Strict guidelines must be followed for immediate sequential bilateral cataract surgery
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WAILEA, Hawaii — Immediate sequential bilateral cataract surgery has gained increasing acceptance over the years. Safety and outcomes are within the standard of care, but strict guidelines must be followed, according to one specialist.
“Why do we do simultaneous surgery? Why do we have this conversation? Greater OR efficiency, less use of resources, decreased number of patient visits, faster visual recovery, and it’s easier for patients. I think we all can agree that there’s good data supporting all of these things,” Julie Schallhorn, MD, MS, said at Hawaiian Eye 2024.
Data from the Kaiser Permanente database show that with modern formulas, there is no need for adjustment between eyes, and refractive outcomes of delayed vs. immediate surgery are comparable.
Regarding safety, Schallhorn quoted several studies showing that the rate of endophthalmitis is not higher and in some cases is even lower with immediate sequential bilateral cataract surgery, likely because stricter safety guidelines are used.
“However, endophthalmitis is super, super rare but when it happens is super, super bad,” Schallhorn said. And toxic anterior segment syndrome, “the ugly sister of endophthalmitis,” can cause great harm when it occurs.
She recommended that a number of “sequential bilateral surgery principles for excellence” should be followed by those who want to safely adopt this practice.
First, both eyes should need surgery. Coexisting ocular disease must be under control, and patients with diseases at a high risk for complications should be excluded. The complexity of surgery should be within the competence of the surgeon, and patients should be properly informed, leaving to them the ultimate choice of whether surgery should be immediate or delayed. Timeout precautions must be taken, making all IOL and astigmatism data for both eyes clearly marked and visible, and staff should be familiar with the IOL.
Operating the two eyes as separate procedures is mandatory.
“Complete aseptic separation between the first and second eyes, and separate lot numbers on all the implants, fluids and instrument sterilization cycles — those are two things that make this difficult to implement but are absolutely critical for the safety of our patients,” Schallhorn said.
Intracameral antibiotics should be routine in all cases, and surgery on the second eye should be postponed if any complication occurs on the first eye, she said.
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Schallhorn J. Immediate sequential bilateral cataract surgery: A look at the data. Presented at: Hawaiian Eye 2024; Jan. 13-19, 2024; Wailea, Hawaii.
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