JCRS HIGHLIGHTS

Cataract surgery - immediate sequential or delayed sequential?

Attitudes regarding the practice of immediate sequential bilateral cataract surgery (ISBCS) have evolved considerably in recent years. The once controversial concept has become regular practice in some areas such as Finland and the Canary Islands, and is gaining adherents in other parts of Europe. JCRS co-editor Emanuel Rosen MD, FRCSEd discusses the current state of ISBCS in light of recent clinical studies and economic analyses. Potential advantages in favour of doing both eyes at once include rapid patient rehabilitation and significant economic benefits, he notes, citing compelling economic and quality-oflife research in favour of ISBCS.

However, this must occur in a context of hard rules, including surgery by experienced cataract surgeons with an excellent personal safety track record; a solid institutional track record, especially in regard to limitation of postoperative endophthalmitis and toxic anterior segment syndrome incidence; careful exclusion criteria; and a database confirming outcomes and ability to modify techniques according to study of outcomes. However, an argument in favour of delayed sequential cataract surgery is the ability to consider the refractive outcome in the firsteye surgery and modify the IOL power in the second-eye surgery.

Dr Rosen cites an article appearing in JCRS that provides additional support for ISBCS. Dr Serrano-Aguilar and colleagues in the Canary Islands conducted a study that randomised patients (1614 eyes) with cataracts requiring bilateral surgery to immediate or delayed sequential bilateral cataract surgery. At one month as well as at one year follow-up, they saw no differences in intraoperative or postoperative surgical complications, visual acuity, or self-perceived visual function between the two techniques. In particular, there were no differences in terms of surgical complications between the two groups.

The authors emphasise that these safety and effectiveness outcomes were related to careful patient selection, surgical expertise, and the systematic use of standardised surgical guidelines to ensure aseptic and independent surgery in each eye. n E Rosen, JCRS, “Editorial: Immediate sequential bilateral cataract surgeryâ€, Volume 38, Number 10, 1707-08. P Serrano-Aguilar et al., JCRS, Immediately sequential versus delayed sequential bilateral cataract surgery: Safety and effectiveness, Volume 38, Number 10, 1734-1742.

Phaco for glaucoma

Early cataract surgery could be “a great option†for patients with mild to moderate glaucoma who have demonstrated less than ideal IOP control with standard medical treatment, say R Chang and colleagues in a guest editorial. The clinical researchers note that modern clear corneal temporal phacoemulsification with posterior chamber intraocular lens implantation appears to offer the characteristics of what would otherwise be considered a blockbuster treatment - lowering intraocular pressure approximately 4.0 mmHg for at least three years and improved vision in over 90 per cent of those who used it with minimal adverse consequences, and perhaps even improved safety with regard to future glaucoma surgery.

They review the evidence for this idea in the literature including the findings of a recently completed analysis from the observation group of the Ocular Hypertension Treatment Study arm. Comparing this approach with other surgical approaches to glaucoma they attest that the benefits of early cataract surgery outweigh the risks in most patients with mild, moderate and, in some circumstances, advanced glaucomatous disease. They add that the case appears to be even stronger for patients with exfoliative glaucoma and those with higher pressures and/or narrow angles for whom an even greater IOP reduction may be anticipated.