Assessing the feasibility and the acceptability of outpatient retinal detachment surgery

Purpose. - To assess the feasibility and acceptability of outpatient care for patients undergoing surgery for retinal detachment. Patients and methods. - Patients successively undergoing retinal detachment surgery between January and November 2012 were prospectively included. Patient age, distance from home, type of detachment, surgical technique, postoperative intravenous medications if applicable, pain as evaluated on the visual analogue scale (VAS), slit lamp findings on the day of surgery (D0) and the next day (D1), the presence of another person in the home, comprehension of instructions, the patient's physical abilities and adherence to outpatient treatment were recorded. Results. - Forty-six surgeries on 17 women and 28 men, including 2 one-eyed patients, with a mean age of 62 years (+/- 16.6; 19-95), were studied. The mean distance from home was 78 km (+/- 108; 1-490 km). The surgery was performed ab-interno in 44 cases (40 transconjunctival, 4 cases of disinsertion with placement of a buckle) and ab-externo in 2 cases; under general anesthesia in 40 cases and local/regional anesthesia in 6 cases. Five cases were recurrent detachments, lensectomy was performed in 6 cases, internal gas tamponade was performed in the majority of cases (4 with silicone oil and 1 without tamponade). Functional signs were absent or limited to simple discomfort in 95.7% of cases on D0 as well as D1. The mean VAS at D0 was very low, described as 0.32/10 (0-8) and 0.63/10 (0-5) at D1. Two patients vomited on D0 and one on D1. Mean intraocular pressure was 12.8 mmHg (+/- 4.4; 4-24) at D0 and 17.6 mmHg (+/- 6.3; 8-34) at D1. The retina was visible in 91.3% of cases on D0 and 89.1% of cases on D1. Sleepiness was present in 3 cases (6.5%) at the D0 exam, and returning home was impossible without assistance from a third party in 4 cases (8.7%) (this incapacity was permanent or related to the patient's one-eyed status in all cases). The instructions for proper positioning were assimilated by all patients on D0, and no intravenous treatment was necessary after awakening. A companion was present at home in 78.3% (n = 36) of cases; 87% (n = 40) of the patients felt they could return home on D0 had it been necessary, with an early return home even desired by 32.6% (n = 15) of the patients. Discussion. - The changes in surgical management of retinal detachment patients and the appearance in France of a specific fee schedule now make it possible to consider ambulatory treatment of patients with retinal detachment. Conclusion. - Outpatient management of retinal detachment patients appears perfectly feasible and acceptable according to this study. (C) 2013 Elsevier Masson SAS. All rights reserved.