Immediately sequential bilateral cataract surgery (ISBCS) adapted protocol during COVID-19

Sandhu, Simrenjeet; Liu, Daisy; Mathura, Pamela; Palakkamanil, Mathew M.; Kurji, Khaliq; Rudnisky, Christopher J.; Kassiri, Kam

doi:10.1016/j.jcjo.2021.10.003

Cited by 14 publications

(12 citation statements)

References 17 publications

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“…It is known that quicker spectacle adjustment and binocular vision would allow patients to return to work sooner, to perform daily activities with less difficulties and to reduce the risk of falls. 7,15,16 From hospital perspective, it helps to reduce waiting lists and backlogs especially in the COVID-19 era, to better manage patients in waiting areas due to social distancing measure and to improve cost effectiveness and theatre productivity. 17 Intra-operative complications in our cohort were low (n = 5/221, 2.3%) with good post-operative outcomes in all cases.…”

Section: Discussionmentioning

confidence: 99%

“…2,4 In fact, ISBCS offers many patient-level and system-level advantages that DSBCS cannot provide: including faster visual rehabilitation and stereopsis, more convenience for patients, fewer hospital visits, greater theatre productivity and cost-effectiveness. [4][5][6][7] Still, there has been much debate among ophthalmology communities on the practice of ISBCS in United Kingdom despite the benefits it brings. A survey conducted among UK ophthalmologists showed few were practising ISBCS routinely due to various barriers including medico-legal concerns, policy approval and fears of bilateral vision threatening complications such as endophthalmitis.…”

Section: Introductionmentioning

confidence: 99%

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Practice of immediate sequential bilateral cataract surgery (ISBCS): A teaching hospital experience in United Kingdom

Wang

Ramjiani

Auger

et al. 2023

European Journal of Ophthalmology

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Background / Objectives Utilisation of ISBCS has been encouraged since COVID-19 in line with the RCOphth recommendations. This study aims to share experience from a UK teaching hospital on ISBCS and to evaluate pre-, intra- and post-operative outcomes from the ISBCS cohort. Methods Of 3402 cataract surgeries performed between July 2020 and July 2021 (1 year since the reopening of the cataract service from COVID-19), 208 eyes of 104 patients (6.1%) undergoing ISBCS were retrospectively studied on their demographics, biometry, surgeon grades, and pre-, intra- and post-operative data. Results The mean age was 74.5 ± 9.4 years and 62% were female. Eighty-nine percent of the eyes were performed under local anaesthesia and 70% were ‘routine’ cases. Other risk factors included: short eyes requiring pre-operative mannitol infusion (10%), high myopia (8%), poor dilation (2%) and a ‘glaucoma’ cohort [angle closure (2%) and prior trabeculectomy (1%)]. Three eyes (1%) had complications intra-operatively in second eye (1 case each: posterior capsule rupture, corneal oedema and zonular dehiscence). Two patients (1%) had complications in the first eye (1 case each: suprachoroidal haemorrhage, conjunctival & iris haemorrhage), hence had their second eye postponed. Twelve months post-operatively, 20 eyes (10%) had recorded post-op complications with cystoid macular oedema being the commonest (4.5%) and no endophthalmitis. Eighty-six percent were discharged with satisfaction. No significant differences were found in pre-operative features, complication rates and post-operative outcomes between consultant and non-consultant surgeons (p > 0.05). Conclusions Our experience which included a cohort of high-risk patients showed safe and successful practice of ISBCS without having a negative impact on training.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Practice of immediate sequential bilateral cataract surgery (ISBCS): A teaching hospital experience in United Kingdom

Wang

Ramjiani

Auger

et al. 2023

European Journal of Ophthalmology

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“…The risk has not been increased in cataract surgery as well, even in cases with simultaneous bilateral surgery. 18,19 On the contrary, regarding PPV, Sakamoto et al observed a higher rate of endophthalmitis relative to face mask wearing during the pandemic. 20 Some of their cases were associated with oral commensals, an unusual cause of post vitrectomy endophthalmitis.…”

Section: Endophthalmitis and Covid-19mentioning

confidence: 97%

Endophthalmitis and COVID-19: A Narrative Literature Review

Markov¹,

Hristova²,

Andonova³

et al. 2022

sjo

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Endophthalmitis is a severe form of intraocular inflammation which is caused by bacteria or fungi. It is a medical emergency with an imminent threat to vision and permanent structural and functional complications. The condition affects the anterior and posterior segments of the eye. It may be either exogenous – following penetrating trauma or intraocular surgery, or endogenous, in which the pathogens enter the eye hematogenous. The diagnosis is based on the clinical picture and on specialized testing – aqueous and/or vitreous cultures, with or without additional PCR for panbacterial and panfungal primers. If endogenous endophthalmitis is suspected, blood and urine cultures may also be performed. The most common bacterial pathogens in acute postoperative endophthalmitis belong to the Staphylococcus and Streptococcus groups. Endogenous endophthalmitis is most frequently fungal and caused by Candida. The incidence of post-traumatic endophthalmitis ranges from 0.9 to 17% and of postoperative - from 0.016 to 5.7%, depending on the surgical procedure and the geographic location. Endogenous endophthalmitis has been observed in up to 8% of all cases. Therapy is urgent and may include intravitreal medications or pars plana vitrectomy (PPV), according to the Endophthalmitis Vitrectomy Study criteria. The combination of COVID-19-associated severe pneumonia, systemic corticosteroid therapy, and diabetes appear to be risk factors for endogenous endophthalmitis. The ethology has mostly been linked to fungal infections, especially Candida, as in the pre-COVID-19 era. There has been a tendency to perform PPV with intravitreal medications as the primary procedure, but the results have been mixed.

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“…Особенно важно подчеркнуть, что, по мнению как зарубежных [7,8], так и российских [13] офтальмохирургов, в целях более широкого внедрения НПДХК в клиническую практику необходима разработка стандартизированной технологии и протокола оперативного вмешательства. В связи с этим следует отметить, что в наибольшей степени клинические стандарты проведения НПДХК были разработаны и адаптированы с учетом сложной эпидемиологической обстановки в Канаде [14]. В то же время, по мнению некоторых авторов, данные стандарты требуют определенной доработки [4].…”

Section: актуальность проблемыunclassified

Modified Immediate Sequential Bilateral Cataract Surgery (Clinical Cases)

Medvedev

Pokrovskiy

2022

Oftalʹmologiâ

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Purpose. Analysis of two clinical cases of immediate sequential bilateral cataract surgery according to the developed modified algorithm (mаISBCS).Materials and methods. The results of two clinical cases of mаISBCS are presented. In both cases, ultrasonic cataract phacoemulsification (FEC) was performed with implantation of an intraocular lens (IOL) under local anesthesia according to the standard technique through a corneal incision of 2.2–2.4 mm. IOL calculation was performed for emmetropic refraction. The modification (compared to the traditional one) of the technology of surgical intervention was based on the inclusion in the algorithm of a long (at least 60 minutes) break between operations for the purpose of a comprehensive ophthalmological examination with a further decision to perform an operation on the second eye.Results. In the first clinical case, the patient failed to measure the anterior-posterior axis by optical biometry before surgery. In such situations, the A-scan is used, which is considered less accurate due to human error and often leads to errors in the calculation of the IOL. In addition, a certain alertness was introduced by the fact of a significant (4 diopters) difference in the preoperative refraction of both eyes. Considering these provisions, after the first operation, after 60 minutes, the correctness of the IOL calculation was monitored by two methods — by measuring (optical biometrics) the anterior-posterior axis of the eye (APA, while the differences were less than 0.3 mm, which confirmed the A-scan data), as well as autorefractometry, which showed almost no deviation from the “target”. The presented results allowed us to formulate a decision to carry out the second operation. In the second clinical case, despite the absence of risk factors (optical biometrics was taken in two eyes, similar APA values), a postoperative refraction of +1.5 diopters was determined in the operated eye, which, apparently, is associated with the identified decrease (by 0.93 diopters) corneal curvature due to hydration of the corneal stroma in the area of surgical accesses and (or) changes in the tear film. The presented results allowed us to formulate a decision to postpone the second operation. At the same time, after a week, the restoration of the corneal tissue was noted, which was proved by the required (0.37 diopters) deviation of refraction from the target values.Conclusion. The use of mаISBCS technology provides the required clinical efficacy and can be recommended taking into account the epidemiological situation, especially for people with visually strenuous work.

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Immediately sequential bilateral cataract surgery (ISBCS) adapted protocol during COVID-19

Cited by 14 publications

References 17 publications

Practice of immediate sequential bilateral cataract surgery (ISBCS): A teaching hospital experience in United Kingdom

Practice of immediate sequential bilateral cataract surgery (ISBCS): A teaching hospital experience in United Kingdom

Endophthalmitis and COVID-19: A Narrative Literature Review

Modified Immediate Sequential Bilateral Cataract Surgery (Clinical Cases)

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