Christina Y. Weng, MD, MBA, FASRS, on comparative study of postop day 0 and day 1 exams

Christina Y. Weng, MD, MBA, FASRS, shares insights into her ASRS 2025 presentation.

Christina Y. Weng, MD, MBA, FASRS, a professor of ophthalmology at Baylor College of Medicine in Houston, Texas, spoke with Modern Retina about her presentation at the American Society of Retina Specialists (ASRS) meeting. This meeting is taking place from July 30 through August 2, 2025.

Her presentation is titled, "Postoperative Day 0 as a Substitute for Postoperative Day 1 Examination Following Vitreoretinal Surgery: A Comparative Prospective Study." This research examines the real-life need to conduct day 0 postop exams and how patients present similarly or differently on day 0 to day 1 postop exams.

Note: The following presentation explanation and review of data has been lightly edited for clarity.

Christina Y. Weng, MD, MBA, FASRS: I am presenting a paper that's comparing exam findings on postoperative day 0 and postoperative day 1, following vitreoretinal surgery. And I'd also like to acknowledge my coauthors, Dr Will Park and Dr Lupe Torres.

There's been a lot of interest in this topic, because every vitreoretinal surgeon has encountered situations where a postop, day 1 exam just simply isn't feasible. And I'll give you 2 real examples of patients of mine. I had a patient from New Orleans who lives 5 hours away from the surgery center, and her caretaker was unable to drive her back the next day after emergent surgery. Another example I think of is a few years ago when one of my longtime patients had a mac-on retinal detachment on a Friday, and I had an early flight I had to catch on Saturday morning, but she really, really wanted to have surgery with me. So in these types of situations, many of us have wondered, "Is it okay to see the patient on postoperative day 0 instead of day 1?"

That's what this study explores. This was a prospective study of eyes operated on by 2 retina surgeons that were seen on both postop day 0 and again on postop day 1. On each of the days, we collected 5 main outcomes of interest, intraocular pressure, visual acuity, postop complications, pain level, and view of retina. So what do we find?

So as a nod to my pilot series, launching scene with Modern Retina, The TLDR, is that a postop day 0 exam may be a safe and effective substitute for the traditional postop day 1 exam. More specifically, we included 90 eyes with a variety of conditions, with the most common being vitreous hemorrhage, tractional retinal detachment, and rhegmatogenous retinal detachment, over half received gas or oil tamponade. The mean time from the end of surgery to the postop day 0 evaluation was about 7 hours. So if a case ended at 9 AM, let's say, we saw them at 4 PM later that day.

Now walking through each of these 5 outcome measures, we found that the visual acuity did improve slightly from day 0 to day 1, probably in due part to the retrobulbar block wearing off. On average, the IOP did increase from 13.8 to 17.5 mm of mercury from day 0 to day 1. But both values, as you can see, were obviously in the normal range. More eyes had IOP elevation on day 1 compared to day 0, but the proportion of eyes with IOP 30 or greater was small and comparable between the 2 days. And of course, what we really want to know is how many eyes had an IOP that was okay on day 0, but then high on day 1. This happened in 9 eyes out of the 90, and regression analysis showed an association with IOL placement, TRD primary diagnosis, or C3F8, gas use. And even so, none of these 9 eyes had an IOP that exceeded 34. There were also no differences in pain levels, visualization of the retina, or postop complications, and there were no cases of endophthalmitis.

So to recap, the postop day 1 exam, while it's important, can occasionally pose real-life challenges, and there have been a number of smaller retrospective studies published on this topic. But what's unique about our study is that it looks at the same patient cohort on both days, and we found that the risk of developing significant complications on postop day 1 after an exam on postop day 0 is low. In fact, the only clinically meaningful differences were with IOP, and they affected a small proportion of eyes only.

Of course, we have sample size limitations and the case mix variability, but our finding support that a postop day 0 exam is a safe and effective substitute for the traditional postop day 1 exam.