Immediate Sequential Bilateral Cataract Surgery Under Local Anaesthesia At A United Kingdom University Hospital

Following a temporary cessation of all elective surgery, as recommended by the Royal College of Ophthalmologists (RCOphth) between March and June 2020, our centre implemented immediate sequential bilateral cataract surgery (ISBCS) for routine cases to minimise waiting times. ISBCS under local anaesthesia (LA) were performed for suitable patients who are at low risk for complications. This retrospective audit compares the case selection, objective clinical outcomes, intra-operative and post-operative complications against the current protocol.

Public sector teaching hospital in the United Kingdom.

Retrospective electronic note review of patients. 78 suitable patients (32 males, 46 females, mean age 70 years) were listed and consented for ISBCS under LA between June 2020 to January 2023. Patients’ baseline information retrieved included: uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), ocular and systemic risk factors. Operative parameters retrieved included: additional procedures, surgeon grade, and intra-operative complications. Post-operative outcomes retrieved included: UCVA, BCVA, refraction, and post-operative complications.

130 eyes in 65 patients (83%), underwent ISBCS as planned. BCVA improved from 0.33 to 0.08 logMAR at last follow-up (P < 0.0001, 95% CI -0.33 to -0.17). There were no cases of posterior capsule ruptures or vitreous loss. 93% of eyes were within 1D of predicted refraction. 12 patients (15%) had second eye surgery deferred, 2 due to first eye complication (zonular dehiscence, iris prolapse), 4 were patient initiated and largely due to anxiety. 1 patient had both eyes deferred. 36 eyes (25%) were operated on by trainees with no post-operative complications. Trainees had similar rate of second eye cancellations (14% vs 16%, p=0.86) and intra-operative complications, mostly mild iris trauma, (5.6% vs 6.6%, p=0.83) compared to consultants.

This audit demonstrates that ISBCS is a safe and effective approach for suitable patients in a real-world clinical setting. With appropriate case selection and adequate supervision, ISBCS also appears to provide a productive and low-risk training environment. Deferral of second eye surgery is an essential safety-net in ISBCS. Cancellations around patient anxiety may be preventable with education around expectations during surgery, therefore, improving efficiency and promote effective use of resources.