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Clinical Studies

THE EARLY COMPLICATIONS OF CATARACT SURGERY: Is Routine Review of Patients 1 Week After Cataract Extraction Necessary?

Ganley, James P. MD, DrPH

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McKellar MJ, Optom B, Elder MJ. The early complications of cataract surgery: is routine review of patients 1 week after cataract extraction necessary? Ophthalmology 2001;108:930–935.

Original study reprint requests: Mark John Elder, Department of Ophthalmology, Christchurch Hospital, Private Bag 4710, Christchurch, New Zealand.

Research Objective

This study sought to define the nature and frequency of complications present 1 week after cataract surgery, to determine whether these complications are predictable, and to ascertain whether patients undergoing cataract surgery require routine review at this time.

Study Design

A retrospective, noncomparative case series.

Location

Christchurch Eye Department, New Zealand.

Funding Sources

None listed.

Relevant Methodology

One thousand consecutive patients undergoing cataract removal by either phacoemulsification or extracapsular extraction at a large teaching hospital between January 1996 and May 1998. Patients with both complicated and uncomplicated histories and surgeries were included.

Outcome Measures

Nature and frequency of complications present 1 week after cataract surgery.

Results

At the routine 1-week examination, postoperative complications were observed in 41 of 1,000 patients (4.1%). Twenty-one (51%) of these patients had a completely unremarkable history to that point, whereas only 4 (19%) were symptomatic, and 20 (95%) required a change to their postoperative management. The most significant unexpected complications were uveitis (seven cases), cystoid macular edema (four cases), and vitreous to the wound, exposed knots, and loose suture (one of each). Complications were present in 20 of 257 (7.8%) patients with a preoperative or surgical risk factor, and there was a significant relationship between preoperative (p = 0.02) and combined preoperative and intraoperative risk factors (p = 0.001), and complications present at the 1-week review. The relationship between surgical risk factors and 1-week complications was not significant (p = 0.07). There were coexistent pathologic features in 19% of all eyes. Registrars performed 38% of surgeries, and 96% of cataracts were removed by phacoemulsification. Operative complications occurred in 6.7% of patients, most commonly a posterior capsule tear (4.4% of all cases). Complications were observed in 10% of eyes on the first postoperative day. Raised intraocular pressure was the complication in 88% of these patients.

Conclusions

This study provides an overview of modern cataract surgery in a large teaching hospital and indicates that abandonment of routine 1-week review may result in the failure to detect significant postoperative complications.

Comment

This study is a retrospective chart review of 1,000 patients who underwent cataract surgery by six experienced ophthalmologists and an unknown number of residents at a New Zealand training hospital. Overall, 4.1% had significant 1-week postoperative complications requiring an alteration in the patient's management routine. Complications were higher in 257 patients with a preoperative or operative risk factor (7.8%) versus a 2.8% complication rate in 743 patients without these risk factors, an odds ratio of 2.90. From these data, we might consider limiting the 1 week follow-up to the high-risk group, but as pointed out by the authors, significant complications occurred in the low-risk group, justifying the time and expense incurred in the examination of all patients with cataracts postoperatively at 1 week.

To place the study in perspective, several observations are germane. The study was a retrospective review of medical records from a number of ophthalmologists at various levels of training and experience, with all the associated caveats. 1 It would have been informative to separate out the frequency of complications by level of training; perhaps in experienced hands the frequency of 1-week complications might be significantly less than the rate found for the total group. Another very useful piece of information that might have been addressed is the frequency of 1-week complications associated with various surgical techniques. One might expect a greater frequency of complications after a planned extracapsular cataract extraction than from phacoemulsification. Of more importance is the frequency of complications among the various subgroups of phacoemulsification techniques, e.g., corneal incision verses scleral tunnel; these data may guide the general surgeon to adopt the technique with least complications, and perhaps negate the need for a 1-week examination.

Overall, a study of this caliber is considerably more valuable to the understanding of postoperative complications than “soap box” testimonials of personal experience that frequently obscure the real data.

Reference

1. Lillienfeld AM. Foundations of Epidemiology. New York: Oxford University Press, 1976:164–193.
© 2002 Lippincott Williams & Wilkins, Inc.