A total of 4006 eyes that underwent immediate sequential bilateral cataract surgery (ISBCS) experienced good visual acuities and refractive outcomes without complications related to the surgical strategy when performed under recommended international guidelines.
Study design
This was a retrospective study of 2003 consecutive patients undergoing ISBCS at a tertiary university teaching hospital in Quebec City, Canada, from January 2019 to December 2019. All cataract surgeries were treated as independent surgeries and included monofocal, toric, or multifocal IOLs. The ISBCS protocol was designed to follow the International Society of Bilateral Cataract Surgeons guide and included intracameral moxifloxacin at the end of each procedure.
Outcomes
Outcomes included intraoperative and postoperative complications, 7-week postoperative uncorrected distance (UCVA), 7-week pinhole visual acuities (PHVA), and autorefraction measurements. The mean age was 74 +/- 8 years with 93.3% of IOLs placed being monofocal, 5.6% toric, and 1% multifocal or multifocal toric. Relevant and common ocular comorbidities included AMD (11.7%), corneal dystrophy (7.7%), glaucoma (7.4%), and diabetic retinopathy (3%). Mean monocular UCVA improved from a preoperative visual acuity of 20/63 to 20/33, while postoperative pinhole vision improved to 20/28. Measured complications included capsular rupture (0.3% of participants), sulcus IOL (0.1%), zonulysis (0.2%), endophthalmitis and TASS (0%), RD (0.02%), macular hole (0.02%), CME (1.8%), endothelial decompensation (0.1%), IOL exchange (0%), and IOL malposition (0.05%).
Limitations
The study was limited by its retrospective nature, significant percentage of patients with ocular comorbidities, and lack of manifest refractions. The study included only a small minority of subjects desiring specific refractive outcomes. There was no matched cohort of delayed sequential bilateral cataract surgeries.
Clinical significance
Given the social distancing changes from the COVID pandemic and an ever-increasing emphasis on patient experience and cost, cataract surgeons and patients have a renewed interest in ISBCS. Although there is currently a financial hit to medical practices when performing ISBCS, there may ultimately be a cost savings to patients, medical practices, and insurance companies if the US compensation structure for cataract surgery were to change. As this study and others found no increased risk of complication from ISBCS over delayed sequential bilateral cataract surgery, there may be a benefit for all stakeholders. Until compensation structures change, ISBCS can currently be considered a safe and cost-effective option for cash payment and premium patients as well as in certain health care systems.