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C.S. Ament, B.A. Henderson; Variations of Post–Operative Instructions After Cataract Surgery . Invest. Ophthalmol. Vis. Sci. 2005;46(13):756.
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Purpose: To describe variation in post operative instructions after routine phacoemulsification cataract surgery with clear corneal incision Methods: A survery was sent to cataract surgeons at 5 academic medical centers. Results: Instructions regarding post–operative pain control, personal hygeine, and eye shield use were similar at all centers. Tylenol was prescribed for pain and patients were told to call the medical center for severe pain. Eye shield wear was prescribed until the office visit post–operative day #1 and then for one week at night only. Normal personal hygeine routines including hairwashing were resumed post–operative day one. Antibiotic and steroid regimens were similar at all centers. Four prescribed third or fourth generation flouroquinolones 4 times per day for one week after surgery. One prescribed Polysporin ointment twice a day for two days prior and 7 days after surgery. All prescribed prednisolone four times per day for one week. The rate and length of taper varied slightly. Instructions regarding activity varied significantly. One center prohibited lifting greater than 10 pounds and allowed only walking for one week. Another prohibited ballistic exercises, bending, and lifting greater than 20 pounds for one week. The third prohibited eye makeup, swimming, and lifting greater than 20 pounds for one week. The fourth prohibited swimming, weight lifting while lying down, holding breath while lifting heavy objects, lifting greater than 25 pounds, and excessive bending for one week. At one center two surgeons provided different instructions. One prohibited lifting greater than 10 pounds and swimming for one week. The other prohibited sex and swimming for one week and lifting greater than 25 pounds, upper body Valsalva (weight lifting, rowing) for one month. Conclusions: Instructions regarding pain control, personal hygeine, eye shield wear, antibiotic and steroid usage after uncomplicated phacoemulsification with clear corneal incision were similar between 5 academic medical centers. Activity limitation varied widely in content and level of specificity. Activity limitation is presribed to prevent spontaneous dehiscence of the unsutured corneal wound. The tensile strength of corneal wounds is well–documented in vitro, (Ernest PH, Fenzl R, Lavery T, Sensoli A, Relative stability of clear corneal incisions in a cadaver eye model, J Cat and Ref Surg, V. 21, Jan 1995) but the daily activities that place patients at risk of exceeding this tensile strength are not known. Patients and clinicians would benefit from standardization and rationalization of post–operative activity limitations.
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