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

Immediate vs delayed sequential cataract surgery: a comparative study

“…Refractive surprises, as a non-catastrophic complication of ISCS, were not a problem in our survey, which is compatible with previous studies. This may be due to the currently used modern biometry instrumentation and software, 10,11,31 as well as the exclusion of susceptible patients 11 (eg, eyes with extreme axial length or those with previous refractive surgery). In both groups, the stringent selection criteria and the strict preoperative, intraoperative, and post-operative protocols for endophthalmitis prophylaxis might have contributed to the successful surgical results without the occurrence of any serious complications.…”

“…[1][2][3][4][5][6][7] However, it is still unknown whether it is better for these patients to have ISCS or delayed sequential cataract surgery (DSCS). Despite the obvious benefits of ISCS to patients and society, [8][9][10][11] the major reluctance of ophthalmologists to perform ISCS revolves to some extent around its non-catastrophic complications, such as refractive surprises, and most importantly, its catastrophic complications, such as endophthalmitis, 11 especially due to contaminated instrument-derived incidents; 12 however, the literature indicates that the safety of ISCS has been increasing, 1,[13][14][15][16][17] particularly with recent advancements of microsurgical techniques 18,19 and the use of strict protocols for post-operative endophthalmitis prophylaxis. 20 Furthermore, if an intraoperative complication occurs during the first-eye surgery, surgery for the second eye can be aborted.…”

‘Bilateral same-day cataract surgery should routinely be offered to patients’ – No

“…If one assumes the eyes are not independent, the risk of bilateral endophthalmitis may lie between 1 in 180 000 and 1 in 46 600. 6 Published series of same-day bilateral cataract surgery have yet to report a single case of bilateral endophthalmitis; however, for rare events one needs large numbers of patients to generate sufficient power. 12 There have been four cases of bilateral endophthalmitis following ISCS reported in the literature, [13][14][15] including one from the UK; however, in each of these cases stricter sterile separation of the two eyes may have prevented the complication.…”

“…6 Postoperative bacterial endophthalmitis has been reported to occur in 0.04-0.2% of cataract surgeries. 10,11 If one assumes no underlying propensity for the complication, the risk of bilateral endophthalmitis may lie between 1 in 6 250 000 and 1 in 250 000.…”

“…1,3,4 Interest in ISCS has been fuelled by improvements in surgical outcomes and studies demonstrating the economic benefits of operating on both eyes on the same day. 5 With appropriate case selection 6 and precautions against endophthalmitis and refractive surprise, ISCS can result in excellent outcomes and high levels of patient satisfaction. 1,7,8 Despite growing interest, in most countries ISCS remains the exception rather than the rule, and it is our view that it should remain this way and that bilateral cataract surgery should not be routinely offered to patients.…”