Resident-performed ISBCS

Fewer visits, better satisfaction, equal outcomes compared to separate procedures. Howard Larkin reports.

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Senior residents performing immediate sequential bilateral cataract surgery (ISBCS) is as safe and effective an approach as delayed sequential bilateral cataract surgery (DSBCS) with significantly fewer clinic visits, Tiffany A Chen MD told the Association for Research in Vision and Ophthalmology 2021 Annual Meeting. The findings of the retrospective cohort study she conducted with her twin sister and fellow ophthalmology resident Stephanie P Chen MD and other colleagues at the University of California – San Francisco (UCSF), USA, suggest that offering senior resident-performed ISBCS for select patients may offer significant benefits. These include reducing potential exposure events for patients and providers during the COVID-19 pandemic, and lowering overall costs while improving patient satisfaction, Dr Chen said. Bilateral cataracts were traditionally treated in a delayed sequential approach to avoid complications such as refractive surprise and bilateral endophthalmitis, Dr Chen noted. However, advances in cataract diagnostics and surgical procedures have greatly reduced the risk of such adverse events, and several large studies have shown similar safety and visual outcomes for ISBCS and DSBCS in appropriately selected patient populations, she emphasised. The current pilot study examined the safety and visual outcomes, patient satisfaction, and number of perioperative visits, of 22 eyes in 14 patients and 56 eyes in 28 patients who underwent senior resident-performed ISBCS and DSBCS, respectively. In 6 of the ISBCS patients, senior residents performed one eye surgery and attending surgeons the other, and only the resident-operated eyes were included in the analysis. The study included patients aged 18 or older with no active ocular or medical comorbidities with the ability to lie flat for both procedures and the ability to tolerate topical anaesthesia in one eye. Thirty days after the second surgery, 21, or 95%, of ISBCS eyes and 51, or 91%, of DSBCS eyes achieved corrected distance visual acuity of 20/25 or better while 77% and 84%, respectively, were within 0.50 D of target refraction. There was no significant difference in the overall visual function score and no difference in preoperative or postoperative complications. ISBCS patients averaged 3.5 fewer visits than DSBCS patients, 5.9 vs. 9.5, a significant difference. All ISBCS and 20 DSBCS patients, or 87%, reported they were overall “very satisfied” or “satisfied” (p=0.701). In addition, 5 of the 6 senior residents who performed the ISBCS cases reported they preferred performing ISBCS over DSBCS. Further study is indicated, Dr Chen said. However, she believes that “residency programs should consider offering senior resident-performed ISBCS to select patients during the COVID-19 pandemic.” Tiffany Chen: tiffany.chen2@ucsf.edu Stephanie Chen: stephanie.chen2@ucsf.edu
Tags: cataract and refractive