM1 questionnaire could be improved by shortening the response scale, although different response categories are required for cataract and LV populations. Calibration of items also differed across populations. While the VCM1 performs well within the Rasch model, in line with its initial purpose, it requires the addition of items to satisfactorily target low vision and cataract populations.
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Affiliation(s)
- Ecosse L Lamoureux
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia.
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Saeed A, Guerin M, Khan I, Keane P, Stack J, Hayes P, Tormey P, Mullhern M, Beatty S. Deferral of first review after uneventful phacoemulsification cataract surgery until 2 weeks. J Cataract Refract Surg 2007; 33:1591-6. [PMID: 17720075 DOI: 10.1016/j.jcrs.2007.05.022] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2007] [Accepted: 05/07/2007] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the safety of deferring the ophthalmic review after uneventful phacoemulsification cataract surgery until 2 weeks after the procedure. SETTING Waterford Regional Hospital, Waterford, Ireland. METHODS After uneventful cataract surgery, 233 patients were randomized to have ophthalmic review 2 hours after the procedure and 2 weeks postoperatively (Group 1) or to forego any ophthalmic review before the 2-week postoperative visit in the outpatient department (Group 2). RESULTS Of the 115 patients randomized to Group 1, 25 (21.7%) had intraocular pressure (IOP) spikes of 30 mm Hg or greater and 2 (1.7%) had a corneal abrasion in the immediate postoperative period. Group 1 and Group 2 were statistically similar in terms of problems encountered in the first 2 postoperative weeks and anterior segment findings and visual acuity at the 2-week postoperative visit. CONCLUSIONS The results of this randomized controlled study indicate that the first ophthalmic review after uneventful cataract surgery can be safely deferred until 2 weeks postoperatively in patients in whom a transient IOP spike would not be deemed clinically deleterious. Such a policy will enhance the efficiency of day-surgery units.
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Affiliation(s)
- Ayman Saeed
- Waterford Regional Hospital, Waterford, Ireland.
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Okhravi N, Morris A, Kok HS, Menezo V, Dowler JGF, Hykin PG, Lightman S. Intraoperative use of intravitreal triamcinolone in uveitic eyes having cataract surgery: pilot study. J Cataract Refract Surg 2007; 33:1278-83. [PMID: 17586387 DOI: 10.1016/j.jcrs.2007.03.030] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2007] [Accepted: 03/12/2007] [Indexed: 11/16/2022]
Abstract
PURPOSE To report the outcomes of cataract extraction with intraoperative intravitreal triamcinolone (IVTA) in eyes with a history of posterior uveitis. SETTING Moorfields Eye Hospital Uveitis Service, London, United Kingdom. METHODS Nineteen eyes of 17 patients with posterior uveitis thought to require systemic corticosteroid prophylaxis for cataract surgery were included. The use of systemic corticosteroids at the time of surgery would have been problematic in 7 of the patients, who had a history of systemic hypertension. Three of the 7 patients were also diabetic. All patients were not happy about using oral corticosteroids. RESULTS Median visual acuity 1 day after surgery was 20/40 (range 20/20 to counting fingers). At final follow-up (mean 25.2 months; range 7 to 41 months), 17 eyes (89.5%) eyes achieved visual acuity of 20/40 or better; 2 eyes failed to achieve a final visual acuity of 20/40 or better, 1 as a result of optic atrophy and the other as a result of macular edema. No patient lost acuity and no eye developed macular edema within 4 months of surgery. Intraocular pressure elevation occurred after surgery in 3 eyes; all were controlled by topical medication that was discontinued after 3 months. One patient developed severe intraocular inflammation after surgery that resolved with intensive topical corticosteroid therapy within 1 week. CONCLUSIONS Cataract extraction by phacoemulsification with concurrent IVTA appears a useful treatment option. Targeted delivery of corticosteroid is achieved without the risks of systemic corticosteroid prophylaxis. The incidence of postoperative macular edema was markedly reduced. Levels of visual acuity after cataract surgery, similar to those in eyes without uveitis, were achieved in eyes with posterior uveitis.
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Affiliation(s)
- Narciss Okhravi
- Medical Retina and Uveitis Service, Moorfields Eye Hospital, London, United Kingdom.
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Barry JS, Spiteri A, Habib NE. Acute post-operative infective endophthalmitis detected on first-day check. Eye (Lond) 2007; 21:1243-4. [PMID: 17618243 DOI: 10.1038/sj.eye.6702923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Abstract
BACKGROUND This study examines the current practice and trends for cataract and refractive surgery in New Zealand. METHODS A confidential postal questionnaire was sent to all consultant ophthalmologists practising in New Zealand in 2004. Most questions were identical to the 2000 New Zealand survey, and were also similar to the 2003 survey of the American Society of Cataract and Refraction Surgeons (ASCRS). RESULTS From 97 surveys there was a 92% response rate. Of those surveyed, 70 were performing cataract surgery, 17 were performing refractive surgery, subtenons anaesthetic was used for cataract surgery in 60%, clear corneal or anterior limbal incision in 86%, one-piece foldable intraocular lens in 65%. For refractive surgery, use of refractive lens surgery was recommended for high refractive errors. Advice to a 45-year-old +3.00 hypermetrope wanting refractive surgery was to have laser in situ keratomileusis (88%), laser epithelial keratomileusis (6%) or clear lens extraction (6%). Ninety-four per cent of refractive surgeons in New Zealand used a wavefront analyser. Clear lens extraction was practised by 23 ophthalmologists, phakic intraocular lenses by 16 ophthalmologists. DISCUSSION New Zealand cataract and refractive surgery practice remains comparable to that of the members of the ASCRS. As in previous comparisons, there is a relatively low use of topical anaesthetic (New Zealand 19%vs. USA 61%vs. UK [pilot study] 33.3%). This survey showed a high uptake of wavefront analysis in refractive surgery (New Zealand 94%vs. USA 45%).
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Affiliation(s)
- Mark Elder
- Department of Ophthalmology, Christchurch Hospital, Christchurch, New Zealand.
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Zamvar U, Dhillon B. Postoperative IOP prophylaxis practice following uncomplicated cataract surgery: a UK-wide consultant survey. BMC Ophthalmol 2005; 5:24. [PMID: 16212667 PMCID: PMC1260022 DOI: 10.1186/1471-2415-5-24] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2004] [Accepted: 10/07/2005] [Indexed: 11/26/2022] Open
Abstract
Background In order to minimise postoperative intraocular pressure (IOP) rise, after routine uncomplicated cataract surgery, prophylaxis may be adopted. Currently, there are no specific guidelines in this regard resulting in wide variation in practice across the UK. We sought to document these variations through a questionnaire survey. Methods A questionnaire was sent to all consultant ophthalmic surgeons in the UK. Results 62.6% of surgeons did not use any IOP lowering agents. 37.4% surgeons routinely prescribed some form of medication. The majority (86.8%) used oral diamox. 20.6% of surgeons said they based their practice on evidence, 43.3% on personal experience, and 17.6% on unit policy. Surprisingly, among the two groups of surgeons (those who gave routine prophylaxis, and those who did not) the percentages of surgeons quoting personal experience, unit policy, or presence of evidence was strikingly similar. The timing of the first postoperative IOP check varied from the same day to beyond 2 weeks. Only 20.2% of surgeons had ever seen an adverse event related to IOP rise; this complication is thus very rare. Conclusion This survey highlights a wide variation in the practice and postoperative management of phacoemulsification cataract surgery. What is very striking is that there is a similar proportion of surgeons in the diametrically opposite groups (those who give or do not give routine IOP lowering prophylaxis) who believe that there practice is evidence based. The merits of this study suggests that consideration must be given to drafting a uniform guideline in this area of practice.
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Affiliation(s)
- Usha Zamvar
- Department of Ophthalmology, Stirling Royal Infirmary, Livilands, Stirling, UK
| | - Baljean Dhillon
- Princess Alexandra Eye Pavilion, Chalmers Street, Edinburgh, UK
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Kumar A, Hugkulstone CE. Uncomplicated phacoemulsification and first-day review: the patient's perspective. Eur J Ophthalmol 2005; 15:221-3. [PMID: 15812763 DOI: 10.1177/112067210501500207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate patients'opinions regarding first-day review following uncomplicated phacoemulsification. METHODS A prospective questionnaire-based survey was conducted on consecutive patients at the time of listing for day-case phacoemulsification. Data collected included demographic details, proposed anaesthetic technique, first or second eye surgery and postcode. Statistical analysis was undertaken with the unpaired t-test, the chi2-test with Yates' correction for small numbers or Fisher's exact test, and Kendal's rank correlation, as appropriate. RESULTS 100 patients (59% female; mean age 74.2 (12.6) years) were recruited. 87% preferred to return to hospital for their first-day review. This result was not significantly affected by sex, proposed anaesthetic technique, first eye surgery or postcode area. Only patients < 65 years old preferred not to return (p<0.02). CONCLUSIONS In this population, patients preferred to return for first-day review following uncomplicated phacoemulsification. There may be some variance in the opinions of surgeons and patients regarding this issue, and the patient's preferences should be taken into account to provide optimum quality of care.
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Affiliation(s)
- A Kumar
- Department of Ophthalmology, Queen Mary's Hospital, Sidcup, Kent DA14 6LT, United Kingdom
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Mandal K, Dodds SG, Hildreth A, Fraser SG, Steel DHW. Comparative study of first-day postoperative cataract review methods. J Cataract Refract Surg 2004; 30:1966-71. [PMID: 15342063 DOI: 10.1016/j.jcrs.2004.01.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2004] [Indexed: 10/26/2022]
Abstract
PURPOSE To assess whether telephone review on the first day after uneventful phacoemulsification is as effective as postoperative review in a hospital or the patients' home by nursing staff. SETTING Sunderland Eye Infirmary, Sunderland, United Kingdom. METHOD This prospective study comprised 3 arms, each of which consisted of 100 patients who had uneventful phacoemulsification with intraocular lens implantation. Patients received the same postoperative medications and were given a questionnaire regarding their opinions on the method of postoperative review. The method of review was different for each arm as follows: (1) home review by a nurse, (2) return to the hospital for review by a nurse, and (3) telephone review by a nurse. Statistical analysis of relative frequencies was done; exact testing was applied throughout to test for differences in proportions and, where applicable, to construct 95% confidence intervals. RESULTS There were no significant differences between the 3 groups in the degree to which patients understood the instructions and questions. The telephone group was significantly less reassured than the home-visit group, but there was no significant difference in the degree of reassurance between the telephone and hospital-visit groups. Seventy percent of patients in the telephone group listed telephone review as their preferred method of postoperative review. CONCLUSION In cases of uneventful phacoemulsification, telephone review is safe, effective, and acceptable and is a reasonable alternative to other first-day review methods.
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Affiliation(s)
- Kaveri Mandal
- Sunderland Eye Infirmary, Sunderland SR2 9HP, England, UK
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