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Jeffrey Lynn Tapley, John Mason; Clinical Outcomes of a Phone Call in Lieu of Day One Exam Following Uncomplicated 25-Gauge Vitrectomy Surgery. Invest. Ophthalmol. Vis. Sci. 2019;60(9):5766.
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© ARVO (1962-2015); The Authors (2016-present)
To determine any adverse consequences of a phone call in lieu of a postoperative day one (POD1) exam in patients undergoing uncomplicated 25-gauge pars plana vitrectomy (25-g PPV). Traditionally, 25-g PPV patients have been examined on POD1. Today, with increasing use of local anesthesia and smaller gauge instruments, the number of post-op events following vitrectomy has dramatically decreased, and growing evidence suggests that a POD1 exam may reasonably be deferred. Additionally, with more surgeons travelling to satellite locations, the logistical burden of POD1 visits on both the patient and surgeon persists. This study was undertaken to assess the safety of a phone call in lieu of exam on POD1, with an initial follow-up visit at one week.
A retrospective chart review was performed of consecutive, uncomplicated 25-g PPV patients seen one week post-op from 7/2016 to 12/2017. Vitrectomies were performed by a single surgeon at a satellite clinic. Patients received a POD1 phone call (instead of exam) from the surgeon asking about vision and pain. Any patient with vision less than count fingers at one foot or pain out of proportion to the surgical procedure was asked to be examined immediately. Otherwise, patients were initially examined at the one week post-op visit. Attention was given to any complications noted at, or prior to, the one week visit.
94 patients were identified; average age was 70.1 years, 66% were female, and 58.5% Caucasian. Indications for vitrectomy included macular pucker (40.4%), vitreous hemorrhage (23.4%), vitreous debris (21.3%), macular hole (10.6%), and vitreomacular traction (4.3%). No tamponade (balanced salt solution) was used in 83%, air 7.4%, SF6 9.6%, while none received C3F8 or silicone oil. Of 94 patients called on POD1, none prompted earlier follow-up exam. Two patients had minor, abnormal intraocular pressure (IOP 5 and 30) at the one week visit; both were managed medically. One case of endophthalmitis was diagnosed and treated with excellent outcome after a patient called with concerning symptoms on the third postoperative day.
Significant post-op events are unlikely to be missed using a phone call in lieu of exam on POD1 following routine vitrectomy. Patients undergoing uncomplicated 25-g PPV with logistical problems preventing a POD1 exam may be reasonably and safely seen at one week following a POD1 phone call.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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