Cohen V M, Demetria H, Jordan K, Lamb R J, Vivian A J
Department of Ophthalmology, West Suffolk Hospital, UK.
Eye (Lond). 1998;12 ( Pt 4):634-6. doi: 10.1038/eye.1998.159.
To determine whether the first day review is essential in management of patients following uncomplicated phacoemulsification with intraocular lens implantation. Patients are routinely seen on the day following surgery. This can produce logistical problems in patient attendance that can necessitate an overnight stay. If the first day review were abandoned this would lead to an increased uptake of day case surgery and a reduction in health care costs.
A retrospective cohort study was performed on all cases of uncomplicated phacoemulsification with intraocular lens implant surgery over a 6 month period. Slit lamp examination findings on the first post-operative day were reviewed. Visual acuity, corneal clarity, anterior chamber activity, intraocular pressure and configuration of the pupil were recorded. Any cases that failed to meet predetermined criteria underwent full case-note review. The subsequent management of these patients was analysed.
Of the 201 cases of uncomplicated surgery, 74 cases (37%) failed to meet the study criteria and underwent review. Of these only 12 (6%) had their management altered as a result of the first day post-operative findings. This was entirely due to raised intraocular pressure. Visual acuity, corneal oedema and activity in the anterior chamber all improved on subsequent follow-up.
The first day review of uncomplicated phacoemulsification with lens implant surgery provides the opportunity to treat raised intraocular pressure. A prospective randomised study is needed to identify means to prevent the post-operative intraocular pressure rise before we are able to consider abandoning the first review.
确定在单纯白内障超声乳化吸除联合人工晶状体植入术后患者的管理中，术后第一天的复查是否至关重要。患者通常在术后当天接受检查。这可能会给患者就诊带来后勤方面的问题，可能需要住院过夜。如果放弃术后第一天的复查，日间手术的接受率将会提高，医疗费用也会降低。
对6个月内所有单纯白内障超声乳化吸除联合人工晶状体植入手术病例进行回顾性队列研究。复查术后第一天的裂隙灯检查结果。记录视力、角膜清晰度、前房情况、眼压和瞳孔形态。任何未达到预定标准的病例都进行全面的病例记录复查，并分析这些患者随后的治疗情况。
在201例单纯手术病例中，74例（37%）未达到研究标准并接受了复查。其中只有12例（6%）因术后第一天的检查结果而改变了治疗方案。这完全是由于眼压升高所致。视力、角膜水肿和前房情况在随后的随访中均有所改善。
单纯白内障超声乳化吸除联合人工晶状体植入术后第一天的复查为治疗眼压升高提供了机会。在能够考虑放弃首次复查之前，需要进行一项前瞻性随机研究，以确定预防术后眼压升高的方法。
