• Sequential Bilateral Cataract Surgery and Refractive Outcomes

    By Jean Shaw
    Selected and Reviewed By: Neil M. Bressler, MD, and Deputy Editors

    Journal Highlights

    JAMA Ophthalmology, August 2021

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    Owen et al. evaluated visual acuity (VA) outcomes among patients who under­went immediate and delayed sequential bilateral cataract surgery. They found that immediate sequential surgery is associated with worse visual outcomes—but that the clinical relevance of these outcomes may depend on patients’ addi­tional risk factors.

    For this study, the researchers used population-based data from the Acad­emy’s IRIS Registry. The patients were divided into three groups: 1) immediate sequential bilateral surgery, with both procedures occurring on the same day (n = 44,525); 2) short-interval delayed sequential bilateral surgery (1-14 days between operations [mean, 11.4 days]; n = 897,469); and 3) long-interval de­layed sequential bilateral surgery (15-90 days [mean, 34.6 days]; n = 882,202).

    Patients in all three groups had similar rates of age-related macular degeneration, diabetic retinopathy, and glaucoma, as well as similar baseline VA in their worse-seeing eyes. Those in the immediate sequential bilateral surgery group had higher pre-op VA in their better-seeing eyes. Univariable and multivariable linear regression models were used to analyze refractive outcomes. Main outcomes were mean uncorrected VA and best-corrected VA following the procedures.

    Results of the analysis showed that patients who underwent immediate sequential bilateral cataract surgery had, on average, worse UCVA following surgery (2.8 fewer letters in first eyes and 1.7 fewer letters in the second eyes) than did those who had the longest intervals between procedures. Other results included the following:

    • Post-op 20/20 UCVA in second eyes: Results were 21% for those in the imme­diate sequential surgery group, 24.2% in the short-interval delayed surgery group, and 21.7% in the long-interval delayed surgery group.
    • Post-op 20/20 BCVA in second eyes: Results were 46.8% for those in the immediate surgery group, 56.9% in the short-interval delayed surgery group, and 53.4% in the long-interval delayed surgery group.

    Ethnicity (specifically, self-reported ethnicity other than White), Medicaid coverage, and comorbid eye disease were independently associated with worse outcomes.

    Given the small sample size of those who underwent immediate sequential surgery and other limitations of the data used in this analysis, further studies on the topic are warranted, the authors said. (Also see related commentary by Fasika A. Woreta, MD, MPH, and Oli­ver D. Schein, MD, MPH, MBA, in the same issue. In addition, see “Update on Sequential Bilateral Surgery,” page 16.)

    The original article can be found here.