|LETTER TO THE EDITOR
|Year : 2020 | Volume
| Issue : 3 | Page : 130-131
Immediate sequential bilateral cataract surgery versus delayed sequential bilateral cataract surgery
Ali Adel Ne'ma Abdullah
University Hospital of Wales, Cardiff, Wales, United Kingdom
|Date of Submission||16-Apr-2020|
|Date of Decision||21-Sep-2020|
|Date of Acceptance||29-Sep-2020|
|Date of Web Publication||4-Dec-2020|
Ali Adel Ne'ma Abdullah
University Hospital of Wales, Cardiff, CF14 4XW, Wales
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Abdullah AA. Immediate sequential bilateral cataract surgery versus delayed sequential bilateral cataract surgery. J Clin Ophthalmol Res 2020;8:130-1
|How to cite this URL:|
Abdullah AA. Immediate sequential bilateral cataract surgery versus delayed sequential bilateral cataract surgery. J Clin Ophthalmol Res [serial online] 2020 [cited 2021 Jan 25];8:130-1. Available from: https://www.jcor.in/text.asp?2020/8/3/130/302198
I read with interest Agrawal et al.’s article that compared immediate sequential bilateral cataract surgery (ISBC) versus delayed sequential bilateral cataract surgery (DSBC) in a paediatric population based in India. They concluded that ISBC resulted in fewer hospital visits, reduced in-hospital stay, reduced costs, reduced operating time, and a comparable postoperative complication rate.
An ageing worldwide population will lead to increased demand for cataract operations. By some estimates, demand will double in the next 25 years. Therefore, it is worthwhile to search for methods that maximise use of limited resources without compromising patient care.
ISBC has been touted as a possible solution to this burgeoning demand. Previous meta-analyses and studies corroborate the authors’ findings; Kessel et al.’s meta-analysis and systematic review also demonstrated no difference in the risk of complications or visual outcome when comparing DSBC to IBSC.
The main two concerns regarding ISBC as a possible solution to increased future cataract surgery demand are the risk of potential complications bilaterally (such as endophthalmitis) and the inability to refine refractive targets for the second surgery using results from the first surgery.
With regards to intra- and post-operative complications, despite multiple studies demonstrating no difference, the aforementioned meta-analysis and systematic review acknowledges that the majority of the evidence thus far has been of low or very low quality. Furthermore, the theoretical risks of causing bilateral problems due to contaminated surgical equipment for example is real. Previous studies have demonstrated that contaminated intraocular solutions and irrigation systems on the day of surgery can cause postoperative endophthalmitis. DSBC would limit the risk of bilateral complications from contaminated equipment. These sources of bilateral infections are especially more important in the setting of a developing country with more limited resources.
Refinement of refractive outcome is a potential issue where some studies have demonstrated better results with DSBC due to the ability to prospectively alter the power of the intraocular lens based on the refractive outcome from the first surgery. This is another aspect more likely to be an issue in developing countries which do not always have access to the most up-to-date technologies that most accurately predict refractive outcome. Although the authors did not find such discrepancies in their study, a larger sample size may have demonstrated some differences.
The possibility of performing cataract surgery in less time, at less expense and with no increased risk is an attractive prospect. We should continue to evaluate the prospect of ISBC through larger scale, higher quality studies before considering it as a serious solution to current and future demand.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Agrawal S, Singh V, Vinod Kumar BM, Meena M, Srivastava RM, Katiyar V. Immediate sequential bilateral cataract surgery in children in a government medical university in India. J Clin Ophthalmol Res 2020;8:14-8. [Full text]
Kessel L, Andresen J, Erngaard D, Flesner P, Tendal B, Hjortdal J. Immediate sequential bilateral cataract surgery: A systematic review and meta-analysis. J Ophthalmol 2015;2015:912481.
Singh R, Dohlman TH, Sun G. Immediately sequential bilateral cataract surgery: Advantages and disadvantages. Curr Opin Ophthalmol 2017;28:81-6.
Ramappa M, Majji AB, Murthy SI, Balne PK, Nalamada S, Garudadri C, et al
. An outbreak of acute post-cataract surgery Pseudomonas sp. endophthalmitis caused by contaminated hydrophilic intraocular lens solution. Ophthalmology 2012;119:564-70.
Olsen T. Use of fellow eye data in the calculation of intraocular lens power for the second eye. Ophthalmology 2011;118:1710-5.