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Site marking for cataract surgery: safer when we are on the patient’s side?

Poster Details

First Author: V.Kit UK

Co Author(s):    M. Schneiders   A. Ismail                 

Abstract Details


Wrong site surgery for ophthalmic procedures are rare, but should be a never event. Site marking, particularly in paired organs is important in identifying the correct site, and forms a key component of the adapted World Health Organisation Surgical safety checklist for cataract surgery. The Patient Safety Alert: correct site surgery document (2005) was jointly released by the National Patient Safety Agency (NPSA) and the Royal College of Surgeons. We aimed to assess if traditional above brow site marking for cataract surgery is compliant with their recommendations, or if this could be improved with a novel temporal marking approach.


Department of Ophthalmology, West Hertfordshire Hospitals NHS Trust, UK


Surgical site marking in cataract surgery was assessed during 12 theatre sessions; 9 of these theatre sessions were performed using a traditional above brow surgical marking, and 3 theatre sessions were performed with temporal marking. All patients were site marked with an indelible pen, and an identical non-woven incise drape with channel bag 140 x 127cm was used for all procedures. The surgical site marking was assessed on whether it was visible at two stages: 1) following skin preparation, and 2) following the application of a surgical drape. Data was collected and analysed using Microsoft Excel.


A total of 45 cataract surgeries were performed with either above brow (32) or temporal (13) site marking. Site marking was visible 100% of the time following skin preparation in both groups. However following surgical drape application, only 16 (50%) remained visible with the above brow surgical marking. Comparatively, 13 (100%) remained visible following draping with temporal marking. This demonstrates a 50% improvement in visibility following surgical draping with temporal marking when compared to above brow marking.


Following surgical draping, traditional above brow site marking was visible for only 50% of the time, compared with a visibility of 100% with temporal marking. Temporal marking enables the correct surgical site to be identified at all times during cataract surgery, and is consequently a safer approach. Furthermore, temporal marking is less likely to be obscured by the patient’s surgical cap, and has no negative impact on the surgical procedure. We therefore propose that for better patient safety and an improved compliance with surgical marking guidelines, a temporal marking approach should be taken when performing cataract surgery.

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