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

Abstract

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.

Evolution of Biometric Formulas and Intraocular Lens Selection in Challenging Cases

“…Finally, high myopia patients undergoing cataract surgery may be at a higher risk of IOL dislocation, especially in younger patients [65]. Immediate sequential bilateral cataract surgery is another technique that may be associated with increased risks in high myopia patients [66].…”