Immediate Sequential Bilateral Cataract Surgery: A Systematic Review and Meta-Analysis

Abstract

The aim of the present systematic review was to examine the benefits and harms associated with immediate sequential bilateral cataract surgery (ISBCS) with specific emphasis on the rate of complications, postoperative anisometropia, and subjective visual function in order to formulate evidence-based national Danish guidelines for cataract surgery. A systematic literature review in PubMed, Embase, and Cochrane central databases identified three randomized controlled trials that compared outcome in patients randomized to ISBCS or bilateral cataract surgery on two different dates. Meta-analyses were performed using the Cochrane Review Manager software. The quality of the evidence was assessed using the GRADE method (Grading of Recommendation, Assessment, Development, and Evaluation). We did not find any difference in the risk of complications or visual outcome in patients randomized to ISBCS or surgery on two different dates. The quality of evidence was rated as low to very low. None of the studies reported the prevalence of postoperative anisometropia. In conclusion, we cannot provide evidence-based recommendations on the use of ISBCS due to the lack of high quality evidence. Therefore, the decision to perform ISBCS should be taken after careful discussion between the surgeon and the patient.

Immediate Sequential vs. Delayed Sequential Bilateral Cataract Surgery

“…Differences in complication rates will remain a salient research topic until larger sample sizes can be obtained in settings such as ours and in meta-analyses. 17 …”

Do evidence‐based guidelines change clinical practice patterns?

“…We were not able to provide an evidence-based recommendation on the use of ISBCS because of a lack of high quality evidence (Kessel et al 2015a). In Denmark, ISBCS is rarely performed and usually only on patients undergoing cataract surgery in general anaesthesia or after specific demands from the patient.…”

“…If both eyes are operated on the same date, the number of visits can be reduced saving time and money (Leivo et al 2011). We evaluated the literature and did not find any evidence that the risks associated with immediate sequential bilateral surgery are increased compared to delayed sequential bilateral surgery, but the level of evidence was very low and we are not able to provide an evidence-based recommendation (Kessel et al 2015a). We evaluated the literature and did not find any evidence that the risks associated with immediate sequential bilateral surgery are increased compared to delayed sequential bilateral surgery, but the level of evidence was very low and we are not able to provide an evidence-based recommendation (Kessel et al 2015a).…”

“…However, operating both eyes at the same date (immediate sequential bilateral surgery) may introduce the risk of bilateral serious periand postoperative complications, and immediate sequential surgery is discouraged by some (Henderson & Schneider 2012;Tan et al 2012). We evaluated the literature and did not find any evidence that the risks associated with immediate sequential bilateral surgery are increased compared to delayed sequential bilateral surgery, but the level of evidence was very low and we are not able to provide an evidence-based recommendation (Kessel et al 2015a). Thus, if immediate sequential bilateral surgery is performed, it should be performed according to the strict hygienic precautions described by the International Society of Bilateral Cataract Surgeons (Arshinoff et al 2015), intracameral antibiotics should be used and the patient should be well informed on the risks and benefits of immediate sequential bilateral cataract surgery.…”

Management of bilateral cataracts when general anaesthesia is required: same‐day or different‐day surgery?

“…Despite the improvement in safety and outcomes of modern cataract surgery, and the advantages in performing same‐day bilateral surgery in appropriate patients, debate continues around this practice, with many surgeons still considering it taboo . Safety concerns are raised about the risk of complications such as endophthalmitis, cystoid macular oedema and retinal detachment, with the risk of bilateral endophthalmitis and visual loss the most feared.…”