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Jacquelyn Daubert, Olivia Dryjski, Stacy Bang, Rosan Choi; The Necessity of a Dilated Fundus Exam in the Early Postoperative Period following Uncomplicated Cataract Surgery. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4798.
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It is common practice for ophthalmologists to dilate their postoperative patients within 1 month following cataract extraction (CE) to evaluate for retinal complications. We performed a retrospective chart review to assess the incidence of retinal complications in the early postoperative period, including retinal detachments or retinal tears (RD/RT), to determine the necessity of a postoperative dilated examination following routine cataract surgery.
Patients who had CE performed by supervised senior residents at Medstar Washington Hospital Center from 07/2016 to 04/2017 were identified. Patients that had a preoperative dilated fundus exam (DFE), a minimum one-month follow up after surgery, and at least one DFE between 0-90 days postoperatively were included in the study. Patients were excluded if there was no view to the fundus preoperatively or no documented DFE within the first 90 days postoperatively. At the post-operative visit, patients were evaluated for symptoms that included decreased vision, photopsias, or floaters and dilated to evaluate for retinal complications.
A total of 125 eyes from 99 patients met the inclusion criteria. One hundred and nineteen cases (95%) were phacoemulsification CE alone, 5 cases (4%) were combined phacoemulsification CE with trabeculectomy, and 1 case (1%) was a combined phacoemulsification CE with tube implantation. Twenty-three eyes (18%) had a prior posterior vitreous detachments, 3 eyes (2.4%) had RD/RT previously in the surgical eye, and 5 eyes (4%) had RD/RT in the fellow eye. There were 11 complicated cases (8.8%) with 7 posterior capsule tears, 3 anterior capsule rents, and 1 zonular dehiscence. Two of the complicated cases required an anterior vitrectomy and 1 case required a pars plana vitrectomy. Twelve patients were symptomatic at their post-operative follow up and zero eyes had RD/RT when dilated at their post-operative visit.
There were zero retinal complications identified in uncomplicated CE performed by senior residents in the 90-day post-operative period. There is little necessity in a DFE in the acute postoperative period to identify retinal complications following an uncomplicated CE if the vision is as anticipated and the patient is asymptomatic.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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