Sequential Bilateral Cataract Surgery Research Articles

Implementing immediate sequential bilateral cataract surgery at Buckinghamshire Healthcare NHS Trust.

Immediate sequential bilateral cataract surgery (ISBCS) was first introduced into NICE guidelines in 2017. In this approach, patients undergo cataract surgery on both eyes on the same day. Although increasingly popular, only 0.5% of all cataract operations nationally are performed using this approach. We redesigned our service to routinely offer ISBCS and are now one of the leading NHS providers of ISBCS in the UK. We audited our cataract operations in 2022 and report our initial experiences with ISBCS here. We redesigned our cataract service to routinely offer ISBCS on the NHS. We audited all cataract operations performed in calendar year 2022. We performed 4652 NHS cataract operations including 498 (10.7%) operations on 249 patients using the ISBCS approach. Trainee surgeons performed 32.5% of these cases. There were two intraoperative complications, both during the second eye operation. One was a suspected suprachoroidal haemorrhage and the other was a posterior capsular rupture post lens implantation. Post-operatively there was one case of retinal detachment requiring vitrectomy following uncomplicated ISBCS and five cases of Irvine-Gass syndrome that were managed medically. From this data, ISBCS does not pose a greater risk to patients in terms of complications. Allowing trainees to operate on ISBCS cases improves the trainee experience. With appropriate pre-operative counselling, patients listed for unilateral surgery can be converted to ISBCS on the day of operation to fully utilise theatre capacity. Patients listed for ISBCS can also be converted to unilateral surgery on the day of operation when surgeons need time to deal with complications safely.

Trends in immediate sequential bilateral cataract surgery in Ontario

ObjectiveBecause of increased evidence for safety and increased demands, there appears to be a recent adoption and endorsement of immediate sequential bilateral cataract surgery (ISBCS). This study aims to determine whether a paradigm shift has occurred in the delivery of cataract surgery in the province of Ontario and its the extent, if any, and to analyze the current role of ISBCS. DesignRetrospective health records analysis. MethodsWe analyzed aggregate Ontario Health Insurance Plan claim counts for cataract surgeries between 2016 and 2022, categorizing cases into unilateral, ISBCS, and delayed sequential bilateral cataract surgery (DSBCS) cases. We examined trends, compared wait times for second surgeries in the DSBCS cohort with wait times for first surgeries, and used previously published cost estimates for ISBCS to estimate annual savings in Ontario. ResultsThere were 1,122 ISBCS cases in 2016, which increased sixfold during the pandemic (2020–2021) and further increased to 11,876 cases in 2022. Unilateral and DSBCS cases decreased during the pandemic but rebounded in 2022 to 102% and 153% of baseline, respectively. ISBCS increased from 1% to 10%, unilateral cases decreased from 41% to 29% of total cases, and DSBCS increased from 58% to 61%. Median wait for patients’ first and second surgeries increased from 65 to 87 days and 28 to 33 days, respectively. Using estimates, ISBCS saved approximately $19 million in 2022. ConclusionOur study demonstrates a paradigm shift in Ontario in favour of ISBCS. ISBCS also may be a strategy to reduce increasing wait times while saving health care system dollars.

Raised intraocular pressure after immediate sequential bilateral cataract surgery with EyeCee one intraocular lens

PurposeThe Medicine and Healthcare products Regulatory Agency (MHRA) reported cases of high intraocular pressure (IOP) after implantation of affected batch numbers of EyeCee One intraocular lens (EC1IOL). In our institution we offered Immediate Sequential Bilateral Cataract Surgery (ISBCS) with EC1IOL and here we examine the rate of raised IOP, management of cases and outcomes of this group. DesignRetrospective case series review. MethodsA search of our electronic patient record system identified 27 patients who had ISBCS with EC1IOL. Patients with IOP ≥30 mmHg at a post op visit were identified as the “spike” group and a case series review performed. Results43 eyes (27 patients) had an affected batch number of EC1IOL implanted during ISBCS, 16 patients had an affected lens in both eyes and 11 in one eye. 7% (3 eyes of 3 patients) had a post op IOP spike (average 51.9 mmHg) at a post-op visit felt to be EC1IOL related. Patients required immediate treatment, an average of 3.33 regular topical IOP lowering agents and 5 outpatient appointments. Using the fellow eye as a control comparison, 2 out of the 3 eyes in the spike group had less visual improvement. 1 eye in the spike group lost 0.2 LogMAR lines. ConclusionsWe found a greater rate EC1IOL related IOP spikes than the MRHA reports. There was a trend towards less visual gain post operatively in patients who had a spike, but due to small numbers meaningful statistical analysis cannot be performed. Surgical intervention was not required in this cohort.

Immediate Sequential Bilateral Cataract Surgery in Patients with Bilateral Visually Significant Cataracts.

To report our experience of performing immediate sequential bilateral cataract surgery (ISBCS) in patients with visually significant cataracts and reduced preoperative corrected distance visual acuity (CDVA). Data of patients who underwent ISBCS for visually significant cataracts and had preoperative CDVA ≤20/32 (≤0.2 logMAR) in each eye were retrospectively reviewed. Refractive and visual outcomes were evaluated for the last available postoperative visit. Intraoperative and serious postoperative adverse events occurring within the first three months of surgery were reviewed. A total of 1335 patients (2670 eyes) were included in the analysis, with a mean age of 71.9 ± 9.5 years. On the last visit, 50.2% and 89.1% of eyes achieved uncorrected distance visual acuity (UDVA) ≥20/20 (0.0 logMAR) and ≥20/32 (0.2 logMAR), respectively. Of all eyes, 83.8% were within ±0.50D, and 96.4% were within ±1.00 D of emmetropia. Ten patients had postoperative bilateral ametropia of more than 1.00D in each eye, but eight of them still achieved binocular UDVA ≥20/40. Intraoperative events occurred in 14 eyes of 13 patients (per-eye incidence: 0.524% or 1 in 191 eyes). A total of 86 postoperative adverse events occurred in 80 eyes of 53 patients (per-eye incidence 2.996% or 1 in 33 eyes), of which cystoid macular edema was the most common. Only three eyes had CDVA reduced by more than two Snellen lines compared to preoperative CDVA, two of which were not related to cataract surgery. There was no patient with bilateral CDVA loss. In our cohort of patients with visually significant cataracts, ISBCS resulted in good refractive predictability and a low incidence of serious adverse events.

Refractive outcomes of immediately sequential bilateral cataract surgery in eyes with long and short axial lengths

PurposeTo report the refractive outcomes of long (≥25.00 mm) and short (≤22.00 mm) axial length (AL) eyes undergoing immediately sequential bilateral cataract surgery (ISBCS).MethodsIn this retrospective cohort study, patients who underwent ISBCS were identified and eyes of patients with bilateral long and short ALs were included. Pre- and postoperative biometry, autorefraction, and ocular comorbidities or complications were recorded. The primary outcome was the mean refractive prediction error.ResultsThirty-seven patients (74 eyes) with long ALs and 18 patients (36 eyes) with short ALs were included. The means ± standard deviations of the ALs were 26.40 ± 1.38 mm and 21.44 ± 0.46 mm in the long and short AL groups, respectively. In long AL eyes, the mean absolute error from the biometry-predicted refraction was − 0.16 ± 0.46 D, corresponding to 74% of eyes achieving a refraction within ±0.50 D of the predicted value. In short AL eyes, the mean absolute error was − 0.63 ± 0.73 D, corresponding to 44% of eyes achieving a refraction within ±0.50 D of the predicted value. Eight (44.4%) patients with short AL eyes had a myopic deviation greater than ±0.50 D from the predicted result in both eyes.ConclusionsCompared to patients with long AL eyes, ISBCS in patients with short ALs had a wider variance in refractive outcome and a lower rate of achieving a postoperative refraction within ±0.50 D of the predicted target.

Immediate Bilateral Sequential Cataract Surgery (IBSCS): Special Procedure for Specific Patients

Abstract
 Introduction & Objectives : Immediate Bilateral Sequential Cataract Surgery (IBSCS) are still controversial topic in Ophthalmology. This paper aims to report the outcome and the efficacy of Immediate Bilateral Sequential Cataract Surgery in writer’s experience.
 Methods : This paper collects datas from 150 patients that underwent IBSCS. The procedure was done if patient have one or more from these criteria: live far away from hospital, difficult to mobilize to hospital, extreme urgency to return to work as fast as possible (daily paid worker), and if general anesthesia was used. The exclusion criterias were if there was intraoperative complication during the 1st eye, any posterior segment abnormality, and in complicated cataract cases (bad cornea, glaucoma eyes, small pupil eye, zonular loss / weakness, post uveitic eye). During intraoperative, after the 1st eye was finished all instruments and consumable was changed before proceed to the second eye.
 Results : From 150 patients, there were 0 (zero) case of endophthalmitis. At 7th days post op results all patients achieve normal range pressures, quiet anterior chamber, and good visual acuity improvement.
 Conclusion : Immediate Bilateral Sequential Cataract Surgery is not less safe than traditional delayed sequential cataract surgery. IBSCS definitely should be considered when encountered with specific patients and specific needs.

Cytokines in aqueous humor of patients with congenital cataract during delayed sequential bilateral cataract surgery

BackgroundTo explore the changes of cytokines expression in aqueous humor (AH) of eyes of patients with congenital cataract (CC) who underwent delayed sequential bilateral cataract surgery (DSBCS).Methods28 patients with CC underwent DSBCS. AH samples were collected from each eye before surgery. The contents of cytokines in AH were detected by Luminex xMAP Technology.ResultsThere was no significant difference in the expression of IL-8, IP-10, MCP-1 and PDGFAA in the AH of the first and second eyes (P = 0.35, 0.39, 0.17, respectively). The level of IL-8 in the first-eye AH was negatively correlated with age (ρ=– 0.519, P = 0.008). IP-10 and MCP-1 in the second-eye AH were negatively correlated with age (ρ=– 0.483, P = 0.009; ρ=– 0.445, P = 0.018,respectively).ConclusionThe first-eye surgery in patients with CC may not cause the change of cytokines in the contralateral eye. The expression of IL-8, IP-10 and MCP-1 in the AH was negatively correlated with the age of patients.Trial registrationThe study was registered at www.chictr.org.cn on March 22, 2022 and the clinical trial number is ChiCTR2200057927.

Patient’s Perception Regarding Vision Related Quality of Life in Immediate Sequential and Delayed Sequential Bilateral Cataract Surgery

Cataract is the main cause of visual impairment and treatable blindness in the world and surgery can restore normal sight to the patients. In bilateral cataract patient, surgery in the second eye is as important and meaningful as surgery in the first eye and it can be performed by immediate sequential (ISBCS) and delayed sequential bilateral cataract surgery (DSBCS). There is no statistically significant difference in surgical complications, visual acuity or long term self-perceived visual function between these two methods. To adopt surgical procedure, to improve the patient’s satisfaction and to improve the quality of services, patient opinion should be a great concern. This evaluative study was done to find out various recommendations and suggestions from patients regarding merits & demerits of both types of cataract surgery that will be helpful for the decision-maker and administrator for future practice of cataract surgery in Canada. In this study, vision related quality of life improved in both groups. Participants in DSBCS group experienced different types of difficulties during the gap period between first eye and second eye cataract surgery i.e. visual imbalance between the two eyes and difficulty in driving. They recommended and suggested that cataract surgery wait time should be reduced and the difficulties experienced during the gap period can be eliminated by adopting ISBCS procedure. Bangabandhu Sheikh Mujib Med. Coll. J. 2023;2(1): 07-13

Immediate sequential vs. delayed sequential bilateral cataract surgery: a systematic review and meta-analysis.

The main aim of this Systematic Review and Meta-analysis was to evaluate the safety and efficacy profile of immediate sequential bilateral cataract surgery (ISBCS) compared to delayed sequential bilateral cataract surgery (DSBCS). MEDLINE Ovid, EMBASE, and CENTRAL databases were searched. Outcome measures were post-operative visual acuity, post-operative spherical equivalent (refractive outcome), endophthalmitis, corneal edema, pseudophakic macular edema and posterior capsule rupture. Thirteen articles met criteria for final inclusion. A total of 11,068,622 participants (18,802,043 eyes) were included. No statistically significant differences between ISBCS or DSBCS was identified in all the postoperative outcomes evaluated. However, a higher risk for posterior capsule rupture was identified in the ISBCS group from the pooled analysis of NRSs (RR: 1.34, 95% CI: 1.08 - 1.67, p = 0.0081). In our view, the ISBCS approach has an acceptable safety-efficacy profile, comparable to DSBCS. Future investigations are warranted, with a focus on the analysis of risk factors for surgical complications, patient-reported outcome-measures, and cost effectiveness.

Comparison of Efficacy and Safety between Immediate Sequential and Delayed Sequential Bilateral Cataract Surgery

Purpose: We compared the efficacy and safety of immediate sequential bilateral cataract surgery (ISBCS) and delayed sequential bilateral cataract surgery (DSBCS).Methods: We analyzed the best corrected visual acuity (BCVA), spherical equivalent (SE), and mean absolute error (MAE) in the ISBSC and DSBSC groups. The study population comprised 72 patients (144 eyes) who underwent ISBCS and 92 patients (184 eyes) who underwent DSBCS at Seoul St. Mary's Hospital between January 2019 and December 2021.Results: At 1 month postoperatively, the ISBCS group demonstrated a BCVA, SE, and MAE of 0.11 ± 0.09, -0.33 ± 0.42 diopters (D), and 0.38 ± 0.32 D, respectively; similarly, the DSBCS group exhibited a BCVA, SE, and MAE of 0.11 ± 0.15, -0.29 ± 0.56 D, and 0.41 ± 0.43 D, respectively. Furthermore, no significant differences were observed between the ISBCS and the DSBCS groups regarding SE and MAE at the 1-month follow-up for the first and second operated eyes. No cases of postoperative endophthalmitis and toxic anterior segment syndrome were reported.Conclusions: ISBCS is an effective and cost-effective approach that yields favorable postoperative outcomes when performed by an experienced surgeon supported by appropriate pre- and postoperative care, particularly in patients who demonstrate good cooperation.

A quality analysis of internet patient information for immediate, sequential, bilateral cataract surgery (ISBCS).

Due to surgical capacity pressures, induced by the COVID-19 pandemic, immediate bilateral simultaneous cataract surgery (ISBCS) has been utilised increasingly throughout the U.K. This surgical method comes with both novel risks and benefits, so the consent process must be modified. Prior randomised trials have demonstrated that appropriate online information may act as an adjunct to the surgical consent process. This study aims to assess the quality of available internet information for ISBCS. Terms searched were 'bilateral cataract surgery patient information', 'double cataract surgery patient information', and 'immediate sequential bilateral cataract surgery patient information'. The Google search engine was used. The DISCERN instrument and JAMA benchmarks were used to assess healthcare information for quality. The Flesch Reading Ease Score (FRE), Flesch Kincaid Grade (FKG) Level and Gunning Fog Score (GFS) were used to assess for readability. HONcode certification was used to assess transparency and quality. Forty-six websites were found. The average DISCERN score was 41.3, meaning a "fair" quality which is below what many patients would anticipate discovering when trying to find information. National Healthcare Service websites had higher DISCERN scores than private healthcare-provided websites (p < 0.01; 95% CI: 1.13-1.88.). Fair patient information for ISBCS has been demonstrated. Specific internet information sources with appropriate information should be further developed, with cited sources, and patients signposted to them if felt appropriate.

Time and Motion Studies to assess surgical productivity in cataract theatre lists within the National Health Service: Immediate Sequential Bilateral Cataract Surgery versus Delayed Sequential Bilateral Cataract Surgery.

To compare productivity of National Health Service cataract lists performing unilateral cataract (UC) surgery vs Immediate Sequential Bilateral Cataract Surgery (ISBCS). Five 4-hour lists with ISBCS cases and five with UC were observed using time and motion studies (TMS). Individual tasks and timings of each staff member in theatre was recorded by two observers. All operations were performed by consultant surgeons under local anaesthesia (LA). Median number of eyes operated per 4-hour list was 8 (range 6-8) in the ISBCS group and 5 (5-7) in the UC group (p = 0.028). Mean total theatre time (defined as time between the entry of the first patient and the exit of the last patient from theatre) was 177.12 (SD 73.62) minutes in the ISBCS group and 139.16 (SD 47.73) minutes in the UC group (p = 0.36). Mean time to complete two consecutive unilateral cataract surgery operations was 48.71 minutes compared to 42.23 minutes for a single ISBCS case (13.30% time saved). Based on our collected TMS data, a possible 5 consecutive ISBCS cases and 1 UC (total 11 cataract surgeries) could be performed during a four-hour theatre session, with a theatre utilisation quotient of 97.20%, contrasting to nine consecutive UC, with a theatre utilisation quotient of 90.40%. Performing consecutive ISBCS cases under LA on routine cataract surgery lists can increase surgical efficiency. TMS are a useful way to investigate surgical productivity and test theoretical models for efficiency improvements.

Perception of Canadian ophthalmologists on immediately sequential bilateral cataract surgery: insights and implications

ObjectifÉvaluer la perception des ophtalmologistes canadiens en ce qui a trait à la chirurgie de la cataracte bilatérale immédiatement séquentielle (CCBIS). NatureSondage anonyme envoyé à tous les membres actifs de la Société canadienne d'ophtalmologie. MéthodesOn a ainsi obtenu de l'information sur les aspects suivants : données démographiques de base, types de pratique professionnelle en lien avec la chirurgie de la cataracte, avantages, inconvénients et préoccupations en lien avec la CCBIS. RésultatsAu total, 352 ophtalmologistes ont répondu au sondage. De ce nombre, 94 répondants (27 %) réalisent régulièrement des CCBIS, 123 (35 %) réalisent des CCBIS à titre exceptionnel et 131 (37 %) ne réalisent jamais de CCBIS. Les ophtalmologistes qui réalisent des CCBIS sont significativement plus jeunes que ceux qui n'en réalisent jamais (p < 0,001) et sont actifs depuis moins longtemps (p < 0,001). La prévalence des ophtalmologistes qui réalisent des CCBIS varie significativement en fonction de la province (p < 0,001) : la plupart des ophtalmologistes qui réalisent couramment des CCBIS proviennent du Québec (n = 44; 48 %), endroit où les mesures de dissuasion financière sont les moins corsées au pays. Les CCBIS sont le plus souvent réalisées dans des centres universitaires (n = 39; 42 %), plutôt que dans des cliniques privées ou communautaires (p < 0,001). Le principal motif justifiant le recours à la CCBIS tient à une utilisation plus efficace des blocs opératoires (n = 142; 65 %). Le risque de complications bilatérales (n = 193; 57 %) et l'absence de résultats réfractifs dans le premier œil au moment de réaliser l'intervention dans le deuxième œil (n = 184; 52 %) constituent les préoccupations principales en lien avec la CCBIS. La pandémie de COVID-19 a eu un effet positif sur la perception de 152 répondants (43 %) à cet égard; il s'agit surtout des ophtalmologistes qui réalisaient déjà régulièrement des CCBIS (n = 77; 84 %). ConclusionsLes ophtalmologistes qui réalisent des CCBIS sont susceptibles d’être plus jeunes et de travailler dans des centres universitaires. Le Québec a la prévalence la plus élevée d'ophtalmologistes qui réalisent des CCBIS. En raison de la pandémie de COVID-19, les ophtalmologistes qui réalisaient déjà des CCBIS se sont mis à en réaliser encore plus, comparativement à ceux qui n'en réalisaient jamais.

Visual outcomes and rotational stability of a new non-diffractive extended-vision toric intraocular lens

ObjectiveTo evaluate visual outcomes and intraocular lens (IOL) rotational stability of patients undergoing immediate sequential bilateral cataract surgery with a non-diffractive extended-depth-of-focus toric IOL. DesignNon-comparative single-centre cohort study. ParticipantsTwenty patients (40 eyes) with significant cataracts and corneal astigmatism who underwent immediate sequential bilateral cataract surgery with the AcrySof IQ Vivity Extended Vision Lens (Alcon Laboratories Inc, Fort Worth, Tex.). MethodsBinocular uncorrected visual acuities (UCVA) and monocular best-corrected visual acuities (BCVA) were assessed at distance (6 m), intermediate (66 cm), and near (40 cm) postoperatively at 1 week and 3 months. The rotational stability of each IOL was assessed at 1 day, 1 week, and 3 months postoperatively. A validated questionnaire (Questionnaire for Visual Disturbances [QUVID]) was used for patient-reported subjective visual disturbances preoperatively at a 3-month follow-up. ResultsBinocular distance, intermediate, and near UCVAs (mean ± SD) were 0.00 ± 0.16, 0.09 ± 0.08, and 0.14 ± 0.11 logMAR at 1 week and 0.01 ± 0.06, 0.08 ± 0.08, and 0.14 ± 0.07 logMAR at 3 months postoperatively, respectively. Distance monocular BCVA improved from 0.22 ± 0.23 logMAR preoperatively to 0.02 ± 0.06 logMAR at 3 months. Monocular BCVAs at 3 months were 0.08 ± 0.08 logMAR at intermediate distance and 0.05 ± 0.08 logMAR at near distance. IOL rotation from the intended placement axis was 2.5 ± 1.7 degrees at 1 week and 1.7 ± 1.7 degrees at 3 months postoperatively. ConclusionsThe AcrySof IQ Vivity Extended Vision IOL achieved good UCVAs and BCVAs for distance, intermediate, and near vision. This IOL also provided excellent rotational stability for astigmatism correction.

Best fit formula approach in delayed sequential bilateral cataract surgery.

We evaluated whether the best-fit intraocular lens (IOL) power formula for the first operated eye (BF1) was also the most accurate formula for the second eye. This was a retrospective study of 152 patients who underwent uncomplicated delayed bilateral cataract surgery with a minimum delay of 3 weeks using only one 1-piece IOL (HOYA, Vivinex) at the Medical University of Vienna, Austria. Seven different formulae (Barrett Universal II, Castrop, Haigis, Hoffer Q, Holladay 1, Kane, and SRK/T) were investigated to test the formula selection approach with regard to the calculated mean and median absolute prediction errors (MAE/MedAE). The mean intraindividual difference in axial length was 0.2 mm (±0.3 mm). BF1 coincided with the best-fit formula for the second eye (BF2) in 56% of patients (p < 0.05). Using BF1 for the second eye led to a lower MedAE (0.22 dioptre, D) than using a formula at random (0.33 D) and was less accurate than using the best-fit formula for each eye separately (0.1 D). The MedAEs of all formulae were generally low, ranging from 0.28 to 0.35 D. Using BF1 for the second eye led to a lower MedAE than the random selection of a formula. Therefore, BF1 can be used for the second eye if the surgeon is unsure of the choice of formula.

Immediate sequential bilateral cataract surgery is a reasonable and safe option during a pandemic

To evaluate the preoperative and intraoperative features, intraoperative and postoperative complications and postoperative satisfaction of patients who underwent immediate sequential bilateral cataract surgery (ISBCS) during the COVID-19 pandemic. The study included ISBCS patients from September 2021 through January 2022. Demographics, comorbidities, type of anesthesia (topical/general), intraoperative complications, postoperative refractive errors, and complications were examined. The one-month postoperative appointment included a patient satisfaction questionnaire. ISBCS was performed in 206 eyes of 103 patients. Intraoperative complications did not occur in 99 (96.1%) of ISBCS patients. No patients had visually significant corneal edema, wound leakage, endophthalmitis, or toxic anterior segment syndrome during postoperative follow-up. Final manifest spherical equivalent refraction was less than 1.00 D in all patients and less than 0.50 D in 70.7% of patients. In the questionnaire given to the patients at the one-month follow-up, 96.1% of patients did not change their preference for surgery on the same day. ISBCS provides an advantage during the pandemic period by reducing hospital visits, especially for the elderly population and patients with comorbidities. ISBCS is a safe and reasonable method that can be used during a pandemic due to the low rates of complications, the success of the refractive results, and the high patient satisfaction rates.

Immediate versus delayed sequential bilateral cataract surgery

Thanks to progress in surgical techniques and intracameral antibiotic use, the safety of cataract removal procedures has improved substantially. 1 Friling E Johansson B Lundström M Montan P Postoperative endophthalmitis in immediate sequential bilateral cataract surgery: a nationwide registry study. Ophthalmology. 2022; 129: 26-34 Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar Immediate sequential bilateral cataract surgery (ISBCS) is a procedure during which a cataract is removed from both eyes of a single patient during the same surgery, compared with delayed sequential bilateral cataract surgery (DSBCS) in which a cataract is removed sequentially within a certain timespan. 2 Malvankar-Mehta MS Chen YN Patel S Leung AP Merchea MM Hodge WG Immediate versus delayed sequential bilateral cataract surgery: a systematic review and meta-analysis. PLoS One. 2015; 10e0131857 Crossref Scopus (31) Google Scholar ISBCS offers multiple benefits from societal, health-care, psychological, and economic perspectives. Among these benefits, the reduction in the number of visits to the clinic appears to be of utmost importance, especially during the COVID-19 pandemic. 3 Dmuchowska DA Pieklarz B Konopinska J Mariak Z Obuchowska I Impact of three waves of the COVID-19 pandemic on the rate of elective cataract surgeries at a tertiary referral center: a Polish perspective. Int J Environ Res Public Health. 2021; 188608 Crossref Scopus (8) Google Scholar Safety, effectiveness, and cost-effectiveness of immediate versus delayed sequential bilateral cataract surgery in the Netherlands (BICAT-NL study): a multicentre, non-inferiority, randomised controlled trialOur results showed non-inferiority of ISBCS versus DSBCS regarding effectiveness outcomes, comparable safety, and superior cost-effectiveness of ISBCS. National cost savings could amount to €27·4 million (US$34·5 million) annually, advocating for ISBCS if strict inclusion criteria are applied. Full-Text PDF

Safety, effectiveness, and cost-effectiveness of immediate versus delayed sequential bilateral cataract surgery in the Netherlands (BICAT-NL study): a multicentre, non-inferiority, randomised controlled trial

In an ageing population, efficiency improvements are required to assure future accessibility of cataract care. We aim to address remaining knowledge gaps by evaluating the safety, effectiveness, and cost-effectiveness of immediate sequential bilateral cataract surgery (ISBCS) versus delayed sequential bilateral cataract surgery (DSBCS). We hypothesised that ISBCS is non-inferior to DSBCS, regarding safety and effectiveness, and being superior in cost-effectiveness. We did a multicentre, non-inferiority, randomised controlled trial, which included participants from ten Dutch hospitals. Eligible participants were 18 years or older, underwent expected uncomplicated surgery, and had no increased risk of endophthalmitis or refractive surprise. Participants were randomly assigned (1:1) to either the ISBCS (intervention) group or DSBCS (conventional procedure) group, using a web-based system stratified by centre and axial length. Participants and outcome assessors were not masked to the treatment groups because of the nature of the intervention. The primary outcome was the proportion of second eyes with a target refractive outcome of 1·0 dioptre (D) or less 4 weeks postoperatively, with a non-inferiority margin of -5% for ISBCS versus DSBCS. For the trial-based economic evaluation, the primary endpoint was the incremental societal costs per quality-adjusted life-year. All analyses were done by a modified intention-to-treat principle. Costs were calculated by multiplying volumes of resource use with unit cost prices and converted to 2020 Euros (€) and US$. This study was registered with ClinicalTrials.gov, number NCT03400124, and is now closed for recruitment. Between Sept 4, 2018, and July 10, 2020, a total of 865 patients were randomly assigned to either the ISBCS group (427 [49%] patients; 854 eyes) or DSBCS group (438 [51%] patients; 876 eyes). In the modified intention-to-treat analysis, the proportion of second eyes with a target refraction of 1·0 D or less was 97% (404 of 417 patients) in the ISBCS group versus 98% (407 of 417) in the DSBCS group. The percentage difference was -1% (90% CI -3 to 1; p=0·526), thereby establishing non-inferiority for ISBCS compared with DSBCS. Endophthalmitis was not observed or reported in either group. Adverse events were comparable between groups, with only a significant difference in disturbing anisometropia (p=0·0001). Societal costs were €403 (US$507) lower with ISBCS than with DSBCS. The cost-effectiveness probability of ISBCS versus DSBCS was 100% across the willingness-to-pay range of €2500-80 000 (US$3145-100 629) per quality-adjusted life-year. Our results showed non-inferiority of ISBCS versus DSBCS regarding effectiveness outcomes, comparable safety, and superior cost-effectiveness of ISBCS. National cost savings could amount to €27·4 million (US$34·5 million) annually, advocating for ISBCS if strict inclusion criteria are applied. Research grant from The Netherlands Organization for Health Research and Development (ZonMw) and Dutch Ophthalmological Society.

Ten-year trends of immediate sequential bilateral cataract surgery (ISBCS) as reflected in the Swedish National Cataract Register.

To analyse trends of ISBCS reported to the Swedish National Cataract Register (NCR) over a 10-year period. Since 2010 the NCR contains social security number of all individuals in the list of parameters reported to NCR after each cataract procedure. Bilateral surgeries were mapped out using social security numbers. When dates of both-eye surgeries are identical for an individual it is classified as an immediate sequential bilateral cataract surgery (ISBCS). This study includes all data reported during the period 1st of January 2010 to 31st of December 2019. During the study period 113 cataract surgery clinics affiliated to the NCR reported their data on consecutive cataract cases. For the whole period 54 194 ISBCS were reported. The total number of bilateral cataract extractions was 422 300. There was a significant trend of increasing ISBCS over time with linear regression (Beta = 1.75, p < 0.001). In ISBCS the occurrence of an ocular comorbidity decreased over time. The use of a capsular tension ring was significantly more common in ISBCS than in delayed sequential bilateral cataract surgery (DSBCS). All other measures taken during surgery were more common in DSBCS. The use of multifocal IOL was significantly more frequent in ISBCS compared to DSBCS (p < 0.001). The use of ISBCS has increased over the study period. The operated eyes have less risk factors than eyes going through a DSBCS, but both ocular comorbidities and surgical complications occur in ISBCS eyes.

Comparison of pain perception in patients undergoing manual cataract surgery versus refractive laser-assisted cataract surgery

ObjectifsMesurer la perception de la douleur pendant la chirurgie manuelle de la cataracte comparativement à la chirurgie de la cataracte au laser femtoseconde (CCLF) de même que la perception de la douleur chez des patients qui font l'objet d'une anesthésie à 2 moments différents de la CCLF. Nous avons également évalué les facteurs liés à la perception de la douleur dans ces différents groupes. NatureÉtude comparative de cohorte prospective portant sur une démarche chirurgicale choisie par les patients. ParticipantsPatients devant subir une chirurgie de la cataracte bilatérale séquentielle retardée dans un centre de chirurgie ambulatoire en Ontario. MéthodesLes patients ont été répartis en 3 groupes : une cohorte devant subir une chirurgie manuelle de la cataracte (n = 30) et 2 cohortes devant subir une CCLF, dont l'une soumise à une neuroleptanalgésie tout juste avant le drapage opératoire en vue de la phacoémulsification (cohorte CCLF standard; n = 38) et l'autre, à une neuroleptanalgésie avant le recours au laser femtoseconde (cohorte CCLF hâtive; n = 35). Les paramètres de mesure comprenaient les scores de douleur sur une échelle visuelle analogique au jour postopératoire 0 et à la semaine postopératoire 1. Au nombre des paramètres secondaires, citons les scores d'anxiété, les scores de coopération de la part des patients selon le chirurgien ou l'anesthésiologiste, les variables oculaires et les signes vitaux peropératoires. RésultatsOn n'a pas noté de différence significative quant à la perception de la douleur au jour postopératoire 0 et à la semaine postopératoire 1 entre la cohorte chirurgie manuelle de la cataracte et la cohorte CCLF standard (p = 0,94 et p = 0,72, respectivement), ni entre la cohorte CCLF hâtive et la cohorte CCLF standard (p = 0,76 et p = 0,67, respectivement). Les scores de douleur des patients étaient plus élevés pendant l'intervention touchant le deuxième œil que pendant l'intervention touchant le premier œil. ConclusionsLe type de chirurgie de la cataracte de même que le moment où a lieu l'anesthésie dans le cas de la CCLF n'ont pas d'incidence sur la perception de la douleur en période postopératoire. L'intervention touchant le deuxième œil est associée à des scores de douleur plus élevés que l'intervention touchant le premier œil.