Immediately Sequential Bilateral Cataract Surgery Research Articles

Bilateral cataract surgery in children: immediate sequential versus delayed sequential surgery

PurposeTo compare ocular and anesthesia-related complications in a cohort of patients having undergone either delayed sequential bilateral cataract surgery (DSBCS) or immediate sequential bilateral cataract surgery (ISBCS). MethodsThe medical records of children who underwent bilateral cataract surgery at our institution between 2012 and 2021were reviewed retrospectively. Included patients were 0-24 months of age, aphakic, and followed for at least 1 year after surgery. ResultsA total of 56 children were included: 23 underwent ISBCS; 33, DSBCS. Mean age at surgery was 2.6 ± 2.5 months for ISBCS patients and 2.8 ± 3.0 months for DSBCS patients (P = 0.752). Association with systemic diseases was more common in the ISBCS group. The mean anesthesia time per child was shorter in the ISBCS group (P < 0.001), although the mean total procedure time was similar in both groups. The rate of intraoperative anesthesia-related complications and intraocular complications was similar in both groups. There were no cases of endophthalmitis. The mean number of additional surgical interventions per child and the mean number of follow-up visits within 1 year were similar between groups. Children in the ISBCS group required fewer nights of hospital admission (P < 0.001). ConclusionsISBCS in children in this series did not lead to an increased incidence of ocular or anesthesia-related complications compared with DSBCS. ISBCS avoids repeated anesthesia and shortens the total time that the child is under anesthesia.

Immediate sequential bilateral cataract surgery: Prevalence, attitudes and concerns Among Italian ophthalmologists.

to investigate the existing practice patterns of immediate sequential bilateral cataract surgery (ISBCS) in Italy and to assess ophthalmologists' attitudes towards performing ISBCS in the future for cataract treatment. It is a multicenter cross-sectional study. From February,1st 2023 to March, 1st 2023 the Members of the Italian Society of Cataract and Refractive Surgery (AICCER) as well as the attendees of its annual national congress were invited to anonymously complete an electronic 7-item questionnaire on their current ICBCS practice. Questions included the average number of procedures per month, the main indications for ICBCS, and the main reasons for performing and not performing ISBCS. Data were analyzed using descriptive statistics. of the 2300 recipients, 246 (10.7%) completed the survey. Of the respondents, 156 (63.4%) replied to perform ISBCS, most of them (82%) occasionally (1 to 5 procedures per month). Fifty-three percent (130 ophthalmologists) considered adopting ISBCS as routine practice in the near future. The conditions most considered for ISBCS were age-related cataract surgery under general and topical anesthesia and congenital cataract surgery. The availability of separate instruments for the two eyes as well as patient and hospital advantages were the most important reasons for performing ISBCS. The risk of bilateral endophthalmitis and medicolegal issues were the main reasons for not performing ISBCS. ISBCS remains controversial among Italian surgeons, despite growing evidence of its safety and efficacy. The risk of potentially blinding complications such as bilateral endophthalmitis, together with medicolegal concerns are the principal barriers to ISBCS implementation in routine practice.

A survey exploring ophthalmologists' attitudes and beliefs in performing immediate sequential bilateral cataract surgery in Singapore.

To evaluate current practice patterns of Immediate Sequential Bilateral Cataract Surgery (ISBCS) by ophthalmologists in Singapore and assess their attitudes towards performing ISBCS in future cataract care. An anonymised electronic survey, modified to local context from a similar study conducted in the United Kingdom, was distributed to members of the College of Ophthalmologists, Academy of Medicine, Singapore, from 20 June to 1 September 2023. An initial screening question on prior experience with ISBCS directed the rest of the survey. Questions explored ophthalmologists' current ISBCS practice patterns and the importance of factors affecting their willingness to perform ISBCS. Results were descriptively analysed. Results collated 2 months upon survey dissemination saw a total of 58 respondents from 235 eligible members (24.7% response rate). Of these, 16 (27.6%) were currently performing ISBCS, 37 (63.8%) had never performed, and 5 (8.6%) had stopped performing. In considering ISBCS, patient convenience (n = 11, 68.8%) and reduced hospital visits (n = 8, 50.0%) were the most important factors nominated. The most important barriers to performing ISBCS were medico-legal issues (n = 31, 83.8%) and risk of endophthalmitis (n = 27, 73.0%), followed by perceived lack of evidence for its effectiveness (n = 19, 51.4%). This is one of the first studies evaluating ophthalmologists' sentiments towards performing ISBCS in an Asian country. It highlights some of the most pertinent barriers and concerns that ophthalmologists face in performing and offering ISBCS. This study provides a better understanding of the potential role and prospects of ISBCS in future cataract care in Singapore.

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.

Bilateral spontaneous Descemet membrane detachment after uneventful immediate sequential bilateral cataract surgery

Introduction: Immediate sequential bilateral cataract surgery (ISBCS) is a practice on the rise. To the authors' knowledge, this is the first reported case of bilateral Descemet membrane detachment (DMD) after uneventful same-day ISBCS, with emphasis on diagnosis and management. Patient and Clinical Findings: The case of a 66-year-old diabetic woman with chronic obstructive pulmonary disease and obstructive sleep apnea on home oxygen who developed spontaneous bilateral DMD after uneventful ISBCS for visually significant cataracts is presented. Although spontaneous DMD after uneventful phacoemulsification has been reported before, it has not been reported after same-day ISBCS to the authors' knowledge. The success rates with air pneumatic descemetopexy are excellent, with ranges between 90% and 95%. In this case, surgical intervention with gas injection in the anterior chamber and surgical peripheral iridotomies resulted in excellent visual acuity restoration in the patient. Diagnosis, Intervention, and Outcomes: Patient underwent same-day ISBCS under local anesthesia by different surgeons in either eye. Standard phacoemulsification techniques were used, and no intraoperative complications were noted. The patient returned with bilateral counting fingers vision 4 weeks postoperatively and reported her vision never improved after her cataract extraction. Anterior segment optical coherence tomography (AS-OCT) confirmed the presence of bilateral DMDs. Because of the patient's severely impaired vision, bilateral air descemetopexies were performed with clinical resolution of the DMD and excellent restoration of vision in both eyes. Conclusions: Sufficient evidence supports that performing ISBCS using internationally agreed protocols minimizes the risk of experiencing bilateral complications to a negligible level when compared with staged surgery. However, with ISBCS being on the rise, spontaneous bilateral DMDs may also be seen increasingly in those eyes with no underlying commonly recognized risk factors for spontaneous DMD. With unilateral DMD, watch and wait is a viable option. However, in bilateral DMD cases, earlier air or gas descemetopexy may be preferable to increase the likelihood of success and reduce the patient's period of decreased vision.

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 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.

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.

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.

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.

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.

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

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.

Patient satisfaction and attitudes towards immediate sequential bilateral cataract surgery.

To investigate patients' first-hand experience, satisfaction and attitudes towards immediate sequential bilateral cataract surgery (ISBCS). Royal Bournemouth Hospital, University Hospitals Dorset NHS Foundation Trust, Castle Lane East, Bournemouth, UK. Retrospective study using semi-structured phone interviews and qualitative content analysis. Semi-structured telephone interviews were conducted by an independent interviewer, to explore patients' experiences of ISBCS, at least four weeks postoperatively. The open-ended responses were analysed using qualitative content analysis. Categories and meaning units were tabulated, with the number and percentage of patients contributing to each category provided. 25 patients were included. All patients rated their overall satisfaction of ISBCS as 'very satisfied' and would opt again to have both eyes operated on the same day. 22 patients (88%) reported a 'very good/comfortable' surgery experience. After surgery, 24 patients (96%) felt completely safe going home, with most organizing for family or friends to drive them home. None of the patients experienced any complications in the postoperative period. 24 patients (96%) experienced only minimal reduction in accomplishing daily living activities after surgery and 24 patients (96%) said they would recommend ISBCS to family and friends. The results support wider implementation of ISBCS from the patient's perspective and experience. Providing written information addressing common themes and concerns is recommended to increase patient acceptance and uptake of ISBCS preoperatively.

Unilateral endophthalmitis after immediate sequential bilateral cataract surgery in a cognitively impaired patient: diagnosis and treatment

Introduction: Immediate sequential bilateral cataract surgery (ISBCS) is a reasonable approach for cataract surgery in patients needing general anesthesia, such as those with cognitive impairment. To our knowledge, this is the first reported case of unilateral acute-onset postoperative endophthalmitis in a patient with cognitive impairment after ISBCS, with emphasis on diagnostic and treatment challenges. Patient and Clinical Findings: A 64-year-old woman with a history of cognitive impairment, seizure disorder, and no prior ocular surgery presented with dense visually significant cataracts and visual acuity of fix and follows in both eyes. Diagnosis, Intervention, and Outcomes: Patient underwent ISBCS under general anesthesia and without intracameral antibiotics or corneal sutures. The patient returned with unilateral acute-onset endophthalmitis 2 weeks postoperatively. Because of the patient's limited ability to comply with treatment, and lack of emergency general anesthesia needed for vitreous cultures, intravitreal vancomycin injection (1 mg/0.1 mL) was empirically given, with clinical resolution of the infection and visual acuity of fix and follows. Conclusions: Acute-onset postoperative endophthalmitis in the setting of cognitive impairment is challenging because emergency general anesthesia may not be available, and the patient can tolerate only limited interventions. In this patient, empiric intravitreal vancomycin injection without cultures led to a satisfactory clinical outcome.