Immediately Sequential Bilateral Cataract Surgery Research Articles

Immediate sequential bilateral cataract surgery: surgeon preferences and concerns

ObjectiveWe surveyed cataract surgeons to gain insight into their perceptions of and attitudes about immediate sequential bilateral cataract surgery (ISBCS). DesignCross-sectional. ParticipantsAll active cataract surgeons in Kaiser Permanente Northern California in 2016. MethodsOnline survey that asked cataract surgeons why they did or did not perform ISBCS, their interest in offering ISBCS, concerns about the procedure, and desired supports. ResultsOf the 165 active cataract surgeons, 107 (65%) participated in the survey, of whom 92 (86%) responded that they currently practiced ISBCS and 15 (14%) reported that they did not. For ISBCS surgeons, patient convenience (95%) and patient request (91%) were the top reasons for performing the procedure. For surgeons who do not perform ISBCS, the most commonly cited concerns were not having the postoperative refractive outcome from the first eye to guide intraocular lens selection in the second eye (80%) and risk of bilateral vision loss (73%). Among those who do not perform ISBCS, 9 (60%) identified the need for evidence-based patient selection criteria to support a decision to adopt the procedure. In addition, many surgeons in both groups wanted streamlined patient education materials and established protocols. ConclusionPatient centeredness is a key construct of contemporary health care delivery, and in an era of low complication risk, many patients request ISBCS; the number of these surgeries has increased. In our capitated health care system, the great majority of surgeons perform ISBCS for the convenience of their patients. Providing surgeons with guidelines and tools to support ISBCS likely would increase adoption.

Immediately sequential bilateral cataract surgery: advantages and disadvantages.

The number of cataract surgeries performed globally will continue to rise to meet the needs of an aging population. This increased demand will require healthcare systems and providers to find new surgical efficiencies while maintaining excellent surgical outcomes. Immediately sequential bilateral cataract surgery (ISBCS) has been proposed as a solution and is increasingly being performed worldwide. The purpose of this review is to discuss the advantages and disadvantages of ISBCS. When appropriate patient selection occurs and guidelines are followed, ISBCS is comparable with delayed sequential bilateral cataract surgery in long-term patient satisfaction, visual acuity and complication rates. In addition, the risk of bilateral postoperative endophthalmitis and concerns of poorer refractive outcomes have not been supported by the literature. ISBCS is cost-effective for the patient, healthcare payors and society, but current reimbursement models in many countries create significant financial barriers for facilities and surgeons. As demand for cataract surgery rises worldwide, ISBCS will become increasingly important as an alternative to delayed sequential bilateral cataract surgery. Advantages include potentially decreased wait times for surgery, patient convenience and cost savings for healthcare payors. Although they are comparable in visual acuity and complication rates, hurdles that prevent wide adoption include liability concerns as ISBCS is not an established standard of care, economic constraints for facilities and surgeons and inability to fine-tune intraocular lens selection in the second eye. Given these considerations, an open discussion regarding the advantages and disadvantages of ISBCS is important for appropriate patient selection.

Predictability of refraction following immediate sequential bilateral cataract surgery (ISBCS) performed under general anaesthesia.

BackgroundTo evaluate the predictability of refraction following immediate sequential bilateral cataract surgery (ISBCS) performed under general anaesthesia.MethodsThis is a retrospective review of all ISBCS performed at Kantonsspital Winterthur, Switzerland, between April 2000 and September 2013. The case notes of 250 patients were reviewed. Patients having full refraction reported (110 patients/220 eyes) were included. 210 (95 %) eyes had a straight forward phacoemulsification with posterior chamber intraocular lens implantation, seven eyes had a planned extracapsular cataract extraction (ECCE); three eyes had an intracapsular cataract extraction.ResultsBoth eyes of 110 patients (64 women, 46 men) with a mean age of 79.0 years, standard deviation (SD) ±11.4 (range 26 to 97 years) were included. Median preoperative best corrected visual acuity (BCVA) was 0.5 LogMAR in the first eye, the interquartile range (IQR) was [0.4, 1.2]; 0.7 LogMAR in the second eye with IQR [0.4, 1.8]. At one month, the median BCVA was 0.2 LogMAR, IQR [0.1, 0.3] in the first eye, median BCVA was 0.1 LogMAR and IQR [0.0, 0.5] in the second eye. There were 3 eyes (3 %) that lost 3 lines or more in BCVA at one month (control vs. pre-operatively). In all three cases, poor visual acuity had been recorded pre-operatively (>1 LogMAR). Achieved refraction was within ±1.0 D of the target in 83 % of eyes. There were only 5 % (n = 6) of cases where if delayed sequential bilateral extraction had been performed could potentially intraocular lens (IOL) choice have been adjusted, in four of these cases, target refraction was within ±1.0 D in the second eye.ConclusionsISBCS performed under general anaesthesia achieves target refraction in 83 % of eyes after consideration of complications, ocular co-morbidities and systemic restrictions. In the majority of cases where IOL power calculation could be considered, the achieved refraction of the second surgical eye was within ±1.0 D of intended refraction. This undermines the utility of IOL power adjustments in the second surgical eye.

Immediate versus Delayed Sequential Bilateral Cataract Surgery: A Systematic Review and Meta-Analysis

BackgroundImmediately sequential bilateral cataract surgery (ISBCS), the cataract surgery that is performed in both eyes simultaneously, is gaining popularity worldwide compared to the traditional treatment paradigm: delayed sequential bilateral cataract surgery (DSBCS), the surgery that is performed in each eye on a different day as a completely separate operation. ISBCS provides advantages to patients and patients’ families in the form of fewer hospital visits. Additionally, patients enjoy rapid rehabilitation, lack of anisometropia - potentially reducing accidents and falls, and avoid suboptimal visual function in daily life. The hospital may benefit due to lower cost.ObjectiveTo perform a systematic review and meta-analysis to evaluate ISBCS and DSBCS.Data SourcesDatabases including MEDLINE, EMBASE, BIOSIS, CINAHL, Health Economic Evaluations Database (HEED), ISI Web of Science (Thomson-Reuters) and the Cochrane Library were searched.ParticipantsNot applicable.MethodsLiterature was systematically reviewed using EPPI-Reviewer 4 gateway. Meta-analysis was conducted using STATA v. 13.0. Standardized mean difference (SMD) and 95% confidence intervals (CI) were calculated and heterogeneity was assessed using I2 statistics. Fixed-effect and random-effect models were computed based on heterogeneity. Meta-analysis was done by instrument used to calculate utility score.ResultsIn total, 9,133 records were retrieved from multiple databases and an additional 128 records were identified through grey literature search. Eleven articles with 3,657 subjects were included for analysis. Our meta-analysis results indicated significant improvement in post-operative utility score using TTO, EQ5D, HUI3, VF-7, and VF-14 and a non-significant improvement using Catquest questionnaire for both surgeries. For ISBCS versus DSBCS, utility-specific fixed-effect model provided an overall SMD of the utility score using the TTO method as 0.12 (95% CI: -0.15, 0.40), EQ5D as 0.14 (95% CI: -0.14, 0.41), HUI3 as 0.12 (95% CI: -0.15, 0.40), VF-7 as -0.02 (95% CI: -0.15, 0.10), and Catquest Questionnaire as 1.45 (95% CI: -0.88, 2.01). The results for utility score, which were measured using various instruments, indicated non-significant improvement in the utility due to DSBCS compared to ISBCS. However, a significant improvement in post-operative utility score was seen using Catquest questionnaire for ISBCS compared to DSBCS. The included studies using VF-14 instrument were highly heterogeneous (I2 = 97.1%). Results provided SMD of -0.25 (95% CI:-1.06, 0.57) using VF-14 indicating non-significant improvement in the utility due to DSBCS compared to ISBCS surgery. Best corrected visual acuity (BCVA) significantly improved after both surgeries (overall SMD of BCVA due to ISBCS was -1.79 (95% CI: -2.45, -1.14) and due to DSBCS was -1.53 (95% CI: -2.25, -0.81)). A non-significant improvement was seen in BCVA due to ISBCS when compared to DSBCS (SMD = -0.18; 95% CI: -0.37, 0.01).ConclusionBoth surgeries, ISBCS and DSBCS significantly improve patients’ quality of life and visual acuity. Further, ISBCS may deliver certain additional benefits at the individual and societal levels as well.

Benefits and risks of immediately sequential bilateral cataract surgery: a literature review.

Immediately sequential bilateral cataract surgery (ISBCS) is a highly contended issue in ophthalmology, mainly due to the risk of bilateral endophthalmitis and financial penalties that many ophthalmologists face when performing simultaneous cataract surgeries. The purpose of this review is to understand the current status of the knowledge of ISBCS, mainly its benefits and risks and how they compare with the standard of care, delayed sequential bilateral cataract surgery. Evidence, although limited, increasingly supports ISBCS for providing faster rehabilitation, improved visual outcomes, and cost and time savings. Evidence does not support the fear of bilateral endophthalmitis resulting from the simultaneous procedure. However, stronger and greater evidence is needed before ISBCSs can be considered the standard of care. Where ISBCS can potentially create the most beneficial impact is in public eye health programmes in developing countries, but this has not yet been explored.

Immediately Sequential Bilateral Cataract Surgery—A Global Perspective

By the mid 1990s, the evolution of progressively safe and predictable cataract surgery saw the resurgence of centuries of interest in performing immediately sequential bilateral cataract surgery (ISBCS). Within 10 years ISBCS had become generally accepted and the International Society of Bilateral Cataract Surgeons (iSBCS) was formed (September 2008) to “promote education, mutual cooperation, and progress in simultaneous bilateral cataract surgery.” The first initiative of the society members was to create a document “iSBCS General Principles for Excellence in ISBCS 2009,” which was intended to disseminate information about the best practices they had discovered to assist novice ISBCS surgeons. Next, ISBCS needed to be studied. Soon, data began to clarify some advantages of ISBCS, and risks were carefully evaluated. It soon became apparent that the main impediment to the performance of ISBCS, globally, was money, in that many jurisdictions financially penalized surgeons who performed ISBCS. Presently, we know that ISBCS carries many benefits to the patient, his/her family, the surgical facility, and society. The feared risks for simultaneous bilateral endophthalmitis, the requirement to adjust intraocular lens (IOL) selection for second eyes, based on first eye results, and others, have simply not been borne out under scrutiny. ISBCS is now rapidly increasing in its performance and acceptance globally, but the financial factors remain to be solved.

Immediately Sequential Bilateral Cataract Surgery—A Global Perspective

By the mid 1990s, the evolution of progressively safe and predictable cataract surgery saw the resurgence of centuries of interest in performing immediately sequential bilateral cataract surgery (ISBCS). Within 10 years ISBCS had become generally accepted and the International Society of Bilateral Cataract Surgeons (iSBCS) was formed (September 2008) to “promote education, mutual cooperation, and progress in simultaneous bilateral cataract surgery.” The first initiative of the society members was to create a document “iSBCS General Principles for Excellence in ISBCS 2009,” which was intended to disseminate information about the best practices they had discovered to assist novice ISBCS surgeons. Next, ISBCS needed to be studied. Soon, data began to clarify some advantages of ISBCS, and risks were carefully evaluated. It soon became apparent that the main impediment to the performance of ISBCS, globally, was money, in that many jurisdictions financially penalized surgeons who performed ISBCS. Presently, we know that ISBCS carries many benefits to the patient, his/her family, the surgical facility, and society. The feared risks for simultaneous bilateral endophthalmitis, the requirement to adjust intraocular lens (IOL) selection for second eyes, based on first eye results, and others, have simply not been borne out under scrutiny. ISBCS is now rapidly increasing in its performance and acceptance globally, but the financial factors remain to be solved.

Efficacy and Safety of Immediate Sequential Bilateral Cataract Surgery

Purpose: To evaluate the efficacy and safety of immediate sequential bilateral cataract surgery with respect to patient outcomes and complication rates. Methods: From January 2010 to December 2014, we conducted a retrospective study of patients who had immediate sequential bilateral cataract surgery (ISBCS) and delayed sequential bilateral cataract surgery (DSBCS) with an interval of one to two months between the first and the fellow eye operations. The changes in visual acuity, manifest spherical equivalent, and refractive error of 140 eyes of 70 patients of both groups were compared postoperatively at one month. The incidence of endophthalmitis was investigated during the same period. Results: At one month postoperatively, log MAR best corrected visual acuity were measured to be 0.06 ± 0.72 in the ISBCS group and 0.09 ± 0.66 in the DSBCS group, and that of the fellow eyes were 0.07 ± 0.64 and 0.07 ± 0.18, respectively (p = 0.331, p = 0.781, respectively). The postoperative spherical equivalents were -0.18 ± 0.23 D in the ISBCS group and -0.19 ± 0.25 D in the DSCBS group, and that of the fellow eyes were -0.15 ± 0.18 D and -0.16 ± 0.21 D, respectively. There were no significant statistical differences between the two groups (p = 0.835, p = 0.676, respectively). The postoperative refractive error was -0.20 ± 0.21 D in the ISCBS group and -0.18 ± 0.13 D in the DSBCS group, and that of the fellow eyes were -0.14 ± 0.22 D and -0.19 ± 0.22 D, respectively (p = 0.482, p = 0.237, respectively). A total of 21,140 eyes had cataract surgery performed, and only 10 eyes (0.05%) developed endophthalmitis. Endophthalmitis did not occur in the ISBCS group. Conclusions: In experienced hands, with stringent patient selection criteria and with a strict aseptic protocol, ISBCS can safely provide comparable visual outcome and better satisfaction of the patient with good efficacy. J Korean Ophthalmol Soc 2015;56(12):1854-1859

Immediate Sequential Bilateral Cataract Surgery: A Systematic Review and Meta-Analysis.

The aim of the present systematic review was to examine the benefits and harms associated with immediate sequential bilateral cataract surgery (ISBCS) with specific emphasis on the rate of complications, postoperative anisometropia, and subjective visual function in order to formulate evidence-based national Danish guidelines for cataract surgery. A systematic literature review in PubMed, Embase, and Cochrane central databases identified three randomized controlled trials that compared outcome in patients randomized to ISBCS or bilateral cataract surgery on two different dates. Meta-analyses were performed using the Cochrane Review Manager software. The quality of the evidence was assessed using the GRADE method (Grading of Recommendation, Assessment, Development, and Evaluation). We did not find any difference in the risk of complications or visual outcome in patients randomized to ISBCS or surgery on two different dates. The quality of evidence was rated as low to very low. None of the studies reported the prevalence of postoperative anisometropia. In conclusion, we cannot provide evidence-based recommendations on the use of ISBCS due to the lack of high quality evidence. Therefore, the decision to perform ISBCS should be taken after careful discussion between the surgeon and the patient.

Immediately sequential bilateral cataract surgery: a cost-effective procedure

ObjectiveThe objective of this project was to perform a cost-effectiveness analysis (CEA) of immediately sequential bilateral cataract surgery (ISBCS) versus delayed sequential bilateral cataract surgery (DSBCS) to determine whether ISBCS represents an appropriate, cost-effective way to rapidly rehabilitate a patient’s visual impairment. DesignA systematic review followed by a primary economic analysis with computer-based econometric modeling. ParticipantsNot applicable. MethodsWe constructed a decision analytic model from the perspective of the public third-party payer (i.e., the Ministry of Health) to conduct a CEA of both surgeries, ISBCS and DSBCS. Cost data consisted of the costs of the surgery, intravitreal injections, medications, and drops, all of which were obtained from a comprehensive literature search and from records at St. Joseph’s Hospital, London, Ont. The effectiveness was measured by the utility values associated with visual acuity in the better seeing eye. ResultsISBCS resulted in an incremental effectiveness of 0.08 utility at an incremental cost of $1607. Discounting the quality-adjusted life-years (QALYs) gained by an annual interest rate of 3% resulted in 0.932 QALYs gained. The cost-effectiveness of ISBCS was calculated to be $1431 per QALY gained. A 1-way sensitivity analysis was performed by varying costs, utility values, probabilities, and discounting rates. This analysis varied the incremental cost-effectiveness ratio but did not change the conclusion. ConclusionsHealth economics assessment showed that, compared with DSBCS, ISBCS is a cost-effective procedure. This finding will be highly useful to policy-makers, decision-makers, clinicians, hospital administrators, and payers in making cost-efficient decisions.

Chirurgie de la cataracte bilatérale immédiatement séquentielle chez le chien : une étude rétrospective de 128 cas (256 yeux)

To describe postoperative complications and visual outcomes after immediately sequential bilateral cataract surgery (ISBCS) and to assess whether additional risk is incurred by operating on the fellow eye immediately following the first. A retrospective review of 128 dogs (256 eyes) that underwent ISBCS in three veterinary ophthalmology centers between May 2007 and December 2011 was performed. Visual status at final evaluation was recorded and intra- and postoperative complications were recorded and analyzed. Data for the first operated eye (FE) and then the second eye (SE) were statistically analyzed to assess whether performing surgery on the SE immediately after the FE resulted in any negative consequences for the second eye. No serious intraoperative anesthetic incident occurred due to prolonged surgery. Phacoemulsification times were significantly shorter for the SE than for the FE. On final examination, 239 eyes out of 256 (93.36%) exhibited functional vision (score 2), and three dogs were completely blind due to long-term bilateral postoperative complications. The most common postoperative complications were uveitis (58 eyes, 22.66%), postoperative ocular hypertension (POH; nine eyes, 3.5%), glaucoma (nine eyes, 3.5%) and total retinal detachment (seven eyes, 2.73%). No case of endophthalmitis was reported. These results were no worse than those typically reported for unilateral phacoemulsification. In addition, the risk of blindness and other postoperative complications was not significantly increased in the SE. The results of this study suggest that ISBCS is not associated with an increased incidence of intra- or postoperative complications compared to classic unilateral cataract surgery and might be a viable option for selected patients. The risk of blindness or postoperative complications was not higher in SEs than in FEs.

Response to Tatham and Brookes

Sir, We were pleased that the Scientific Journal of the Royal College of Ophthalmologists recognizes that immediate sequential bilateral cataract surgery (ISBCS) now merits open discussion in the pages of the August 2012 edition of your journal. We read with interest the submission by Tatham and Brookes,1 but could not follow their logic. Their paragraph 1 seems to summarize all the published peer-reviewed evidence in favor of ISBCS. However they state that the interest in ISBCS is fueled by economic benefits. In fact, many jurisdictions financially penalize bilateral cataract surgery, and in many countries it is a money-losing proposition for the surgeon. Almost all the articles referenced by Tatham and Brookes discuss the medical benefits to the patients, which are considerable, but not economic benefits.2 We would also like to encourage health care providers/financing bodies to take in account patient benefits and logistical and economic effects for the social system as a whole when deciding upon the reimbursement of ISBCS. Paragraph 2 waves the shroud of ‘bilateral blindness', but omits that bilateral simultaneous ophthalmic surgery is common, and the risk of bilateral infection has been shown to be extremely small in bilateral cataract surgery.3 LASIK, blepharoplasties, ptosis, and squint surgery are all commonly performed bilaterally, and bilateral simultaneous retinal surgery is not that rare. In paragraphs 3 and 4, they effectively summarize the recommendations of our Society (see www.isbcs.org), for which we thank them, as good advice deserves repetition. However, in paragraph 5, they state that ISBCS may be ‘logistically difficult'. We disagree; if ISBCS is a regular event, then there are no logistical problems. Setting up for cases of ISBCS is much easier than for double the number of single eye cases. They then turn to the question of endophthalmitis, stating that diabetes is a risk factor. This does not appear to be the opinion of The Royal College of Ophthalmologists, who do not mention it in their document ‘Cataract Surgery Guidelines' published September 2012. Curiously, they also state that if one eye develops endophthalmitis, there is less chance of both being involved by deferring second eye surgery. We know of no evidence to support this statement. As it is known that most cases of endophthalmitis emanate from the patient's own flora, it is questionable whether delaying the second eye reduces the risk for that eye. Furthermore, they refer to diabetes and blepharitis as risk factors, and while we agree that this is widely believed, and many increase precautions in the presence of these conditions, we again know of no published data on which to base these suppositions. In paragraph 6, the authors turn to economics and turnover. Our experience is the reverse of their suppositions; we can easily add one or two eyes to a 4-h operating list when the majority of cases are ISBCS as opposed to unilateral surgery. The time saved is in moving patients in and out of theater and redundant paperwork. The comments on time from listing to surgery, and time from first to second eye surgery is likely to be very variable for multiple reasons. However, we are aware that within 16 miles of the authors' hospital the current waiting time for cataract surgery routinely exceeds 6 months. In the final two paragraphs, the authors equate bilateral endophthalmitis with bilateral blindness. This extraordinary assumption would imply no treatment of this complication, which seems unlikely. Our experience is that the modern management of endophthalmitis leaves many eyes with useful, (and often excellent) vision, and to assume blindness shows a rather alarmist approach. In these closing paragraphs, the authors muse on ‘Should bilateral same day cataract surgery routinely be offered to all?' We accept that they may have been asked to opine on this specific question, and may indeed have used the narrowness of the question to reply. We believe that ISBCS should be offered routinely to all appropriate patients, and that full consent and explanation of options should be offered. We believe that there are patients who should not have such surgery, but with increasing experience with ISBCS, as with any other procedure, the surgeon discovers that fewer and fewer patients fall into the routine exclusion group. However, ISBCS is currently routinely NOT offered to appropriate patients in the UK, and many other countries, despite peer-reviewed published evidence of effectiveness, economy, and very low risk. We would suggest that many patients would benefit if more ophthalmologists would remember to consider this option when listing patients for surgery.

Same-day Cataract Surgery Should Be the Standard of Care for Patients With Bilateral Visually Significant Cataract

Same-day, or immediately sequential, bilateral cataract surgery (ISBCS) is being practiced with increasing frequency worldwide. It provides many advantages including convenience for the patient and the patient's family. ISBCS repairs the visual system, not merely one eye, restoring normal binocularity as well as unilateral clarity, creates a much more relaxed surgical atmosphere in harried operating rooms, and saves money for society. It is often preferred by busy professionals. The purported risks of ISBCS have been unsupported by the literature, including bilateral retinal detachment, bilateral corneal decompensation, bilateral diabetic macular edema, bilateral severe cystoid macular edema, significant IOL power errors in the first eye that could be refined and thereby prevented in the second eye, and toxic anterior segment syndrome. The greatest fear of ISBCS has been possible simultaneous bilateral endophthalmitis, which did not occur in a series of nearly 100,000 ISBCS cases and has only occurred elsewhere when complete separation of the two eyes and strict sterile protocol were not followed. The International Society of Bilateral Cataract Surgeons (www.isbcs.org) has prepared the “iSBCS General Principles for Excellence in ISBCS,” which should be followed for safe ISBCS.

‘Bilateral same-day cataract surgery should routinely be offered to patients’ – Yes

For some, the very mention of immediate sequential bilateral cataract surgery (ISBCS) or cataract surgery to both eyes on the same day would invoke a strong gut reaction and vehement objection. Although at one time there was good reason for this, advances in technology in cataract surgery have been dramatic. We now perform cataract surgery under topical anaesthesia through ever smaller corneal wounds that allow for more predictable refractive outcomes, quicker visual recovery, and quicker refractive stabilisation. The bulk of cataract operations are now done as a day-case procedure. Cataract surgery nowadays has a generally very low rate of complications, and we would argue that ISBCS has now become a viable and safe alternative. We have learnt from LASIK that bilateral simultaneous surgery is a viable option if the complication rate is low and the visual recovery is rapid.

Incidence of postoperative endophthalmitis after immediate sequential bilateral cataract surgery

To determine a best estimate of the incidence of endophthalmitis after immediately sequential bilateral cataract surgery (ISBCS) and assess the benefit of prophylactic intracameral antibiotics. Eye Foundation of Canada, Toronto, Ontario, Canada. Cohort study. A detailed literature search was performed to obtain recently reported frequencies of postoperative endophthalmitis with or without the use of prophylactic intracameral antibiotics. Members of the International Society of Bilateral Cataract Surgeons were surveyed. The data were collected to determine the results of unilateral and bilateral cataract surgeries performed by experienced bilateral cataract surgeons. The data were statistically analyzed. In recently published European prophylactic intracameral cephalosporin studies, the incidence of postoperative endophthalmitis after unilateral cataract surgery weight-averaged to 1 in 331 (0.3%) without prophylactic intracameral antibiotics and to 1 in 1977 (0.05%) with prophylactic intracameral antibiotics, whereas studies in the United States using only topical antibiotics reported infection rates as low as 0.028%. Four cases of bilateral simultaneous endophthalmitis after ISBCS have been reported in the past 60 years, all with breaches of aseptic protocol. No bilateral simultaneous endophthalmitis occurred in the 95 606 ISBCS cases collected. The overall rate of postoperative endophthalmitis after ISBCS was 1 in 5759. Infection rates were significantly reduced with intracameral antibiotics to 1 in 14 352 cases. The risk for postoperative endophthalmitis in ISBCS appears to be at least as low as and possibly lower than published rates for unilateral surgery, particularly when recommended precautions are taken. Intracameral antibiotics significantly reduced the risk for postoperative endophthalmitis.

Immediately sequential bilateral cataract surgery versus delayed sequential bilateral cataract surgery: potential hospital cost savings

Objective: Cataract surgery represents a substantial cost to health care systems around the world. Canada's socialized medical system allows an opportunity to accurately track costing because of the institutional record keeping necessary for public reporting to provincial governments. Cataract surgical costs consist of medical costs, hospital costs, and social costs. Our study compared the hospital costs of immediately sequential bilateral cataract surgery (ISBCS) with delayed sequential bilateral cataract surgeries (DSBCS), minimizing other interfering variables. Design: Retrospective chart review with collection of associated costing information from the hospital. Participants: Twenty-two consecutive patients undergoing ISBCS with posterior chamber intraocular lens implantation and a randomly selected group of 22 patients undergoing similar DSBCS during the same period. Methods: Hospital costs were determined using the London Health Sciences Centre case-costing system. Average costs were calculated and compared statistically. Results: Average hospital costs were significantly reduced when performing ISBCS ( p < 0.0001); 2 separate unilateral cataract surgeries totaled $ 1566.30, compared with $ 1059.10 for one bilateral cataract surgery (32.4% reduction). Pre- and post-operative in-hospital care accounted for a significant portion of this difference (54%), as 2 separate surgeries cost $547.92 compared with $273.96 for ISBCS. Conclusions: ISBCS provided considerable hospital cost savings compared to DSBCS.

Arthritis associated with Salmonella infections.

<h3>Objective</h3> To test a hypothesis that operating room (OR) productivity in the National Health Service (NHS) can be improved with the introduction of immediately sequential bilateral cataract surgery (ISBCS). <h3>Methods and analysis</h3> Previously published time and motion data of 140 unilateral cataract surgeries conducted at five different NHS locations were reanalysed to construct a hypothetical model where only ISBCS (±one unilateral case) were conducted while maintaining time durations of all key tasks previously studied. Possible time efficiency savings were calculated for the ISBCS model and percentage increases in numbers of eyes operated per 4-hour theatre session calculated. Gains in efficiency were correlated with factors from the baseline data to predict which settings could improve efficiency most by undertaking ISBCS. <h3>Results</h3> Based on remodelling our time and motion study (TMS) data as hypothetical ISBCS cases, we could expect a mean 16% reduction (range 9.8%–17.8%) in the time taken for two cataract operations, translating into a mean 54% improvement (range 38%–67%) in number of cases currently performed per list and an 18% improvement (range 9%–28%) even if the number of unilateral cases per list had been fully maximised. An average number of four ISBCS cases per list (range 3–6) were required to achieve sufficient time savings to allow an extra unilateral surgery to be conducted. <h3>Conclusion</h3> The introduction of routine ISBCS has the potential to improve the productivity of cataract surgery within the NHS, with efficiencies being possible in both high-volume and low-volume surgical models.