ASRS 2025: Post-op day 0 vs day 1 exams

Christina Weng, MD, MBA, FASRS, gave a presentation at the ASRS 2025 conference in Long Beach, California, that focused on a study comparing post-operative examinations on day 0 and day 1 following vitreoretinal surgery. Conducted with co-authors Dr. Will Park and Dr. Lupe Torres, the research addressed a critical challenge faced by ophthalmologists: the practical difficulties of conducting consistent post-operative follow-up exams.

The prospective study examined 90 eyes with various conditions, primarily vitreous hemorrhage, tractional retinal detachment, and rhegmatogenous retinal detachment. Over half of the patients received gas or oil tamponade, with the average time between surgery and day 0 evaluation being approximately 7 hours. The research investigated five key outcome measures: intraocular pressure (IOP), visual acuity, post-operative complications, pain level, and retinal visualization. Key findings revealed subtle but important insights:

1. Visual acuity showed a slight improvement from day 0 to day 1, likely due to the retrobulbar block wearing off.
2. IOP increased from 13.8 to 17.5 mmHg, with both days remaining within normal ranges.
3. 9 out of 90 eyes demonstrated IOP elevation from day 0 to day 1, with associations found with IOL placement, TRD primary diagnosis, or C3F8 gas use.
4. No significant differences were observed in pain levels, retinal visualization, or post-operative complications.
5. Critically, no endophthalmitis cases were reported.

Weng highlighted real-world scenarios that inspired the research, such as patients traveling long distances or surgeons with scheduling constraints. The study's unique approach of examining the same patient cohort on both days provides valuable insights into post-operative care flexibility. The primary conclusion suggests that a post-operative day 0 exam can be a safe and effective alternative to the traditional day 1 exam. While acknowledging limitations in sample size and case mix variability, the research offers promising implications for improving patient care and surgical follow-up protocols in vitreoretinal surgery.