Do we need day-1 postoperative follow-up after cataract surgery?

Author: Grzybowski A, Kanclerz P.

Geographical coverage: Not reported

Sector: Cataract surgery

Sub-sector: Treatment follow-up

Equity focus: Not reported

Study population: Patients with cataract

Review type: Effectiveness review

Quantitative synthesis method: Narrative synthesis

Qualitative synthesis method: Not applicable

Background:

Rising healthcare costs have intensified pressure to reassess routine clinical practices and eliminate low-value care. Cataract surgery is generally safe, yet post-operative follow-up schedules vary widely. The American Academy of Ophthalmology now advises a post-operative day-1 (POD1) review only for patients at heightened risk of complications, whereas routine POD1 visits have largely been abandoned in the UK except for individuals with co-morbidities such as glaucoma or uveitis. Recent evidence questions the need for routine POD1 assessment after uncomplicated phacoemulsification, suggesting that resources could be redirected without compromising patient safety.

Objective:

To determine the nature and frequency of complications detected on POD1 and to assess whether a follow-up at this time is warranted after standard phacoemulsification cataract surgery (PCS).

Main findings: The review included 44 studies, published between 1994 and 2017. The most common complications after PCS include corneal oedema, postoperative uveitis, intraocular pressure (IOP) elevation, cystoid macular oedema, and posterior capsule opacification. Notably, IOP spikes typically peak 3–7 hours after surgery, and are potentially more dangerous in eyes with preexisting optic nerve damage. IOP-lowering agents do not completely prevent the occurrence of IOP spikes. However, postoperative application of a combination of dorzolamide/timolol and brinzolamide topically in high-risk patients with raised IOP or preexisting optic nerve damage may be appropriate. The study found that most complications did not require early surgical intervention and suggested alternatives to POD1 visits, such as nurse-administered telephone questionnaires or shared care with non-ophthalmologists.

The findings revealed that postoperative complications like wound dehiscence and IOL dislocation are rare, with modern surgical techniques further reducing their incidence. For instance, wound dehiscence rates dropped from 2.8% to 0.02–1.1% with small-incision phacoemulsification. Similarly, early IOL dislocations are uncommon and often linked to preexisting conditions like pseudocxfoliation.

Socioeconomic considerations highlight the potential cost savings of eliminating routine POD1 visits, estimated at $0.8 billion annually in the U.S. The authors argued that redirecting these resources could improve healthcare efficiency without compromising patient safety. They recommend tailored approaches, such as using potent steroids for anti-inflammatory treatment and combination IOP-lowering agents for glaucoma patients, to mitigate risks in the absence of a POD1 visit. The study concluded that POD1 follow-ups are not justified for uncomplicated PCS but remain important for high-risk

Methodology:

MEDLINE and Embase were searched to 31 December 2017 for English-language studies reporting POD1 complications after PCS; reference lists of included papers were hand-searched. Data were summarised narratively. No unpublished data were sought.

Applicability / external validity:

Findings support a flexible, patient-centred approach: low-risk patients may safely avoid POD1 review, whereas individuals with glaucoma, intra-operative complications or poor access to follow-up should still be seen early. Nonetheless, most included studies were small, retrospective and drawn from high-income settings, so conclusions may not apply universally.

Geographic focus:

No geographical limits were set, but included studies were not mapped by region.

Summary of quality assessment:

Confidence in the evidence is low. Although inclusion criteria were explicit and two major databases were searched, only English-language reports were considered, study characteristics were incompletely described, and risk-of-bias assessment was absent.