The Royal College of Ophthalmologists’ National Ophthalmology Database study of cataract surgery: Report 7, immediate sequential bilateral cataract surgery in the UK: Current practice and patient selection

Abstract

Background Cataract extraction is the most frequently performed surgical intervention in the world and demand is rising due to an ageing demography. One option to address this challenge is to offer selected patients immediate sequential bilateral cataract surgery (ISBCS). This study aims to investigate patient and operative characteristics for ISBCS and delayed bilateral cataract surgery (DSCS) in the UK. Methods Data were analysed from the Royal College of Ophthalmologists’ National Ophthalmology Database Audit (NOD) of cataract surgery. Eligible patients were those undergoing bilateral cataract extraction from centres with a record of at least one ISBCS operation between 01/04/2010 and 31/08/2018. Variable frequency comparison was undertaken with chi-square tests. Results During the study period, 1073 patients had ISBCS and 248,341 DSCS from 73 centres. A higher proportion of ISBCS patients were unable to lie flat (11.3% vs. 1.8%; p < 0.001), unable to cooperate (9.7% vs. 2.7%; p < 0.001); underwent general anaesthesia (58.7% vs. 6.6% ( p < 0.001)); had brunescent/white/mature cataracts (odds ratio (OR) 5.118); no fundal view/vitreous opacities (OR 8.381); had worse pre-operative acuity 0.60 LogMAR ISBCS vs. 0.50 (first) and 0.40 (second eye) DSCS and were younger (mean ages, 71.5 vs. 75.6 years; p < 0.001). Posterior capsular rupture (PCR) rates adjusted for case complexity were comparable (0.98% ISBCS and 0.78% DSCS). Conclusions ISBCS was performed on younger patients, with difficulty cooperating and lying flat, worse pre-operative vision, higher rates of known PCR risk factors and more frequent use of general anaesthesia than DSCS in centres recorded on NOD.

Management of Cataract in Patients with Age-Related Macular Degeneration

“…Posterior capsular rupture (PCR) is a complication of cataract surgery that can be associated with significantly worse visual outcomes [44]. The Royal College of Ophthalmologists of England National Ophthalmology Database study of cataract surgery for cases between 2010 and 2018 reported a mean PCR rate of just less than 1% [45]. The hypothesis that previous intravitreal therapy is a predictor of increased risk of PCR during cataract surgery was tested on a large registry of eyes undergoing cataract surgery from 20 UK Hospital Trusts between 2004 and 2014 [46].…”

Cataract service redesign in the post-COVID-19 era

“…48 Currently, ISBCS in the UK is offered to limited patients who require general anaesthesia for social reasons, for example, patients with learning difficulty. 49 Post-COVID, the real benefit of bilateral surgery should be applied to carefully selected, counselled and consented patients. 50 Cataract surgery by appointment This is a model where patients self-prepare for surgery, arrive and discharge directly from the operating theatre.…”

A stakeholder meeting exploring the ethical perspectives of immediately sequential bilateral cataract surgery

“… 5 In 73 centres where at least one patient had undergone ISBCS, the overall rate was 0.4% of the cataract operations performed. 6 Some commentators believe that for a routine elective procedure, ISBCS should not be undertaken as the potential benefits do not outweigh the potential harms of the protocol. 7 …”