Study shows comparable outcomes of same-day vs. delayed surgery with multifocal IOLs
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Immediate sequential bilateral cataract surgery with implantation of multifocal IOLs showed comparable outcomes to delayed sequential bilateral cataract surgery in a large case series.
“With the use of optical biometry, refractive surprises are rare in normal but also post-LASIK eyes,” Jan Venter, MD, said at the virtual European Society of Cataract and Refractive Surgeons winter meeting.
Immediate sequential bilateral cataract surgery (ISBCS) minimizes patient visits to the office and OR, provides fast recovery of binocular vision, particularly in patients with high refractive error, and decreases the cost for both patients and the health care system. Disadvantages are the risk for bilateral endophthalmitis and toxic anterior segment syndrome, and the inability to use the outcome from the first eye to refine the prediction for the second eye. In addition, in some countries, surgeons receive no reimbursement for the second eye when surgery is performed bilaterally on the same day.
In a retrospective study, the results at 3 months of 2,440 ISBCS procedures were compared with those of 1,136 delayed sequential bilateral cataract surgery (DSBCS) procedures. Multifocal lenses of various types were used in all cases.
“Visual acuity outcomes were comparable, with only a slight advantage in near vision in the DSBCS group,” Venter said.
Postoperative binocular distance visual acuity was 6/6 (20/20) or better in 88.7% of ISBCS patients and 89.5% of DSBCS patients. Near visual acuity was N6 (20/40) in 86.3% and 89.5%, respectively, with a slight statistically significant difference in favor of the DSBCS group. Predictability was comparable, with 84.2% vs. 85.5% of patients within 0.5 D in the two groups.
“For IOL power calculation, we used the IOLMaster 700 (Carl Zeiss Meditec) with the Haigis and Barrett formulas. Refraction was very precise, also in some post-LASIK eyes that we treated. We include in our package also postoperative LASIK enhancement, but it is rarely required,” Venter said.
Change in best corrected visual acuity was comparable, and so were complication rates, with the exception of elevated IOP, which was seen more often in the ISBCS group (3.8%) than in the DSBCS group (1.9%), probably due to insufficient removal of viscoelastics, according to Venter.
A questionnaire showed a high level of patient satisfaction in both groups.
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Venter J. Simultaneous bilateral same day cataract surgery with multifocal IOLs. Presented at: European Society of Cataract and Refractive Surgeons winter meeting; Feb. 19-21, 2021 (virtual meeting).
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