Outcome Of Immediate Sequential Bilateral Cataract Surgery In A Tertiary Centre

A retrospective analysis of pilot implementation of Immediate Sequential Bilateral Cataract Surgery (ISBCS) service started during COVID outbreak and its outcome.

A retrospective review of all ISBCS operated at UHCW over a 34-month period (September 2020 – July 2023). The patients were divided into two groups (Group 1: patient with mental capacity and Group 2: Patients without Mental Capacity) at University Hospital Coventry, and Warwickshire (UHCW). The surgeries were performed by 2 surgeons only (MR AND SP), part of pilot implementation of the service.

Data was collected from electronic Patient record systems (Medisoft, Clinical Results Reporting System (CRRS)), which was compared against The Royal College of Ophthalmologists (RCOphth) Cataract National Dataset guidelines.

Along with demographics, the relevant data collected included:

• Pre-operative and post operative visual acuities
• Ocular co-pathologies causing guarded visual prognosis
• Intra-operative and post operative complications
• Refractive suprise (> than 1 D range)
• Subjective responses were analysed using a modified patient response outcome measure (PROM) questionnaire regarding improvement in vision, quality of life, decision for chosing ISBCS rather than delayed sequential cataract surgery, post operative instructions and recovery. 

42 eyes with mental capacity vs 34 eyes with best interest meeting were operated.

Over 70% of both groups had worse than 0.3 LogMAR pre-op vision.  66% achieved post op 0.3 LogMAR and better vision with co-pathology of 57% in group 1 and 59% in group 2.

No intraoperative and major sight threatening post op complications happened in either group.

In group 1, 1 eye had post op cystoid macular oedema. In group 2, 9 eyes had PCO and 1 eye had post op uveitis.

Zero refractive surprise in group 1 and 3 eyes in group 2.

Objective and Subjective visual improvement were noted in 74%, 93%, 83 % and 92% respectively.

Quality of life was improved in 75% and 92%.

100% positive responses in chosing ISBCS, clear post op instructions and recovery.

In our pilot study ISBCS has been found to be a safe practice. It has become a lucrative option among the patients who lack mental capacity and their relatives’ taking decisions for them, as the procedure offers a single trip to the hospital, both eyes done at the same time, minimising the discomfort of arranging transport and support from primary care and other rehabilitation teams. It also offers a quicker and faster neuroadaptation avoiding any anisometropias and difference in quality of vision from a clearer operated eye and non-operated cloudy eye. 

In summary, we recommend ISBCS as a go to procedure.