Incidence of Management Changes at the Postoperative Week One Visit after Cataract Surgery: Results from the PCIOL Study.

PURPOSE: To ascertain the incidence of unexpected management changes at the postoperative week one visit in asymptomatic patients who have had an uncomplicated cataract surgery and a routine postoperative day one examination.

DESIGN: Retrospective observational study METHODS: 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 one and week one (postoperative days 5-14) visits were reviewed. Cases with intraoperative complications, as well as clinical findings at postoperative day one requiring close follow up, were excluded. The main outcome measure was incidence of unexpected management changes at the postoperative week one 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 one exam. Of these 1510 cases, 238 (15.8%) reported symptoms at the postoperative week one visit, including flashes, floaters, redness, pain, or decreased vision, which warranted an exam. In total, 1272 cases were asymptomatic, and only 11 of these cases (0.9%) had an unexpected management change at postoperative week one. Eight of the 11 patients were asymptomatic steroid responders requiring alteration of their postoperative drops. Two of these patients had an intraocular pressure over 30 mm Hg.

CONCLUSIONS: Unexpected management changes at the postoperative week one timepoint after cataract surgery are very rare in asymptomatic patients who have had uncomplicated cataract surgery and a routine postoperative day one examination. Limited data are available to outline an optimal postoperative regimen after cataract surgery. The results of this study suggest that postoperative week one examinations could potentially be done on an as needed basis in the appropriate subgroup of patients after cataract surgery.