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Bilateral cataract surgery can be safe, surgeon says
On a purely statistical basis, two operations can be more dangerous than one.
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TORONTO — Ophthalmologists have been leery about performing bilateral cataract surgery because of the risks of endophthalmitis and cystoid macular edema. Some physicians also say it is not economical and it is not consistent with the American Academy of Ophthalmology’s Preferred Practice Patterns of 1996.
According to Steve A. Arshinoff, MD, FRCSC, reasons for bilateral cataract surgery include a reduction in morbidity, access to care, patient preference and reduced risk of complications. “It is safer than unilateral surgery,” Dr. Arshinoff said. “Most complications associated with cataract surgery have to do with ancillary issues like anesthesia, alteration of medication routines, travel and induced anisometropia, and not the surgery itself.” Dr. Arshinoff added that bilateral surgery is economical.
The advantages are that the surgical episode is foreshortened, clinical postoperative procedures are reduced and the patient’s rehabilitation is maximized.
Separate procedures
Dr. Arshinoff performs bilateral cataract surgery by using topical or intracameral anesthesia and clear corneal incisions. No sutures are used, and a small incision and foldable IOL are employed.
Dr. Arshinoff treats the bilateral procedure as two operations. For the second eye Dr. Arshinoff changes drapes, gloves and instruments and uses different balanced salt solution and viscoelastic lot numbers. Additionally Dr. Arshinoff uses intraocular vancomycin 1 mg/0.1 cc in the capsular bag at the end of the procedure. The second eye is not operated on if there were difficulties associated with the initial eye.
Dr. Arshinoff recommends bilateral cataract surgery only to those confident, experienced surgeons who have extremely low complication rates.
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John Bolger, MB, CRCS, DO, of Harpenden, England, had addressed the safety question in simultaneous bilateral cataract extraction in the Consultation Section in the April 1998 issue of the Journal of Cataract and Refractive Surgery. In summary, Dr. Bolger said that by performing bilateral cataract surgery, not only eyes but lives could be saved.
Dr. Bolger told readers to consider 500,000 patients having bilateral cataract surgery, or 1 million surgeries. If each of the patients lived an average of 10 km from the clinic and made four visits to the clinic for a preoperative visit, surgery and two postoperative visits, this group will have traveled 80 million kilometers. According to the Royal Society for the Prevention of Accidents road fatalities for Britain in 1996, Dr. Bolger calculated that 50 patients would have been killed in a fatal road accident while traveling to their clinic. If patients had bilateral simultaneous surgery, 25 patients would have been killed and one would have had bilateral endophthalmitis.
For Your Information:Reference:
- Steve A. Arshinoff, MD, FRCSC, can be reached at 2115 Finch Ave. W, Ste. 316, Toronto, ON M3N 2V6, Canada; (416) 745-6969; fax:: (416) 745-6724. Dr. Arshinoff has no direct financial interest in any of the products mentioned in this article, nor is he a paid consultant for any companies mentioned.
- Bolger J. Letters. J Cataract Refract Surg. 1998;24:430-431.