First day follow up for routine phacoemulsification?
Editor,—We would certainly concur with Whitefieldet al 1 that an important reason why patients decline day case surgery is the need for an examination the next day. We would also question this necessity following uncomplicated sutureless phacoemulsification with lens implant. However, we feel it may be unsafe practice if patients are not examined at all in the early postoperative period.
Firstly, intraocular pressure can be raised following cataract surgery,2 as indeed it was in three cases in this study. The maximum pressure rise tends to occur 5–7 hours postoperatively3 and so if patients were examined then many more may well be found to have raised pressure. For most patients this transient ocular hypertension is not associated with significant morbidity, but central retinal artery and venous occlusions and non-arteritic anterior ischaemic optic neuropathy4 have been reported following cataract surgery and this pressure spike may be a significant factor.
It may be better, therefore, to examine the patient on the same day as surgery before discharge. The use of a prophylactic ocular antihypertensive agent would also be recommended. An early examination would also allow a significant wound leak to be detected.5In the study by Tufail et al 5 it was concluded that no complications were missed by examining the patients on the same day as surgery that would have been detected the next day.
Iris prolapse and endophthalmitis are both very rare (0.3%)6 and so would not be expected to be detected by a study of this size (100 patients). Often these conditions do not present on the first postoperative day, with endophthalmitis typically presenting 48–72 hours postoperatively.7 A fibrinous uveitis, which may be a warning of impending endophthalmitis, again is often worse a few days after surgery rather than at day 1. It is possible some of these cases could be screened for with a visit 3 days after surgery. It is our practice, however, to ask the patient to return as an emergency if symptoms change, especially increasing pain, rather than seeing all patients at day 3.
Our policy is to examine on the same day as surgery, before discharge, and again at 2 weeks and if all is well the patient is discharged for refraction by their optician, as no further intervention is required. If one suture has been used this is removed at this 2 week visit.
