The concept of immediate sequential bilateral cataract surgery (ISBCS)
Currently, the standard approach to cataract surgery involves a two-step process where patients have their eyes operated on separately on different days. This method is termed delayed sequential bilateral cataract surgery (DSBCS). Another option entails performing surgery on both eyes during a single day, as two distinct procedures.
This technique is referred to as immediate sequential bilateral cataract surgery (ISBCS).
A recent study, focusing on a Finnish clinic, meticulously documented the incidence of ISBCS over a span of 13 years, ranging from January 2008 to December 2020. The study also tracked cases of endophthalmitis, an intraocular inflammation.
The dataset derived from electronic patient records encompassed 56,700 cataract surgeries involving 34,797 patients. This comprehensive collection captured procedural metrics, complications, and the frequency of the surgeries. The study also analyzed rates of endophthalmitis and vitreous loss, comparing these with unilateral cataract surgeries.
Among the 56,700 cataract surgeries conducted, 39% underwent ISBCS. This percentage was roughly averaged out between the initial and final periods of the study. In 2008, a mere 4.2% of patients underwent ISBCS, but this figure surged remarkably to 46% by 2020. Instances of vitreous loss occurred in 0.9% of cataract surgeries, and remarkably, there were no reported cases of postoperative endophthalmitis.
The authors attribute the sharp rise in ISBCS procedures partially to the impact of the COVID-19 pandemic. ISBCS presented patients with an avenue to reduce infection exposure risks by condensing surgery and follow-up visits. This trend has persisted since then, both in Finland and beyond.
The study's authors underscore the efficacy of ISBCS and assert that its increased prevalence has enhanced surgical access by streamlining the time required for the procedure. Their perspective is that "the gradual increase in ISBCS frequency over a 13-year period reflects the growing expertise of surgeons in performing ISBCS, supported by evidence of its safety profile, patient satisfaction, and awareness."
The study indicates that significantly more patients would be willing to undergo ISBCS if given the choice.
The reluctance of surgeons to recommend ISBCS and patient misunderstandings regarding the risk may be limiting its uptake.
