Revisiting early postoperative follow-up after phacoemulsification

Purpose: To determine whether postoperative evaluation of routine phacoemulsification can be safely and effectively performed on the day of surgery and 4 days postoperatively and evaluate the incidence and management of early intraocular pressure (IOP) elevations 3 to 7 hours postoperatively in patients with or without glaucoma. Setting. Community-based hospital. Methods: This retrospective series comprised 465 consecutive patients who had phacoemulsification and intraocular lens implantation, All patients had postoperative follow-up on the day of surgery (3 to 7 hours postoperatively) and at 4 days, Patients were classified into 2 groups: nonglaucoma (NG), 396 patients; and glaucoma (GL), 69 patients. The main outcome measures were the incidence and management of postoperative complications including IOP spikes, wound leaks, uveitis, and endophthalmitis. Results: Three to 7 hours postoperatively, 73 NG (18.4%) and 32 GL (46.4%) patients had IOP elevations greater than 28 mm Hg, a significant change from baseline (P <.0001). Fourteen NG (3.6%) and 13 GL (18.8%) patients had IOP elevations greater than 40 mm Hg (P <.0001). Significant IOP elevations were effectively managed with a paracentesis with or without short-term antiglaucoma medications on the day of surgery, with 75 NG (18.9%) and 39 GL (56.5%) patients requiring IOP intervention, There were no IOP elevations greater than 21 mm Hg on the next day or at 4 days, There were no complications that were missed at the same-day evaluation that may have been identified at the 1-day postoperative visit. Conclusions: The results indicate that after routine phacoemulsification, patients can be safely and effectively reviewed on the day of surgery and 4 days postoperatively to identify and manage early postoperative IOP spikes. A significant number of patients, particularly those with preexisting glaucoma, had potentially harmful IOP spikes 3 to 7 hours postoperatively. J Cataract Refract Surg 2002; 29:100-108 (C) 2002 ASCRS and ESCRS.