IMMEDIATE SEQUENTIAL BILATERAL CATARACT SURGERY (ISBCS) IN A COHORT OF NATIONAL HEALTH SERVICE (NHS) PATIENTS IN THE UK

To present audit data on ISBCS in NHS patients. To discuss our initial experiences with providing ISBCS in the NHS. 

In patients with senile bilateral cataract, immediate sequential bilateral cataract surgery (ISBCS) is gaining popularity, but currently accounts for just 0.5% of all NHS cataract surgeries. Concerns still exist about the possibility of bilateral sight-threatening postoperative complications with ISBCS, such as bilateral postsurgical endophthalmitis and risk of postoperative refractive error surprise. On the other hand, potential advantages of ISBCS include faster visual recovery, fewer postoperative visits and lower economic burden.

Data of ISBCS cases undertaken at Southend University Hospital in the last 5 years (2019-2024) was collected from Theatres Logbook.  Indications for bilateral surgery and visual acuity data were collected from clinical notes. Timing of surgery was compared with a cohort of 106 unilateral cataract cases undertaken between September-October 2024. 

212 eyes of 106 patients underwent ISBCS in the last five years, with a median age of 76 years. The majority of patients were female (69%). Indications for ISBCS included general anaesthesia (GA) (n=40), diplopia (n=14), high refractive error (n=13), and narrow angle (n=7). Bilateral surgery was more likely to be performed by consultants (61%) than trainee ophthalmologists (39%) and 40% of ISBCSs required GA. Mean procedure time (from first incision to end of procedure) was 35 minutes, compared to 16 minutes in the unilateral group; turnaround time between patients was 14 minutes and 9 minutes respectively. There were no intraoperative complications, and as far as we know no post-operative complications. Visual acuity improved in 95% of patients and remained unchanged in 2.7%.  

ISBCS in our cohort of patients was safe and effective. Patient benefits of this include faster visual rehabilitation, more efficient use of theatre time and fewer hospital visits. In patients who require GA, this approach reduced the risk of a further anaesthesia and is also more cost effective.