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Sherveen Shayegan Salek, Hannah Lee Park, Andrew Hendrick; Comparative outcomes of same-day versus day one postoperative examinations following vitreoretinal surgery. Invest. Ophthalmol. Vis. Sci. 2018;59(9):868.
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Traditionally, the initial examination after vitreoretinal (VR) surgery is conducted on the first day after surgery (POD1). However, same-day post-operative examination (POD0) has been noted to be a safe practice for cataract surgery, yet little has been published regarding outcomes for VR surgery. Concerns remain that skipping the POD1 visit may miss important complications.
We present a retrospective case series of 310 patients who underwent pars plana vitrectomy (PPV) and/or scleral buckle (SB) by a single surgeon - 117 seen on POD0 and 193 on POD1 (control). Demographics, history of glaucoma and diabetes mellitus (DM), and placement of gas tamponade or silicone oil (SO), visual acuity, intraocular pressure (IOP), examination, and interventions for complications were included. Statistical analysis was performed with Microsoft Excel.
Mean IOP at POD0 was 10.4 mmHg, and 20.9 mmHg on POD1 (2-tailed T-test, p-value <0.0001). At the second post-operative visit (SPOV, from post-operative day 4 to 14), mean IOP was 18.0 mmHg for patients initially seen on POD0, and 17.8 mmHg for patients seen on POD1 (p-value 0.80). For patients seen on POD0, six (5.1%) had an IOP above 26 mmHg, while 21 patients (18.0%) had an IOP of less than 5 mmHg. For patients seen on post-operative day one, 49 (25.4%) had an IOP above 26, and one patient (0.52%) had an IOP below 5 mmHg. Topical IOP-lowering drops were initiated in 5 patients (4.3%) on POD0, and 42 patients (21.8%) on POD1. All of these differences reached statistical significance (chi-squared test, p-value less than 0.0001). At SPOV, differences in elevated IOP, hypotony, need for IOP drops and repeat VR surgery between patients seen initially at POD0 versus POD1 did not reach statistical significance. Patients with gas or SO did not show significant differences in IOP at SPOV. History of glaucoma was not a risk factor for post-operative IOP elevation, while DM was associated with a signficantly lower likelihood of elevated IOP at SPOV.
Same-day post-operative visits appear to be safe for VR surgery in our case series, the largest reported thus far. While IOP was lower at POD0, rates of IOP elevation and hypotony were similar at the second visit, suggesting that missed episodes on POD0 may resolve without intervention. Findings held for eyes with gas or SO tamponade. Corroboration with prospective studies is necessary.
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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