ABSTRACT
This systematic review was conducted to examine the value of the preoperative history and physical (H&P) examination and preoperative care prior to cataract extraction and the resulting outcomes of adverse events, patient experience, and cost. Four databases were searched using appropriate keywords from 2012 to 2022. Observational studies, randomized controlled trials, and quality improvement studies with data on the precataract H&P were included. Outcome measures were adverse events, cost, and patient experience. Of the 4,170 studies screened, 12 studies were included. Risk stratification of patients into a high-risk group with an H&P and a low-risk group without an H&P resulted in an increased incidence of minor adverse events in the low-risk group but did not increase the incidence of major adverse events or surgical adverse events. A short-term cost savings was reported, and patient experience was unchanged. In 2020, the Centers for Medicare and Medicaid Services removed the requirement for the precataract H&P within 30 days prior to ambulatory surgery, which has implications for surgery center policy. More research on the role of the preoperative H&P on patient experience, adverse events, cost, and outcomes should be conducted, given the methodological heterogeneity of this review.
Subject(s)
Cataract Extraction , Cataract , Aged , United States , Humans , Medicare , Cost Savings , Physical ExaminationABSTRACT
PURPOSE: To report a case of Ahmed tube exposure secondary to Prokera implantation. METHODS: Case report. RESULTS: We present a 48-year-old woman who developed tube erosion after penetrating keratoplasty and Prokera implantation for dense vascularized corneal scar. The patient subsequently underwent wound revision with repeat scleral patch graft and closure of the conjunctival defect. CONCLUSIONS: The case presented demonstrates that caution should be exercised in using this implant in patients who have irregular elevations of the ocular surface because of glaucoma drainage devices.
