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PubMed1999

Refractive astigmatism after oblique clear corneal phacoemulsification cataract incision.

PURPOSE: To determine the astigmatic effect of a supero-oblique clear corneal phacoemulsification cataract incision. SETTING: A university-based general ophthalmology practice. METHODS: All eyes having supero-oblique phacoemulsification cataract surgery using the right hand of a single surgeon between April 17, 1997, and July 24, 1997, were prospectively included. There were 52 eyes of 52 consecutive patients. Manifest refraction was performed preoperatively and 1, 3, and at least 6 months postoperatively. A Fourier method of vector analysis was used. RESULTS: Mean refractive error (Fourier corrected) for all eyes and all ages preoperatively was -1.422 + 0.085 x 35.85. At 6 months, it was -0.620 + 0.190 x 14.2. There was little difference between right and left eyes. Patients older than 80 years had greater induced astigmatism. CONCLUSION: This study provides evidence that making a supero-oblique clear corneal phacoemulsification incision while sitting in the more natural superior position does not induce a clinically important amount of oblique astigmatism.

Adult↗
PubMed1999

Long-term changes in intraocular pressure after clear corneal phacoemulsification: normal patients versus glaucoma suspect and glaucoma patients.

PURPOSE: To compare the effects of clear corneal phacoemulsification on intraocular pressure (IOP) in patients without glaucoma, glaucoma suspects, and patients with glaucoma. SETTING: Urban, multisubspecialty private practice. METHODS: A retrospective analysis of patients who had clear corneal phacoemulsification with a minimum of 12 months follow-up was performed. The patients were divided into 3 groups: no glaucoma (NG), glaucoma suspects (GS), and glaucoma (GG). None had a history of prior surgery. Glaucoma suspects included patients with elevated IOPs, abnormal discs, pseudoexfoliation syndrome, or pigment dispersion syndrome on no medications and with no field defects. Glaucoma patients had received only medical treatment. Two-tailed, homoscedastic t tests were used for statistical analysis. RESULTS: There were 143 patients (164 eyes) in the NG group, 65 (75) in the GS group, and 61 (71) in the GG group. The mean preoperative IOP was 16.42 mm Hg +/- 2.77 (SD), 17.59 +/- 4.15 mm Hg, and 16.97 +/- 4.86 mm Hg in the 3 groups, respectively. At 1 year, the mean IOP was lower in all groups: 14.37 +/- 2.97 mm Hg, 15.68 +/- 3.38 mm Hg, and 15.86 +/- 4.00 mm Hg, respectively. The change was statistically significant in the NG and GS groups. Glaucoma patients showed a statistically significant reduction in the number of glaucoma medications postoperatively. CONCLUSION: Clear corneal phacoemulsification was associated with a statistically significant long-term reduction in IOP.

Aged↗
PubMed1999

Phacoemulsification of white hypermature cataract.

PURPOSE: To evaluate the safety of phacoemulsification of white hypermature cataract, which is common in developing countries. SETTING: Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. METHODS: In a teaching hospital setting, a prospective evaluation of phacoemulsification in 25 eyes of 25 consecutive patients with hypermature cataract was done. Patients with good pupil dilation, optimal endothelial cell count, and disease-free ocular and systemic status were included. High magnification, sodium hyaluronate, and a Utrata capsulorhexis forceps were used to perform continuous curvilinear capsulorhexis (CCC). The stop and chop technique was used for nuclear emulsification. A 5.5 mm optic allpoly(methyl methacrylate) intraocular lens (IOL) was implanted, and wound closure was sutureless. RESULTS: Successful CCC was performed in 23 of 25 cases. In 2 cases, the CCC edge extended toward the periphery and a Vannas scissors was used to achieve an even cut. No complications were seen during nuclear emulsification and IOL implantation. Eighty percent of the patients had a visual acuity of 20/40 or better on the first postoperative day. Five patients had significant corneal edema that resolved within 1 week in all cases. CONCLUSION: Phacoemulsification was successfully and safely performed in appropriately selected patients with white hypermature cataract.

Aged↗
PubMed1999

Topical anesthesia for phacoemulsification, intraocular lens implantation, and posterior vitrectomy.

PURPOSE: To evaluate the efficacy of topical anesthesia as an alternative to peribulbar or retrobulbar anesthesia in phacoemulsification and intraocular lens (IOL) implantation combined with pars plana vitrectomy. SETTING: Clinica de Ojos de Maracaibo, Maracaibo, and the Retina and Vitreous Service, Clinica Oftalmologica Centro Caracas, Caracas, Venezuela. METHODS: In this prospective study, phacoemulsification, IOL implantation, and posterior vitrectomy using topical anesthesia (lidocaine 4% drops) were prospectively performed in 45 eyes (45 patients) with varied vitreoretinal pathology including macular holes, epiretinal membranes, subfoveal neovascular membranes, proliferative diabetic retinopathy, and vitreous hemorrhage. Preoperative and intraoperative sedation of varying degrees was necessary. Subjective pain and discomfort were graded from 1 (no pain or discomfort) to 4 (severe pain and discomfort). RESULTS: All patients had grade 1 pain and discomfort during most of the procedure. All patients had grade 2 (mild) pain and discomfort during pars plana sclerotomies, external bipolar cautery, and conjunctival closure. The mean amount of lidocaine 4% drops required during each procedure was 0.5 mL. No patient required additional retrobulbar, peribulbar, or sub-Tenon's anesthesia. CONCLUSIONS: This technique avoids the risks of globe perforation, retrobulbar hemorrhage, and prolonged postoperative akinesia of the eye at a lower cost. With appropriate case selection, topical anesthesia was a safe and effective alternative to peribulbar or retrobulbar anesthesia in phacoemulsification and IOL implantation combined with posterior 3-port pars plana vitrectomy.

Aged↗
PubMed1999

Cystoid macular edema after phacoemulsification: relationship to blood-aqueous barrier damage and visual acuity.

PURPOSE: To ascertain the incidence of cystoid macular edema (CME) after phacoemulsification and its relationship to blood-aqueous barrier damage and visual acuity. SETTING: A British teaching hospital. METHODS: A prospective trial was performed to document the incidence of CME after routine phacoemulsification with continuous curvilinear capsulorhexis. LogMAR visual acuity and laser flare were measured using the KOWA FC 1000 laser cell-flare meter preoperatively and 1, 14, 30, and 60 days postoperatively. At day 60, a standardized fluorescein angiogram was performed and graded by masked observers. RESULTS: The rate of angiographic CME on day 60 was 19%. Visual acuity at each visit was significantly worse in the CME group (P < .05). The flare and cell values at days 14, 30, and 60 were higher in the CME group at day 60; however, the difference was not statistically significance (P > .05). CONCLUSIONS: The incidence of CME after routine phacoemulsification was 19%. Patients with CME at day 60 had significantly worse visual acuity than those who did not from the first postoperative day throughout the follow-up. There was a trend for patients who had CME at day 60 to have more postoperative inflammation.

Aged↗
PubMed1999

Detection of lens proteins in phaco tips after phacoemulsification.

PURPOSE: To determine the efficacy of cleaning procedures to remove water-soluble and water-insoluble lens proteins from phaco tips after phacoemulsification. SETTING: Academic Hospital Maastricht, Department of Ophthalmology, University Eye Clinic, and Rotterdam Hospital, Rotterdam, The Netherlands. METHODS: Detection of alpha A-crystallins, cytoskeletal lens proteins (vimentin), and lens-cell membranes (MP26) was performed on new and reused phaco tips with specific markers. To detect antibodies, sodium dodecyl sulfate-polyacrylamide gel electrophoresis and Western blotting techniques were used. RESULTS: Threshold detection levels for alpha A-crystallins, vimentin, and MP26 were 100, 43, and 108 ng, respectively. No detectable residues of water-soluble or water-insoluble lens proteins were found in outflow samples of routinely cleaned phaco tips or in outflow samples of phaco tips that were not cleaned after phacoemulsification. Urea effectively eliminated water-insoluble lens proteins from contaminated phaco tips. CONCLUSION: After regular cleaning of phaco tips, no detectable lens protein residues were found in the outflow samples. Moreover, omitting the cleaning of phaco tips after phacoemulsification did not lead to detectable lens proteins in the outflow samples.

Animals↗
PubMed1999

Long-term results of combined 1-way phacoemulsification, intraocular lens implantation, and trabeculectomy.

PURPOSE: To analyze the results of 1-way phacoemulsification and posterior chamber intraocular lens (IOL) implantation combined with trabeculectomy. SETTING: Department of Ophthalmology and Neurosurgery, University of Siena, Siena, Italy. METHODS: This retrospective study comprised 42 eyes of 36 patients with glaucoma and cataract who had phacoemulsification with posterior chamber IOL implantation combined with trabeculectomy. The mean follow-up of 28.24 months +/- 10.99 (SD) (range 11 to 52 months) included measurement of intraocular pressure (IOP), visual acuity, visual field, endothelial cell loss, and notation of complications. RESULTS: There was a statistically significant postoperative improvement in visual acuity (P < .001). Mean preoperative best corrected visual acuity (BCVA) was 20/200 (range 20/30 to hand movements). Mean 1 year postoperative BCVA was 20/30 (range 20/20 to 20/60). The preoperative mean IOP of 24.06 mm Hg decreased to 15.36 mm Hg at 1 year (P < .001). All 42 eyes had a postoperative IOP of less than 21.00 mm Hg. Mean central cornea endothelial cell density preoperatively was 2238 +/- 396 cells/mm2 (range 1697 to 2906 cells/mm2) and postoperatively, 2005 +/- 397 cells/mm2 (range 1302 to 2801 cells/mm2). Early postoperative complications consisted of a choroidal detachment in 2 patients (4.76%). Three and 4 days after surgery, respectively, 2 patients (4.76%) had surgery to remove viscoelastic substance under the IOL. Late complications included posterior synechias in 3 eyes (7.14%). One year after surgery, because of a significant decrease in vision, a neodymium:YAG laser posterior capsulotomy was necessary in 2 eyes, 1 with an acrylic IOL (3.70%) and 1 with a silicone lens (9.09%). CONCLUSION: Combined phacoemulsification, posterior chamber IOL implantation, and trabeculectomy was safe and effective in patients with coexisting glaucoma and cataract.

Aged↗
PubMed2000

Combined phacoemulsification, vitrectomy, foreign-body extraction, and intraocular lens implantation.

PURPOSE: To assess the outcome of simultaneous phacoemulsification, pars plana vitrectomy, intraocular foreign-body extraction, and intraocular lens (IOL) implantation. SETTING: SSK Ankara Eye Hospital, Department of Vitreoretinal Surgery, Ankara, Turkey. METHODS: Seventeen patients with corneal perforation, intraocular foreign body, vitreous hemorrhage, and lens opacity had simultaneous clear corneal phacoemulsification, pars plana vitrectomy, intraocular foreign-body extraction, and IOL implantation. RESULTS: Postoperative complications included massive retinal fibrosis in 2 patients, retinal detachment in 1, and cilioretinal artery occlusion in 1. At a mean follow-up of 15.2 months, best corrected visual acuity improved in the remaining 13 eyes (76%). The IOL was stable in all cases. CONCLUSION: Combined phacoemulsification with IOL implantation and vitreoretinal surgery was safe in selected cases of penetrating ocular trauma resulting from an intraocular foreign body.

Adolescent↗
PubMed2000

Subjective visual experience during phacoemulsification and intraocular lens implantation using retrobulbar anesthesia.

PURPOSE: To investigate the subjective visual experience of patients during phacoemulsification and intraocular lens (IOL) implantation using retrobulbar anesthesia. SETTING: Department of Ophthalmology, Tan Tock Seng Hospital, Singapore. METHODS: Seventy cataract patients who had routine phacoemulsification and posterior chamber IOL implantation under retrobulbar anesthesia were interviewed on the day of their surgery regarding their visual experience in the operated eye during surgery. Thirty-nine men (55.7%) and 31 women (44.3%) were included in the study. Their mean age was 65.1 years (range 37 to 87 years). Preoperative best corrected visual acuity ranged from 6/12 to counting fingers. Sixty eyes (85.7%) had no ocular pathology other than cataract. Eleven patients (15.7%) reported no light perception during the surgery. The rest reported they could see light (59 patients, 84.3%), 1 or more colors (39 patients, 55.7%), flashes (35 patients, 50.0%), movements (34 patients, 48.6%), instruments (12 patients, 17.1%), and the surgeon's fingers or hands (11 patients, 15.7%). The colors seen included red (23 patients, 32.9%), blue (17 patients, 24.3%), yellow (12 patients, 17.1%), green (7 patients, 10. 0%), and orange (1 patient, 1.4%). Eight patients (11.4%) saw a spectrum of colors similar to a rainbow. Thirty-one patients (44.3%) reported that the brightness of light changed during surgery. Five patients (7.1%) found their visual experience frightening. Patients who reported seeing colors (P =.048, Fisher exact test) and flashes of light (P =.027, Fisher exact test) were more likely to find the experience frightening. There was no statistically significant correlation between those who found the experience frightening and patient sex or age, length of surgery, or history of cataract surgery in the fellow eye. CONCLUSIONS: Many patients having phacoemulsification and IOL implantation under retrobulbar anesthesia experienced a variety of visual sensations that were frightening in a small proportion of cases.

Adult↗
PubMed1999

Posterior capsule opacification after phacoemulsification in patients with diabetes mellitus.

PURPOSE: To compare posterior capsule opacification (PCO) after phacoemulsification and implantation of heparin-surface-modified (HSM) poly(methyl methacrylate) (PMMA) intraocular lenses (IOLs) in the capsular bag in patients with diabetes mellitus with that in a control group. SETTING: St. Erik's Eye Hospital, Stockholm, Sweden. METHODS: This prospective study comprised 26 patients with diabetes mellitus and 26 control patients without diabetes. Those with glaucoma, exfoliation syndrome, uveitis, and pupil size smaller than 6.0 mm after dilation were excluded. All patients received the same standardized phacoemulsification procedure with implantation of an HSM PMMA IOL in the capsular bag. Posterior capsule opacification was scored 1 and 2 years after surgery by evaluating retroillumination images taken with a Scheimpflug camera (Nidek Anterior Eye Segment Analysis System) after pupil dilation with phenylephrine 10% and cyclopentolate 1%. The PCO density behind the IOL optic was graded clinically from 0 to 4 (0 = none, 1 = minimal, 2 = mild, 3 = moderate, 4 = severe) and scored using the Evaluation of Posterior Capsule Opacification medical software developing system. RESULTS: No differences in PCO were found between the diabetic and control groups 1 year after surgery. The total PCO score was significantly less in diabetic than in control eyes 2 years after surgery (P < .05, Mann-Whitney). In addition, progression of PCO from 1 year to 2 years after surgery was significantly less in diabetic groups with different stages of diabetic retinopathy than in the control group (P < or = .05, Kruskal-Wallis analysis of variance and multiple comparisons). CONCLUSION: The rate of PCO after phacoemulsification was statistically significantly lower in patients with diabetes mellitus than in those without diabetes.

Aged↗
PubMed1999

Visual outcome and complications after posterior capsule rupture during phacoemulsification surgery.

PURPOSE: To determine the visual outcome and incidence of complications after posterior capsule rupture during phacoemulsification surgery. METHODS: Forty-four eyes of 43 patients which sustained posterior capsule rupture or zonulysis during phacoemulsification surgery between April 1993 and May 1996 were retrospectively studied. Eyes With pseudoexfoliation syndrome, traumatic cataract and myopia > 6 dioptres were excluded from the study. The mean postoperative follow-up period was 26 months (range 3 to 47 months). RESULTS: Forty-one eyes had posterior capsule rupture and 3 eyes had zonulysis. Of these 44 eyes, 41 eyes had vitreous loss and anterior vitrectomy at the time of surgery or subsequently. Excluding 2 eyes with pre-existing conditions that precluded good vision, 36 out of 42 eyes (85.7%) achieved spectacle corrected visual acuity of 6/12 or better post-operatively. Of all 42 eyes, 20 had anterior chamber intraocular lens (ACIOL) implantation while the others had posterior chamber intraocular lens (PCIOL) implantation. For eyes with ACIOL, 17 out of 20 eyes (85.0%) had best corrected visual acuity of 6/12 or better. For eyes with PCIOL, 19 out of 22 eyes (86.4%) had best corrected visual acuity of 6/12 or better. CONCLUSIONS: Phacoemulsification surgery, even if complicated by posterior capsule rupture or zonulysis, is compatible with good visual outcome. This is provided prompt attention is paid to the management of complications.

Adult↗
PubMed2001

Fluorescein-assisted viscodissection for easier phacoemulsification.

TITLE: Fluorescein-assisted viscodissection for easier phacoemulsification. SETTINGS: Department of Ophthalmology, Cairo University. PURPOSE: The description of a new surgical technique to help overcome difficulties in the learning curve of phacoemulsification. METHODS: A mixture of Fluorescein 0.25% and methyl cellulose 0.25% is used for hydrodissection. Standard phacoemulsification is then continued until the initial groove reaches the plane between the lens cortex and the capsule when the fluorescein flows towards the anterior chamber in a Green Smoke. This sign indicates a proper depth for attempting to crack the nucleus into two halves.

Contrast Media↗
PubMed2001

Combined phacoemulsification, intraocular lens implantation and trabeculectomy for chronic angle closure glaucoma.

PURPOSE: To investigate the results of combined phacoemulsification, intraocular lens implantation and trabeculectomy in Asian patients with chronic angle closure glaucoma (CACG). METHODS: This was a retrospective non-comparative case series of 55 consecutive patients (57 eyes) who underwent phacoemulsification, posterior chamber intraocular lens implantation and trabeculectomy for CACG at the Singapore National Eye Centre between 1997-1998. The surgical outcome was assessed in terms of intraocular pressure (IOP), the incidence of complications and the visual acuity at last follow-up. Success was defined as final IOP < or = 21 mmHg without medication and qualified success as final IOP < or = 21 mmHg with medication. Patients with final IOP > 21 mmHg who required further glaucoma surgery, lost light perception or became pthisical, were classified as failures. The eyes were further categorized into two groups according to whether single-site or separate-site surgery was performed. The outcome was also compared among eyes in which per-operative antimetabolites were applied to the trabeculectomy site and those without antimetabolites. RESULTS: The mean follow up was 22.0 +/- 5.6 months (mean +/- SD). Success was achieved in 46 (81%) eyes, qualified success in 10 (17%) eyes, and failure in 1 (2%) eye. In terms of IOP outcome, the success rate was similar in the two surgical groups (single-site or separate-site). There was no significant difference in IOP outcome among eyes in which per-operative antimetabolites were used and eyes with no per-operative antimetabolites use. Forty-one eyes (72%) had 6/12 or better vision. There were no cases of intraoperative complications and the incidence of postoperative complications was low. CONCLUSIONS: Combined phacoemulsification, intraocular lens implantation and trabeculectomy is associated with good intraocular pressure control and visual outcome in patients with CACG.

Aged↗
PubMed2004

Efficacy and safety of rimexolone 1% versus prednisolone acetate 1% in the control of postoperative inflammation following phacoemulsification cataract surgery.

PURPOSE: The aim of this study was to evaluate the efficacy and safety of rimexolone 1% ophthalmic suspension compared to that of 1% prednisolone acetate in the control of inflammation in eyes undergoing cataract extraction with phacoemulsification followed by posterior chamber intraocular lens implantation. METHODS: Forty-eight patients who underwent uncomplicated cataract extraction with phacoemulsification followed by posterior chamber IOL implantation constituted the study group of this prospective, randomized, double-masked investigation. Patients were randomly assigned to two treatment groups; rimexolone 1% ophthalmic suspension (27 subjects) or prednisolone acetate 1% (21 subjects). Postoperatively, patients used topical rimexolone or prednisolone drops four times a day for 15 days. Patients were examined at the first postoperative day (day 1), and days 3, 7 and 15. The major efficacy parameters assessed clinically on each visit were anterior chamber cells, anterior chamber flare and conjunctival hyperemia. Safety of the rimexolone was evaluated by IOP values and the presence of adverse effects. RESULTS: Regarding all three efficacy parameters, rimexolone was found to be clinically and statistically equivalent to prednisolone acetate. Intraocular pressure values during the postoperative period were also similar in both groups. CONCLUSION: Rimexolone 1% ophthalmic suspension is both an effective and safe topical steroid in controlling postoperative inflammation after cataract extraction with phacoemulsification.

Double-Blind Method↗
PubMed1995

Topical anaesthesia for phacoemulsification surgery.

Although phacoemulsification with only topical anaesthesia is possible, the level of any discomfort perceived by the patient is unknown. Topical anaesthesia eliminates any risk of inadvertent ocular or orbital injury. Twenty-four patients undergoing phacoemulsification under only topical anaesthesia (g. amethocaine 1%) were compared with 23 patients undergoing the same procedure with peribulbar anaesthesia (5 ml lignocaine 2%, 5 ml bupivacaine 0.5% and 75 units hyaluronidase). Perceived pain on administration of the anaesthesia, per-operatively and post-operatively was assessed by a nursing officer using a visual analogue scale (0-10). It was found that there was no difference in pain score between the two groups on induction of anaesthesia. Per-operatively and post-operatively scores were higher in the topical group than in the peribulbar group (p < 0.05, Mann-Whitney U-test), though most of these were within the range 0-3, ('no pain' to 'slight pain'). There was no difference in the amount of analgesia dispensed to the two groups on the ward post-operatively. In conclusion, topical anaesthesia provides adequate anaesthesia for phacoemulsification. Although a small increase in the level of discomfort was observed, the pain levels reported were small and may not be clinically significant when set against the reduced incidence of anaesthetic-related complications.

Adult↗
PubMed1997

Capsulorhexis phymosis following uncomplicated phacoemulsification surgery.

PURPOSE: The aim of the study was to assess and compare the degree of capsulorhexis phymosis following uncomplicated phacoemulsification cataract surgery in polymethylmethacrylate (PMMA) and silicone lens implants. METHOD: Sixty-four patients were evaluated 1 day, 6 weeks and 6 months following phacoemulsification cataract extraction. The anterior capsular diameters were measured with the illuminated beam of the slit lamp at 45 degrees and 135 degrees and the surface area of the opening calculated. We have measured and compared the change in the capsulorhexis size for both lens types and assessed its statistical significance with a paired Student's t-test. RESULTS: A statistically significant contraction of the capsulorhexis was noted in all patients within the first 6 weeks (p < 0.001). Capsular contraction continued between 6 weeks and 6 months post-operatively but to a lesser extent (p < 0.05). The difference in the degree of phymosis between the first period (1 day to 6 weeks) and the second (6 weeks to 6 months) was statistically highly significant for all patients (p < 0.001). The capsular areas for the silicone lens implants were significantly smaller than for the PMMA implants at 6 weeks and 6 months. None of our patients had a clinically significant capsular contracture requiring Nd:YAG laser capsulotomy. CONCLUSION: Anterior capsular contraction is commonly observed following capsulorhexis in phacoemulsification surgery. This study demonstrates that the maximum rate of contraction occurs in the first 6 weeks following surgery and is more pronounced with silicone lens implants.

Aged↗
PubMed1997

Post-operative iris prolapse following phacoemulsification and extracapsular cataract surgery.

PURPOSE: This study retrospectively compared and contrasted iris prolapse occurring following extracapsular cataract extraction and phacoemulsification. METHODS: The clinical notes of all patients who had undergone iris prolapse repair in the last 5 years at Southampton Eye Unit were recalled. Sixty-five patients (mean age 73 years; 41.6% male, 58.4% female) were identified out of a total of 7252 cataract operations performed (5983 extracapsular, 1269 phacoemulsification). RESULTS: Fifty-nine (93.3%) iris prolapses occurred following extracapsular surgery (83% had corneal incisions, 17% limbal). We identified 3 cases of phaco-related prolapse each of which occurred where the scleral tunnel had been extended to enable insertion of a 7.0 mm optic intraocular lens but had not been sutured. Overall, the average best corrected visual acuity achieved was 6/9. CONCLUSION: The authors conclude that although iris prolapse is much less common following phacoemulsification, all scleral sections that are extended should be sutured.

Aged↗
PubMed1998

First day post-operative review following uncomplicated phacoemulsification.

PURPOSE: To determine whether the first day review is essential in management of patients following uncomplicated phacoemulsification with intraocular lens implantation. Patients are routinely seen on the day following surgery. This can produce logistical problems in patient attendance that can necessitate an overnight stay. If the first day review were abandoned this would lead to an increased uptake of day case surgery and a reduction in health care costs. METHODS: A retrospective cohort study was performed on all cases of uncomplicated phacoemulsification with intraocular lens implant surgery over a 6 month period. Slit lamp examination findings on the first post-operative day were reviewed. Visual acuity, corneal clarity, anterior chamber activity, intraocular pressure and configuration of the pupil were recorded. Any cases that failed to meet predetermined criteria underwent full case-note review. The subsequent management of these patients was analysed. RESULTS: Of the 201 cases of uncomplicated surgery, 74 cases (37%) failed to meet the study criteria and underwent review. Of these only 12 (6%) had their management altered as a result of the first day post-operative findings. This was entirely due to raised intraocular pressure. Visual acuity, corneal oedema and activity in the anterior chamber all improved on subsequent follow-up. CONCLUSIONS: The first day review of uncomplicated phacoemulsification with lens implant surgery provides the opportunity to treat raised intraocular pressure. A prospective randomised study is needed to identify means to prevent the post-operative intraocular pressure rise before we are able to consider abandoning the first review.

Ambulatory Surgical Procedures↗