Speaker: Bilateral, same-day cataract surgery poses no additional risk to patients

Issue: January 2016

LAS VEGAS — Bilateral, same-day cataract surgery should not pose any additional undue risks to the patient than sequential cataract surgery, according to a presentation here.

Perspective from George Beiko, BM, BCh, FRCSC

“Bilateral, same-day cataract surgery offers convenience and time saving for patients through reduced time off work, fewer appointments, less travel and concurrent recovery of eyes. Costs savings may also be realized to payers, employers and employees,” Neal H. Shorstein, MD, said at the American Academy of Ophthalmology annual meeting.

To assess the risk for bilateral, same-day cataract surgery, a failure modes and effects analysis analyzed the risk of endophthalmitis, toxic anterior segment syndrome (TASS) and unintended IOL implantation based on lens type and power.

More than 25 clinicians and experts examined 4,754 bilateral cases from 21 Northern California Eye Department centers undertaken between 2009 and 2014.

There were no instances of bilateral endophthalmitis, one instance of unilateral endophthalmitis, one instance of unintended IOL implantation in one eye, and no instances of TASS. There was one instance of dilution error in onsite compounding of cefuroxime, and no instances of manufacturer recalls of pertinent medicines or products.

Shorstein said work is ongoing to train surgeons and staff in order to maintain a high degree of reliability.

“This is accomplished through instilling everyone with preoccupation with failure, promoting surgeon sensitivity to the role of others including nurses and staff, cultivating nimbleness and resilience in the workplace to unexpected situations, and moving toward standardization and simplification wherever possible,” he said. — by Kristie L. Kahl

Reference:

Shorstein NH. Bilateral, same-day cataract surgery: risk analysis and recommendations in a Northern California Eye Department. Presented at: American Academy of Ophthalmology annual meeting. Nov. 15, 2015; Las Vegas.

Disclosure: Shorstein reports no relevant financial disclosures.

Perspective

George Beiko, BM, BCh, FRCSC

The presentation by Shorstein and colleagues demonstrated that by using a rigid protocol, it is possible to perform bilateral same-day cataract surgery with a considerable degree of confidence that the outcomes would be safe. The rigid protocol included recommendations for cleaning and sterilization enhancements, separating lots of compounded medicines for each eye, and refining and standardizing IOL measurement, selection and implantation workflows.
Compelling as the evidence is for safety in performing bilateral same-day cataract surgery, my personal feeling is that TASS continues to be a rare event that could potentially affect both eyes and could result in blindness. Vision continues to be the single most important thing for patients; in fact, blind patients are willing to exchange up to 70% of their remaining life for the return of vision. So, although rare, it must be made perfectly clear to patients that perfect surgery may still result in TASS and blindness, and that this risk is inherent in all ocular surgery, including bilateral same-day cataract surgery. Thus, for me, bilateral same-day surgery is an option only in the event of surgery under general anesthesia (GA) because the risks of a second GA trump the possible risk of TASS.

George Beiko, BM, BCh, FRCSC

Cataract, anterior segment and refractive surgeon

St. Catharines, Ontario, Canada

Disclosures: Beiko reports he is a consultant for and receives research support from Abbott Medical Optics and Bausch + Lomb.