Is An In-Person Postoperative Week One Review Necessary After Uncomplicated Cataract Surgery?

To assess the safety of omitting the post-operative week one (POW1) clinic visit and replacing it with a nurse-conducted telephone call, for patients who have undergone uncomplicated cataract surgery with an unremarkable postoperative day one (POD1)  examination

Retrospective observational study of 32500 cases with uneventful phacoemulsification and a routine POD1 exam between June 2015 to June 2021 at Singapore National Eye Centre

All patients were seen in clinic at day 1 by an ophthalmologist. They then had a telephone conversation with a nurse (instead of an in-person doctor consultation) at POW1. All patients then had an in-person postoperative month one (POM1) clinic consultation by an ophthalmologist. The main outcome measure was the incidence of unexpected management changes (UMC) related to cataract surgery complications within the first month. Data was also collected on the number and reasons for unscheduled patient-initiated visits

There were 897 cases (2.76%) who had an UMC within POM1. Of these, there was 1 case of endophthalmitis (0.003%), 5 cases of retinal detachment (0.02%), 32 cases of retinal breaks (0.10%), 34 cases (0.10%) requiring additional corrective surgery, 712 cases required initiation of non-steroidal anti-inflammatory drops, and 63 cases had a raised intraocular pressure at POM1. Separately, 1126 patients (3.46%) had unscheduled visits between POD1 to POM1. The most common symptoms for unscheduled visits were pain, followed by redness, then blurring of vision. Only 8 cases (0.02%) were recalled during the telephone consult.

Significant adverse post-operative events were rare. 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.