Clinical Outcomes And Shifting Attitudes Towards Immediate Sequential Bilateral Cataract Surgery At A University Tertiary-Centre In London

To report outcomes of Immediate Sequential Bilateral Cataract Surgery (ISBCS) in a large tertiary ophthalmology department. Cataract surgery is the most frequently performed surgical procedure worldwide. Conventionally, cataract surgery is offered as a unilateral procedure, mostly performed under local anaesthesia as a day case procedure where each eye is operated on a different day and reviewed on separate post-operative clinic appointments. ISBCS involves operating on both eyes on the same day and provides an alternative to meet patient’s special needs or an increasing surgical demand.

The study was performed in the Ophthalmology Department of King’s College Hospital NHS Foundation Trust between January 2018 and August 2022.

We conducted a retrospective study using Medisoft electronic records software Audit Suite to retrieve clinical notes of patients who underwent ISBCS from January 2018 to August 2022 in a single centre in the United Kingdom. The data was analysed for selection criteria for ISBCS, preoperative and postoperative LogMAR visual acuity (VA), the choice of anaesthetic, either general anesthetic (GA) or local anesthetic (LA) with topical or subtenon’s block, clinical outcomes of ISBC and complication rate. Cases with incomplete preoperative and/or postoperative clinical data were excluded.

82 patients (52 F; 24 M), age 27 to 96 years (average 71 years) underwent ISBCS and 74 patients (148 eyes) completed all reviews. Selection criteria for ISBCS included systemic comorbidities/inability to cooperate during surgery in 26%; narrow angle glaucoma in 17% and patients preference in 57%. The VA showed a statistically significant improvement of 2 LogMAR with a high level of patients satisfaction. ISBCS was performed as GA (47%) and LA (52%).

There were no cases of adverse effects related to ISBCS and no endophthalmitis; there was 3% posterior capsular rupture, 4% uveitis; 1% return to theatre for toric repositioning. ISBCS increased from 2018 to 2022: 13 cases, in 2018-2019, 5 cases in 2020, 25 cases in 2021 and 39 cases in 2022.

This study reflects a shift in the attitudes of ISBCS since COVID-19 pandemic with a significant annual increase in the number of procedures performed between 2018 to 2022. The outcomes of our cohort of ISBCS showed the same safety profile and complication rates as for unilateral sequential cataract surgery. ISBCS allowed to meet patient’s special needs and patient’s personal preference whilst increasing theatre efficiency. The ISBCS resulted in quicker binocular visual rehabilitation and high level of postoperative satisfaction from the patients.