Sequential bilateral cataract surgery safety

Advocates of sequential bilateral cataract surgery point to improvements in economy and patient satisfaction. Opponents have voiced concerns over the safety and potential increased risks posed by this approach. A large Canadian study indicated that the sequential bilateral approach is at least as safe as the traditional approach. The researchers surveyed members of the International Society of Bilateral Cataract Surgeons (iSBCS) to determine the results of unilateral and bilateral cataract surgeries performed by experienced bilateral cataract surgeons. They also looked at recently reported frequencies of postoperative endophthalmitis with or without the use of prophylactic intracameral antibiotics (as used in the landmark ESCRS Endophthalmitis Study). Four cases of bilateral simultaneous endophthalmitis after immediately sequential bilateral cataract surgery (ISBCS) have been reported in the past 60 years, all with breaches of aseptic protocol. No bilateral simultaneous endophthalmitis occurred in the 95,606 ISBCS cases collected. The overall rate of postoperative endophthalmitis after ISBCS was one in 5,759. Infection rates were significantly reduced with intracameral antibiotics to one in 14,352 cases. These rates are at least as low as and sometimes even lower than published rates for unilateral surgery, particularly when recommended precautions are taken. The researchers suggest that simultaneous bilateral cataract surgery is more accurately referred to as immediately sequential bilateral cataract surgery (ISBCS) to clearly differentiate it from delayed sequential bilateral cataract surgery. The approach is becoming more popular around the world.

SA Arshinoff et al., JCRS, “Incidence of postoperative endophthalmitis after immediate sequential bilateral cataract surgeryâ€, Volume 37, Issue 12, 2105-2114.