More than 10 Years of Experience with Immediate Sequential Bilateral Cataract Extraction (ISBCE)—A Retrospective Study

Guber, Ivo; Bergin, Ciara; Stürmer, Jörg

doi:10.4236/ojoph.2014.44022

Cited by 9 publications

(5 citation statements)

References 15 publications

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“…Further, ISBCS may deliver certain additional benefits at the individual and societal levels as well. A substantial amount of research has showed declining rates of a major post-operative complications such as endophthalmitis [ 16 , 26 , 30 – 32 ] and cystoid macular edema (CME) [ 33 , 34 ] due to ISBCS and no case of bilateral endophthalmitis has been observed when careful sterile separation is considered. And finally, little attention has been paid to the process of identifying numerous factors (e.g., previous ocular and non-ocular surgeries, family history, other ocular and non-ocular diseases, pre-operative and post-operative medications, number of medications, comorbidities) that can influence the estimates due to both types of surgeries.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2015

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BackgroundImmediately sequential bilateral cataract surgery (ISBCS), the cataract surgery that is performed in both eyes simultaneously, is gaining popularity worldwide compared to the traditional treatment paradigm: delayed sequential bilateral cataract surgery (DSBCS), the surgery that is performed in each eye on a different day as a completely separate operation. ISBCS provides advantages to patients and patients’ families in the form of fewer hospital visits. Additionally, patients enjoy rapid rehabilitation, lack of anisometropia - potentially reducing accidents and falls, and avoid suboptimal visual function in daily life. The hospital may benefit due to lower cost.ObjectiveTo perform a systematic review and meta-analysis to evaluate ISBCS and DSBCS.Data SourcesDatabases including MEDLINE, EMBASE, BIOSIS, CINAHL, Health Economic Evaluations Database (HEED), ISI Web of Science (Thomson-Reuters) and the Cochrane Library were searched.ParticipantsNot applicable.MethodsLiterature was systematically reviewed using EPPI-Reviewer 4 gateway. Meta-analysis was conducted using STATA v. 13.0. Standardized mean difference (SMD) and 95% confidence intervals (CI) were calculated and heterogeneity was assessed using I2 statistics. Fixed-effect and random-effect models were computed based on heterogeneity. Meta-analysis was done by instrument used to calculate utility score.ResultsIn total, 9,133 records were retrieved from multiple databases and an additional 128 records were identified through grey literature search. Eleven articles with 3,657 subjects were included for analysis. Our meta-analysis results indicated significant improvement in post-operative utility score using TTO, EQ5D, HUI3, VF-7, and VF-14 and a non-significant improvement using Catquest questionnaire for both surgeries. For ISBCS versus DSBCS, utility-specific fixed-effect model provided an overall SMD of the utility score using the TTO method as 0.12 (95% CI: -0.15, 0.40), EQ5D as 0.14 (95% CI: -0.14, 0.41), HUI3 as 0.12 (95% CI: -0.15, 0.40), VF-7 as -0.02 (95% CI: -0.15, 0.10), and Catquest Questionnaire as 1.45 (95% CI: -0.88, 2.01). The results for utility score, which were measured using various instruments, indicated non-significant improvement in the utility due to DSBCS compared to ISBCS. However, a significant improvement in post-operative utility score was seen using Catquest questionnaire for ISBCS compared to DSBCS. The included studies using VF-14 instrument were highly heterogeneous (I2 = 97.1%). Results provided SMD of -0.25 (95% CI:-1.06, 0.57) using VF-14 indicating non-significant improvement in the utility due to DSBCS compared to ISBCS surgery. Best corrected visual acuity (BCVA) significantly improved after both surgeries (overall SMD of BCVA due to ISBCS was -1.79 (95% CI: -2.45, -1.14) and due to DSBCS was -1.53 (95% CI: -2.25, -0.81)). A non-significant improvement was seen in BCVA due to ISBCS when compared to DSBCS (SMD = -0.18; 95% CI: -0.37, 0.01).ConclusionBoth surgeries, ISBCS and DSBCS significantly improve patients’ qu...

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Section: Discussionmentioning

confidence: 99%

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

et al. 2015

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“…[ 21 24 ] Intraoperative and postoperative complications were very low and comparable with different simultaneous bilateral cataract surgery done by phacoemulsification on same day. [ 25 26 ] Only four (0.37%) patients were left aphakic and needed secondary IOL implantation at a later date in our study. There was no incidence of button holing or premature entry in any case; however, 5 cases required suturing at tunnel which is similar to the study done by Schroeder, who reported tunnel complications in 1.5% of his cases.…”

Section: Discussionmentioning

confidence: 75%

Safety, efficacy and cost-effectiveness of consecutive bilateral cataract surgery on two successive days in tribes at base hospital through community outreach program: A prospective study of Aravali Mountain, North West India

Mohan¹,

Kaur²,

Bhatanagar³

2017

Indian J Ophthalmol

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Purpose:The aim of the study was to evaluate the safety and efficacy of consecutive bilateral cataract surgery (CBCS) on two successive days in a single hospital visit.Methods:Prospective study was conducted on 565 patients of various tribes of hilly area of West Rajasthan who had come to our hospital through community outreach programmed (CORP) between January 2015 and March 2016. Patients with significant bilateral cataract without any other ocular morbidity were advised bilateral manual small incision cataract surgery on two consecutive days. Intraoperative and postoperative complications were evaluated, and follow-up was done at 1 week, 1 month, and 3 months.Results:Out of 565 patients, 519 underwent both eye surgeries. Second eye surgery was deferred for a later date in 46 cases. Because of intraoperative and postoperative complications in the first eye, 31 had delayed surgeries while 15 patients refused to undergo another eye surgery either because of postoperative day 1 poor vision in the operated eye due to retinal pathologies (n = 8) or unwillingness (n = 7). The second eye surgery was performed for 519 patients, out of whom six had intra or postoperative complications. At 1 month follow-up, four patients had unilateral cystoid macular edema and three had prolonged postoperative inflammation. At 3 months, all patients were satisfied and had no complications. None of the patients had sight-threatening complications such as endophthalmitis, corneal decompensation, or vitreoretinal complications.Conclusion:CBCS may be considered safe and cost-effective for patients living in remote locations, dependent on CORP.

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“…There are 4 reports in the literature, discussed in the editorial by Li et al, 20 of bilateral endophthalmitis from bilateral same-day cataract surgery, all stemming from inadequate sterilization and the lack of separating instrument trays between the 2 eyes. Although 2 cases of unilateral suspected TASS have been reported in 2 patients having bilateral same-day surgery 21 and a case of suspected bilateral TASS has been reported in a patient following bilateral surgery separated by 2 days, 22 we are unaware of any reports of bilateral TASS in patients having bilateral same-day surgery. Before performing high volume bilateral same-day surgery, we performed an FMEA to uncover potential process failures with the goal of reducing patient risk for endophthalmitis, TASS, and unintended IOL implantation.…”

Section: Discussionmentioning

confidence: 93%

Failure Modes and Effects Analysis of bilateral same-day cataract surgery

Shorstein¹,

Lucido²,

Carolan³

et al. 2017

Journal of Cataract and Refractive Surgery

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PURPOSE To systematically analyze potential process failures related to bilateral same-day cataract surgery toward the goal of improving patient safety. SETTING Twenty-one Kaiser Permanente surgery centers, Northern California, USA. DESIGN Retrospective cohort study. METHODS Quality experts performed a Failure Modes and Effects Analysis (FMEA) that included an evaluation of sterile processing, pharmaceuticals, perioperative clinic and surgical center visits, and biometry. Potential failures in human factors and communication (modes) were identified. Rates of endophthalmitis, toxic anterior segment syndrome (TASS), and unintended intraocular lens (IOL) implantation were assessed in eyes having bilateral same-day surgery from 2010 through 2014. RESULTS The study comprised 4754 eyes. The analysis identified 15 significant potential failure modes. These included lapses in instrument processing and compounding error of intracameral antibiotic that could lead to endophthalmitis or TASS and ambiguous documentation of IOL selection by surgeons, which could lead to unintended IOL implantation. Of the study sample, 1 eye developed endophthalmitis, 1 eye had unintended IOL implantation (rates, 2 per 10 000; 95% confidence intervals [CI] 0.1–12.0 per 10 000), and no eyes developed TASS (upper 95% CI, 8 per 10 000). Recommendations included improving oversight of cleaning and sterilization practices, separating lots of compounded drugs for each eye, and enhancing IOL verification procedures. CONCLUSIONS Potential failure modes and recommended actions in bilateral same-day cataract surgery were determined using a FMEA. These findings might help improve the reliability and safety of bilateral same-day cataract surgery based on current evidence and standards.

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More than 10 Years of Experience with Immediate Sequential Bilateral Cataract Extraction (ISBCE)—A Retrospective Study

Cited by 9 publications

References 15 publications

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

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

Safety, efficacy and cost-effectiveness of consecutive bilateral cataract surgery on two successive days in tribes at base hospital through community outreach program: A prospective study of Aravali Mountain, North West India

Failure Modes and Effects Analysis of bilateral same-day cataract surgery

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