Immediate Sequential Bilateral Cataract Surgery Outcomes For Consultants Versus. Trainees At A Large Tertiary Referral Centre

Immediate sequential bilateral cataract surgery (ISBCS) refers to operating on both eyes of a patient in the same theatre session. By reducing time required for patient transfer and preparation, ISBCS potentially increases efficiency so more eyes can be operated in a given time. Therefore, there is potential for ISBCS to increase surgical opportunities for ophthalmology trainees. This is particularly key post-COVID-19, where routine 'trainee cataracts' are being increasingly diverted into the independent sector and away from trainee lists in the UK. We aimed to evaluate cataract outcomes for ISBCS at a large tertiary referral centre, including trainee vs. consultant numbers, refractive outcomes, and intra-operative complications.

A large tertiary referral centre and teaching hospital and its satellite sites across London, United Kingdom. 

The electronic records of all adult patients who underwent ISBCS at our unit on the National Health Service (NHS) between March 2021 and March 2023 were retrospectively analysed for surgeon grade, refractive outcomes and error, and intra-operative complications. 

624 patients (1240 eyes) with a median age of 73 (65-78) were included. 684/1240 (55%) were performed by consultants and 556/1240 (45%) by trainees. Posterior capsule rupture rate was 0.5%. There were no bilateral complications or cases of endophthalmitis. There was no significant difference in post-operative refractive error or intra-operative complication rate between consultants and trainees (P>0.5). 1056 eyes had post-operative refractive data. 845/1056 (80%) and 996/1056 (94.3%) had refractive error of <0.5D and <1D, respectively. Where the first eye had a refractive error of >0.5D or >1D, there was an increased chance of the second eye also having a refractive error of >0.5D (P<0.001) or >1D (P<0.001), respectively. 

A good proportion of ISBCS at our unit was performed by trainees with no significant difference to consultants in complications and post-operative refractive error. Therefore, ISBCS does provide further opportunity for cataract surgery training. Our data suggests that refractive error in one eye predicts refractive error in the second eye. It is important to counsel patients about the theoretical risk of refractive error bilaterally before proceeding with ISBCS.