From the Guidelines
Pre-operative screening for eye surgery patients with high ROPLAS positive rates should prioritize a comprehensive retinal assessment and careful evaluation of the external eye, with strict cleaning and disinfection protocols to minimize the risk of infection and complications. The most recent and highest quality study, 1, emphasizes the importance of preventive measures, including careful examination of the external eye, strict cleaning and disinfection, and improved disinfection methods for medical apparatus and instruments.
When considering pre-operative screening, the following key points should be taken into account:
- A comprehensive retinal assessment with optical coherence tomography (OCT), fluorescein angiography, and electroretinography to evaluate outer retinal layer integrity, as high ROPLAS positivity may indicate potential retinal instability 1.
- Patients should undergo visual field testing and contrast sensitivity evaluation to establish baseline function, allowing for the identification of any pre-existing conditions that may impact surgical outcomes.
- Laboratory tests, including complete blood count, coagulation profile, and blood glucose levels, are essential to ensure the patient's overall health and minimize the risk of complications.
- Medication review is crucial, with particular attention to anticoagulants, which may need to be temporarily discontinued 5-7 days before surgery (with physician approval) to reduce the risk of bleeding and hemorrhage.
- Prophylactic topical antibiotics, such as moxifloxacin 0.5% or gatifloxacin 0.3%, should be administered four times daily beginning 3 days before surgery to minimize the risk of infection, as recommended by 1.
- Anti-inflammatory preparations, like prednisolone acetate 1%, should be started 2 days pre-operatively to reduce inflammation and promote healing.
It is also important to consider the patient's preoperative expectations and psychological characteristics, as these can impact satisfaction with surgical outcomes, as noted in 1. By prioritizing a comprehensive retinal assessment, careful evaluation of the external eye, and strict cleaning and disinfection protocols, clinicians can minimize the risk of complications and ensure the best possible outcomes for eye surgery patients with high ROPLAS positive rates.
From the Research
Pre-operative Screening for Eye Surgery Patients with High ROPLAS Positive Rate
- The ROPLAS test is used as a screening tool for chronic dacryocystitis in patients undergoing cataract surgery, with a sensitivity of 93.2% and specificity of 99.3% 2.
- A study found that when ROPLAS is negative, preoperative syringing in cataract surgery may be unnecessary, unless the findings are equivocal or the index of suspicion for chronic dacryocystitis is very high 2.
- There is no direct evidence on the pre-operative screening recommendations for eye surgery patients with a high ROPLAS positive rate, but studies suggest that ROPLAS can be used as a reliable screening tool for nasolacrimal duct obstruction 3.
- The use of preoperative topical nonsteroidal anti-inflammatory drugs (NSAIDs) has been shown to prevent intraoperative prostaglandin level elevation during femtosecond laser-assisted cataract surgery, which may be beneficial for patients with high ROPLAS positive rate 4.
- Perioperative antibiotics and anti-inflammatory agents, such as fluoroquinolones and NSAIDs, are commonly used in cataract surgery to minimize the risk of endophthalmitis and postoperative inflammation 5, 6.
ROPLAS Positive Rate and Post-Cataract Surgery Endophthalmitis
- A study compared the post-cataract endophthalmitis rates among eyes undergoing syringing or ROPLAS test prior to cataract surgery and found that the rates were comparable between the two groups 3.
- The study suggests that ROPLAS can be used as a reliable screening tool for nasolacrimal duct obstruction, and its use may not increase the risk of post-cataract surgery endophthalmitis 3.