Simultaneous bilateral cataract extraction in the UK.

Abstract

The risk of endophthalmitis was minimised by administration of subconjunctival antibiotics (cefuroxime) at induction of anaesthesia, followed by lid and conjunctival toilet with 5% aqueous povidine-iodine. The usual strict aseptic technique associated with intraocular surgery was observed. The procedures were treated as two separate operations under one anaesthetic. The surgeon, assistant, and instrument nurse rescrubbed and regowned before operating on the second eye. A separate irrigation system and theatre trolley were used for each eye. Postoperatively two bottles of topical steroid-antibiotic preparation (Betnesol-N, Evans Medical, Horsham, Sussex) were used, one for each eye.Our results are analysed and 95%/o confidence intervals calculated.

Is it time for a new attitude to "simultaneous" bilateral cataract surgery?

“…17Both eyes were affected in 0.3–1.5% and the final visual acuity was 6/12 or better 13 The national rate for unilateral surgery was 1.3% on the first postoperative day and had resolved in all cases by 3 months 15…”

“…Hyphaema was seen in 0.8% of cases following immediately sequential ECCE1 and in 0–1.2% following immediately sequential phacoemulsification 217Both eyes were affected in 0.3–1.5% and the final visual acuity was 6/12 or better 1…”

“…No patient had both eyes affected. Although there was one case of endophthalmitis (0.16%) it was not stated if the posterior capsule had been breached 1. Ramsay and colleagues reported a posterior capsule rupture rate of 5% with vitreous loss in 3%, there was one case of bilateral vitreous loss during 453 cases of immediately sequential ECCE 3.…”

“…Unilateral iris prolapse occurred in 0.6% 1. There are no reports following immediately sequential phacoemulsification 2…”

“…Transient intraocular pressure (IOP) elevation was seen in 3.0% after immediately sequential ECCE, two cases were bilateral (0.6%) and all achieved 6/12 acuity or better 1. Transient IOP elevation occurred in 3.7% after immediately sequential phacoemulsification, but resolved by the second postoperative day 2.…”