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C Tinley, NA Frost, KN Hakin; Randomized Controlled Trial Investigating Differences in Outcome Between Elective Cataract Surgery Patients Discharged on the Day of Surgery and a Control Group Reviewed on the First Post-operative Day . Invest. Ophthalmol. Vis. Sci. 2002;43(13):933.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To examine the safety implications of omitting the first day clinical review following phacoemulsification cataract surgery. Method: 362 patients undergoing elective phacoemulsification cataract surgery were randomly assigned, after stratification by first or second eye, to 'Same Day Discharge' (SDD) or 'Next Day Review' (NDR). All patients were reviewed approximately 2 weeks after surgery. Three primary outcomes were measured: post-operative complications in the first 2 weeks, Snellen visual acuity at 2 weeks and Vision-Related Quality Of Life (using the VCM1 questionnaire) at 4 months after surgery. 14 Patients (13 SDD, 1 NDR), whose management for clinical reasons differed from the allocated strategy, were retained in the study. Analysis was by group of initial allocation. Results: Of the 174 patients randomized to NDR, 17 (9.8%) were treated for raised intra-ocular pressure (25-48mmHg) on the first post-operative day. 2 received increased treatment for uveitis and 1 was treated for a significant wound leak. 11 (6.3%) required additional reviews prior to two-week follow-up, for treatment of the following complications: drop toxicity (5), raised intra-ocular pressure (5) and corneal abrasion (1). Of the 188 randomized to SDD, 6 (3.2%) returned to the department before the planned review for reassurance of patients' concerns regarding eye symptoms (4) and emergency treatment of raised intra-ocular pressure (2). At the two-week post-operative review of all the trial patients, 5 (1.4%) required treatment for persistent uveitis. Three of these patients did not have significant uveitis at first-day review. There were two cases of iris prolapse in the SDD group, but in one case, the complication was anticipated and early review had been planned. Post-operative acuities of 6/12 or better were achieved in 83% SDD and 82.75% NDR patients. P=0.96 by the Chi-squared test. Good post-operative quality of life scores (VCM1 index<1.0: "no or hardly any concern about vision") were achieved in 67% SDD and 72.5% NDR. P=0.26. Conclusions: The intention to discharge patients on the day of surgery, with planned post-operative review at two weeks, was associated with a low frequency of serious ocular complications. Differences in the proportions achieving a good visual outcome between the two groups, based on two-week visual acuity and four-month quality of life, were not significant.
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