Immediate Sequential Bilateral Cataract Surgery: Safety, Efficacy, And Patient-Reported Outcomes In A Middle East Prospective Cohort

This study compares immediate sequential bilateral cataract surgery (ISBCS) and delayed sequential bilateral cataract surgery (DSBCS) regarding safety, visual outcomes, refractive results, visual functioning, and patient satisfaction in a Middle Eastern population. Additionally, it evaluates whether ISBCS can deliver equivalent clinical outcomes while enhancing efficiency and patient experience. This is the first regional study to address surgical backlog concerns following COVID-19 and the increasing demand associated with an aging population.

A prospective cohort study was conducted at a tertiary referral eye center in accordance with international guidelines for bilateral cataract surgery. To ensure consistency, all procedures were performed by a single experienced cataract surgeon, adhering to the International Society of Bilateral Cataract Surgeons (ISBCS) and Canadian Ophthalmological Society 2020 guidelines.

Forty-five patients with bilateral age-related cataracts and no ocular comorbidities were enrolled and assigned to two matched groups: ISBCS (n=24; 48 eyes) and DSBCS (n=21; 42 eyes). All surgeries followed standardized protocols. Comprehensive data were collected at preoperative, intraoperative, and postoperative stages, including uncorrected distant visual acuity (UCDVA), best-corrected distant visual acuity (BCDVA), intraocular pressure, refractive outcomes, complications, and surgery duration. Patient satisfaction was assessed using the validated VF-14 questionnaire and a cataract satisfaction form. Follow-up visits occurred at both early and intermediate postoperative intervals, facilitating accurate outcome assessment.

Both groups demonstrated comparable baseline characteristics. No intraoperative or postoperative complications were observed in either group. Significant improvement in UCDVA was noted from preoperative to postoperative visits in both groups (p<0.001). UCDVA improved from 0.43±0.35 to 0.13±0.18 (visit1) and 0.11±0.15 (visit2). DSBCS group: UCVA improved from 0.41±0.41 to 0.17±0.18 (visit1) and 0.12±0.15 (visit2). BCDVA and refractive outcomes were similar between groups. VF-14 scores similar between groups (ISBCS 85.1±9.1, DSBCS 83.9±12.1, p=0.807). Patient satisfaction was high in both groups, with ISBCS patients reporting a greater willingness to choose same-day surgery again (91.7% vs 14.3%, p<0.001) and to recommend it to others.

In carefully selected Saudi patients, ISBCS demonstrated safety and efficacy comparable to DSBCS, with similar visual outcomes, refractive results, visual functioning, and complication rates. High patient satisfaction and preference for same-day surgery support broader adoption. Findings advocate for ISBCS inclusion in training curricula, health policy advocacy, and community education campaigns to address the surgical backlog and improve the efficiency of healthcare delivery.