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Brian C Joondeph, Jon Zick; Is the postoperative day one examination necessary after uncomplicated vitreoretinal surgery?. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5101.
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Patients are routinely examined on the first day after vitreoretinal surgery. Due to scheduling and logistic issues, it may be more convenient for patients to receive a day two exam instead. We performed a retrospective, observational clinical study to determine if there were any adverse consequences from seeing patients on the second rather than the first postoperative day.
A single-surgeon series of uncomplicated vitreoretinal surgery cases examined on the second, but not the first postoperative day were reviewed. Baseline and demographic patient data were recorded including surgical details, as well as postoperative day two findings.
From 2006 through 2014, 90 eyes of 90 patients were identified, ranging in age from 27 to 96 years. 12 (13.3%) were being treated for glaucoma and 23 (25.5%) had diabetes. All 90 patients underwent pars plana vitrectomy (20g-2, 23g-75, 25g-10, 27g-3), 8 (8.8%) had scleral buckle placement, 33 (36.6%) had membrane peeling, 48 (53.3%) had endolaser photocoagulation performed. 41 (45.5%) had an SF6 gas bubble, with the concentration ranging from 10-28%. 42 (46.6%) had an air bubble, 5 (5.6%) had silicone oil, and 3 (3.3%) had no tamponade. All patients received a phone call from a technician on the first postoperative day, confirming the patient had at least hand motion vision and no more than moderate pain. On the second posteroperative day, intraocular pressures ranged from 4 to 57 with a mean of 15.9 mmHg. 6 patients (6.6%) had a pressure over 30 mmHg, all successfully treated medically. The 57 mmHg pressure was a steroid responder treated medically and by stopping the steroid. One patient was seen on the first postoperative day, due to severe pain noted on the technician phone call. This patient had a pressure of 46 relieved by a vitreous gas tap and subsequently treated medically with pressure normalization. There were no cases of endophthalmitis.
Patients undergoing uncomplicated small gauge vitreoretinal surgery can reasonably be seen on the second, rather than the first, postoperative day. A phone call should be made to the patient on the first postoperative day inquiring about symptoms indicating the need for prompt same day evaluation. This extra day may improve the patient experience of care, allowing them to see their own surgeon at a convenient location, which may otherwise be impossible in large multi-office practices.
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