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PUBLICATION EXCLUSIVE: Debate continues over immediate sequential bilateral cataract surgery

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Welcome to another edition of CEDARS/ASPENS Debates. CEDARS/ASPENS is a joint society of cornea, cataract and refractive surgery specialists, here to discuss some of the latest hot topics in ophthalmology.

One topic that is gaining interest but always stirs controversy is the idea of immediate sequential bilateral cataract surgery. While the fear of the well-known risks remains, there are also many perceived benefits. This month, P. Dee Stephenson, MD, FACS, and Sumitra Khandelwal, MD, discuss the pros and cons of this method. We hope you enjoy the discussion.

Kenneth A. Beckman, MD, FACS
OSN CEDARS/ASPENS Debates Editor

No to same-day surgery

Immediate sequential bilateral cataract surgery (ISBCS) is currently a hot topic. There are well-documented advantages in terms of quicker visual recovery and decreased costs, but the risk is the same as it has ever been: bilateral simultaneous endophthalmitis and bilateral blindness, even though minuscule, occurring in only 0.02% to 0.5% of all cataract surgeries. Even with the advent of intracameral antibiotics and management of preop, intraop and postop inflammation, the risks are still a reality. I also worry about the rise of MRSA/MRSE infections, with the treatment of choice being vancomycin, as well as toxic anterior segment syndrome and cystoid macular edema.

For me, refractive surprises are an issue but are rare in normal eyes with the use of sophisticated optical biometry and intraoperative aberrometry. A fundamental and to me overriding principle that should be followed is to treat each eye surgery as individual and autonomous, as recommended by the International Society of Bilateral Cataract Surgeons.

On the journey to emmetropia, patient satisfaction outcomes become so important, and effective lens position, residual astigmatism and refractive outcome are the things that will set you up for failure. I follow my outcomes in a database to give my patients the best outcomes I can. I learn so much about the first eye, and I use that knowledge to obtain the result I want with the second eye. With the new EDOF and low add multifocal lenses, I would be doing an injustice to my patients to perform same-day cataract surgery. I need to know about their near vision and their satisfaction level with the first eye before proceeding with the other eye. With the advent of femtosecond laser-assisted cataract surgery, it is clearly more efficient to use the laser bilaterally.

• Click here to read the full publication exclusive, Cedars/Aspens Debates, published in Ocular Surgery News U.S. Edition, June 25, 2017.