Immediate sequential vs delayed sequential bilateral cataract surgery: systematic review and meta-analysis

Patient-reported visual function outcomes in immediately sequential versus delayed sequential bilateral cataract surgery

PURPOSE

To compare patient-reported visual function outcomes of immediate sequential bilateral cataract surgery (ISBCS) and delayed sequential bilateral cataract surgery (DSBCS).

METHODS

Single-center, randomised controlled trial of patients eligible for bilateral cataract surgery allocated to ISBCS or DSBCS. Patients filled out the Catquest-7SF questionnaire before surgery, 1 week after surgery, and 3 months after surgery.

RESULTS

Ninety-eight patients were included for analysis (ISBCS = 51; DSBCS = 47). In both groups, there was a statistically significant improvement in Catquest-7SF patient-reported outcomes after surgery (p < 0.001), and no difference between the ISBCS and DSBCS groups (p ≥ 0.424). At both 1 week and 3 months post-surgery, a statistically significantly higher proportion of patients were "very satisfied" with the surgical approach in the ISBCS group (94.1% at both 1 week and 3 months) compared to the DSBCS group (55.3% at 1 week and 63.8% at 3 months), both p < 0.001.

CONCLUSIONS

Both ISBCS and DSBCS are effective options to treat bilateral cataracts with no statistically significant difference in patient-reported vision outcomes. However, we found postoperative satisfaction with the surgical approach to be higher among ISBCS patients, which suggests that ISBCS-related benefits, such as fewer health care visits and shorter vision rehabilitation, are compelling to patients.

High patient acceptance of immediately sequential bilateral cataract surgery (ISBCS) as part of a one-stop see-and-treat pathway within an innovative NHS cataract unit

BACKGROUND

Constituting ~0.5% of all NHS cataract operations, national provision of immediately sequential bilateral cataract surgery (ISBCS) is limited. Combining offering ISBCS within a novel one-stop see-and-treat (S&T) cataract pathway would offer patients the opportunity for two cataract operations in a single hospital visit. Patient acceptance of ISBCS amongst urban populations has been investigated. However, little is understood about ISBCS acceptance rurally.

METHODS

Retrospective observational study at the Nightingale Hospital, Exeter investigating patient acceptance of ISBCS within S&T; following the implementation of a S&T cataract pathway entailing a pre-operative patient-clinician telephone consultation and subsequently scheduled single date of assessment and surgery. Patient acceptance and factors potentially influencing decisions were investigated.

RESULTS

200 patient telephone consultations between 22nd August 2023 and 9th January 2024 were evaluated. 198 (99%) patients referred were suitable for S&T cataract surgery, of whom 109 (54.5%) were deemed eligible for offering ISBCS S&T cataract surgery. Of the eligible participants, 78 (71.56%) favoured ISBCS. No significant differences in age, sex, distance from hospital or refractive data were identified between ISBCS accepting and declining participants.

CONCLUSIONS

Our results illustrate a high patient acceptance rate (71.56%) of ISBCS within our population in contrast with published national rates. Offering ISBCS within a S&T model would allow patients to benefit from having both cataracts assessed and treated within a single hospital visit.

Refractive outcomes and safety profile after sequential bilateral cataract surgery

PURPOSE

To evaluate the safety and effectiveness of simultaneous bilateral cataract surgery (SBCS) in a private ophthalmology clinic, focusing on postoperative refractive outcomes, visual acuity, and the incidence of complications.

METHODS

This observational, retrospective study included 200 eyes from 100 patients who underwent SBCS between January 2018 and April 2020. Preoperative evaluations comprised visual acuity, refraction, biometry, and anterior segment examinations. Surgeries were performed sequentially by a single surgeon using femtosecond laser-assisted or stop-and-chop techniques, with adherence to iSBCS guidelines. Postoperative care included topical antibiotics and steroids, with follow-up at one day and four weeks. Safety outcomes included the incidence of complications, particularly Toxic Anterior Segment Syndrome (TASS), while effectiveness was assessed by postoperative visual acuity and refraction.

RESULTS

Postoperative complications were observed in 2.5% of cases, including two cases of unilateral TASS, one case of corneal edema, one reactivation of diabetic macular edema, and one of ocular hypertension. All complications were resolved with medical management, and no cases of endophthalmitis were reported. Visual acuity improved significantly, with all eyes achieving 0.096 logMAR or better by week four. Refractive outcomes showed high accuracy, with no significant refractive surprises.

CONCLUSIONS

SBCS is a safe and effective procedure, delivering excellent visual and refractive outcomes. The incidence of complications, including TASS, was low, and all cases were successfully managed. This approach can be a viable alternative for patients with bilateral cataracts, particularly in settings with strict adherence to sterilization and surgical protocols.

Immediate sequential bilateral cataract surgery: Prevalence, attitudes and concerns Among Italian ophthalmologists

PURPOSE

to investigate the existing practice patterns of immediate sequential bilateral cataract surgery (ISBCS) in Italy and to assess ophthalmologists' attitudes towards performing ISBCS in the future for cataract treatment.

METHODS

It is a multicenter cross-sectional study. From February,1st 2023 to March, 1st 2023 the Members of the Italian Society of Cataract and Refractive Surgery (AICCER) as well as the attendees of its annual national congress were invited to anonymously complete an electronic 7-item questionnaire on their current ICBCS practice. Questions included the average number of procedures per month, the main indications for ICBCS, and the main reasons for performing and not performing ISBCS. Data were analyzed using descriptive statistics.

RESULTS

of the 2300 recipients, 246 (10.7%) completed the survey. Of the respondents, 156 (63.4%) replied to perform ISBCS, most of them (82%) occasionally (1 to 5 procedures per month). Fifty-three percent (130 ophthalmologists) considered adopting ISBCS as routine practice in the near future. The conditions most considered for ISBCS were age-related cataract surgery under general and topical anesthesia and congenital cataract surgery. The availability of separate instruments for the two eyes as well as patient and hospital advantages were the most important reasons for performing ISBCS. The risk of bilateral endophthalmitis and medicolegal issues were the main reasons for not performing ISBCS.

CONCLUSIONS

ISBCS remains controversial among Italian surgeons, despite growing evidence of its safety and efficacy. The risk of potentially blinding complications such as bilateral endophthalmitis, together with medicolegal concerns are the principal barriers to ISBCS implementation in routine practice.

Surgeon adoption of immediate sequential bilateral cataract surgery in the United States from 2018 to 2022

PURPOSE

To assess 5-year trends in the rate of immediate sequential bilateral cataract surgery (ISBCS) and surgeon characteristics associated with performing ISBCS.

SETTING

100% Medicare Fee-For-Service beneficiaries from 2018 to 2022.

DESIGN

Cross-sectional study.

METHODS

ISBCS cases were identified among patients aged 65 years or older undergoing bilaterally performed cataract surgery (BPCS). Cochrane Armitage trend test was used to assess patient and surgeon characteristics over time. Multivariate logistic regression was used to evaluate surgeon characteristics associated with performing ISBCS.

RESULTS

Among 1 190 169 BPCS, 3954 (0.33%) were ISBCS. Quarterly ISBCS rate increased from 2.12 to 5.5 per 1000 BPCS ( P < .001). Among 10 290 surgeons, 1119 (10.87%) performed ISBCS on some patients. Proportion of surgeons performing ISBCS per 1000 cataract surgeons increased from 15.63 during the first quarter of 2018 to 26.55 during the last quarter of 2022 ( P < .001). Among the ISBCS surgeons, the proportion of ISBCS cases per 1000 BPCS doubled from 17.20 in 2018 to 35.50 in 2022 ( P < .001). On multivariate analysis, surgeons in the highest surgical volume quartile (odds ratio [OR], 1.21; 95% CI, 1.01-1.45; Ref: lowest quartile), recent graduates (0 to 10 years: OR, 2.43; 95% CI, 1.87-3.15; Ref: ≥ 31 years), and surgeons in the West (OR, 2.408; 95% CI, 2.052-2.826; Ref: South) had higher odds of performing ISBCS.

CONCLUSIONS

There was an increased rate of ISBCS possibly suggesting greater interest among patients and surgeons. Although the overall ISBCS rate remained low, the number of surgeons performing ISBCS increased. Higher volume surgeons, recent graduates, and those practicing in the West were more likely to perform ISBCS.

Cataract and Risk of Fracture: A Systematic Review, Meta-Analysis, and Bayesian Network Meta-Analysis

TOPIC

To evaluate the odds ratio (OR) and hazard ratio (HR) of bone fracture in phakic subjects with cataract compared with phakic subjects without cataract and pseudophakic individuals.

CLINICAL RELEVANCE

Despite the growing recognition of the link between cataract and fracture, the available evidence remains inconclusive.

METHODS

The results of this meta-analysis were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The study protocol was registered on the International Prospective Register of Systematic Reviews (ID: CRD42024587477). Four electronic databases were searched from their inception to May 2024: PubMed, Embase, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Two reviewers performed title and abstract screening, full-text assessment, and study quality appraisal. Frequentist inference meta-analysis and Bayesian network meta-analyses (NMAs) were conducted to assess the OR and HR of fracture among the 3 groups of interest.

RESULTS

Sixteen articles met the predefined inclusion and exclusion criteria, with the 11 included in the quantitative synthesis encompassing a population of 4 713 458 subjects and reporting on 284 811 fractures. The certainty of evidence was rated from low to moderate. Compared with subjects without cataract, the OR and the HR for fractures in the cataract group were 1.44 (95% confidence interval [CI]: 0.75-2.75; P > 0.05) and 1.51 (95% CI: 1.14-2.01; P = 0.0152), respectively. Bayesian NMAs indicated that subjects with cataracts have an increased OR and HR of fractures compared with both phakic subjects without cataracts (OR: 3.0 [95% credible interval (CrI): 2.8-3.3]; HR 1.1 [95% CrI: 1.09-1.12]) and pseudophakic individuals (OR: 1.7 [95% CrI: 1.6-1.8]; HR: 1.28 [95% CrI: 1.24-1.31]). Pseudophakic individuals exhibit a 27% reduction in fracture risk compared with phakic individuals with cataracts, with 1 less fracture event for every 8 pseudophakic subjects.

CONCLUSION

Low-certainty evidence suggests a higher fracture risk in individuals with cataract compared with those without. Moderate-certainty evidence indicates that pseudophakic individuals have the lowest fracture risk compared with phakic patients with or without cataract. Further research should explore the causal link between cataract and fracture risk and evaluate the impact of cataract surgery on fracture prevention.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Safety and efficacy of a novel 'One-Visit, Both-Cataracts' high-volume see-and-treat immediate sequential bilateral cataract surgery service in a public healthcare setting

PURPOSE

To evaluate the safety and efficacy of a novel cataract surgery pathway that combines a See-and-Treat (S&T) model with Immediate Sequential Bilateral Cataract Surgery (ISBCS) at the Nightingale Hospital, Exeter, UK.

METHODS

A retrospective observational study was conducted on 102 consecutive patients (204 eyes) who underwent S&T ISBCS between July 2023 and July 2024. Patients were triaged based on referral information and underwent preoperative telephone consultations. On the day of surgery, clinical assessment and bilateral cataract surgery were completed in a single visit. Data collected included patient demographics, intraoperative and postoperative outcomes, and complications.

RESULTS

Of the 127 patients listed, 102 (84.3%) completed S&T ISBCS. No intraoperative complications were recorded. Fourteen patients (13.7%) required unplanned postoperative consultations, with most cases being non-sight-threatening and self-resolving. Cystoid macular oedema (CMO) was reported in 2.9% of eyes, with no cases of visual loss or endophthalmitis.

CONCLUSION

The S&T ISBCS model demonstrated safety and efficiency in delivering cataract care, with a high one-visit completion rate and low complication rates. This model offers significant time and resource savings whilst maintaining patient safety. It holds potential for broader implementation in healthcare settings facing increased demand for cataract services. Further studies are recommended to assess long-term outcomes and optimise this approach.

Perspectives on the Incidence of Acanthamoeba Keratitis: A Systematic Review and Meta-Analysis

TOPIC

To provide an overview on the incidence of Acanthamoeba keratitis (AK).

CLINICAL RELEVANCE

Although being a sight-threatening cause of infectious keratitis, a comprehensive assessment of the incidence of AK is lacking.

METHODS

Incidence of AK was computed as the number of eyes with AK per health care center, per year (annualized center incidence [ACI]). Two meta-analytical ratios also were calculated: (1) the ratio of eyes with AK to the count of eyes with nonviral microbial keratitis (MK) and (2) the ratio of eyes with AK to the overall population (i.e., the total number of people in a nation or region, as indicated by the authors in each study). Center was defined as the health care facility where the study took place. Actual and projected estimates of the number of eyes with AK in years were calculated multiplying the ratio of eyes with AK to the total population and the corresponding population estimates, sourced from the United Nations Population Prospects.

RESULTS

Overall, 105 articles were included, published between 1987 and 2022. The total number of eyes identified was 91 951, with 5660 eyes affected by AK and 86 291 eyes affected by nonviral MK. The median ACI was 1.9 eyes with AK per health care center per year (95% confidence interval [CI], 1.5-2.6 eyes), with no statistically significant differences among continents. The ratio of eyes with AK to the total number of eyes with MK was 1.52% (95% CI, 1.03%-2.22%), whereas the ratio of eyes with AK in relationship to the entire population was estimated at 2.34 eyes per 1 000 000 people (95% CI, 0.98-5.55 per 1 000 000 people). The projected increase in the numbers of eyes with AK indicated an increase of 18.5% (n = 15 355 eyes with AK) in 2053 and 25.5% (n = 16 253 eyes with AK) in 2073, compared with the baseline of 2023 (n = 12 953 eyes with AK).

DISCUSSION

Acanthamoeba keratitis emerged as a relatively low-incident disorder, and no significant differences in terms of its incidence were found among different continents.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Recent trends and outcomes in immediate and delayed sequential bilateral cataract surgeries: a nationwide cohort study in South Korea

PURPOSE

To analyze the latest annual trends in immediate sequential bilateral cataract surgery (ISBCS) and delayed sequential bilateral cataract surgery (DSBCS) among patients with bilateral cataracts in Korea, and to identify the factors influencing the choice of surgery and the outcomes associated with ISBCS and DSBCS.

METHODS

This retrospective, nationwide cohort study included all patients aged 65 and older who were covered by the Korean National Health Insurance and underwent ISBCS or DSBCS from 2016 to 2021. The study recorded yearly numbers of ISBCS and DSBCS procedures, the interval between surgeries in DSBCS cases, patient demographics, types of implanted intraocular lenses (IOLs), and the incidence of cystoid macular edema and endophthalmitis following ISBCS or DSBCS.

RESULTS

A total of 50 878 (7.2%) patients underwent ISBCS, and 658 609 (92.8%) patients underwent DSBCS. ISBCS cases more than doubled in 2020 (7902) from 2019 (3703) before increasing even more significantly in number in 2021 (33 645). Age, hospital size, ocular and systemic comorbidities, type of IOL, and calendar year were associated with receiving ISBCS. In 2020 alone, the incidence of postoperative endophthalmitis among ISBCS patients was significantly higher (1.39 per 1000 procedures) than among DSBCS patients (0.40 per 1000 procedures; P = 0.001).

CONCLUSION

The number of patients undergoing ISBCS for bilateral cataracts increased annually, particularly after the onset of the COVID-19 pandemic in Korea in 2020. However, this significant rise in ISBCS also led to a surge in the incidence of postoperative endophthalmitis in 2020.

A survey exploring ophthalmologists' attitudes and beliefs in performing immediate sequential bilateral cataract surgery in Singapore

BACKGROUND

To evaluate current practice patterns of Immediate Sequential Bilateral Cataract Surgery (ISBCS) by ophthalmologists in Singapore and assess their attitudes towards performing ISBCS in future cataract care.

METHODS

An anonymised electronic survey, modified to local context from a similar study conducted in the United Kingdom, was distributed to members of the College of Ophthalmologists, Academy of Medicine, Singapore, from 20 June to 1 September 2023. An initial screening question on prior experience with ISBCS directed the rest of the survey. Questions explored ophthalmologists' current ISBCS practice patterns and the importance of factors affecting their willingness to perform ISBCS. Results were descriptively analysed.

RESULTS

Results collated 2 months upon survey dissemination saw a total of 58 respondents from 235 eligible members (24.7% response rate). Of these, 16 (27.6%) were currently performing ISBCS, 37 (63.8%) had never performed, and 5 (8.6%) had stopped performing. In considering ISBCS, patient convenience (n = 11, 68.8%) and reduced hospital visits (n = 8, 50.0%) were the most important factors nominated. The most important barriers to performing ISBCS were medico-legal issues (n = 31, 83.8%) and risk of endophthalmitis (n = 27, 73.0%), followed by perceived lack of evidence for its effectiveness (n = 19, 51.4%).

CONCLUSION

This is one of the first studies evaluating ophthalmologists' sentiments towards performing ISBCS in an Asian country. It highlights some of the most pertinent barriers and concerns that ophthalmologists face in performing and offering ISBCS. This study provides a better understanding of the potential role and prospects of ISBCS in future cataract care in Singapore.

Immediate Sequential Bilateral Implantable Collamer Lens Surgery Is Safe and Effective

PURPOSE

To assess the clinical outcomes and safety profiles of patients who underwent immediate sequential bilateral phakic lens surgery.

METHODS

This retrospective multicenter study included 254 consecutive patients (508 eyes) who underwent bilateral same-day Implantable Collamer Lens (ICL) (STAAR Surgical) surgery. The authors focused on 1-year postoperative clinical outcomes and adverse events.

RESULTS

In the initial cohort, 176 patients (352 eyes) met inclusion criteria. Of these, 335 eyes underwent myopic ICL placement, and 17 eyes received a hyperopic ICL. Notably, 87% of eyes achieved ±0.50 diopters (D) and 95% achieved ±1.00 D of the intended refraction. One year postoperatively, 78% of eyes demonstrated optimal vaulting (250 to 750 µm), with a significant 19% reduction in vaulting observed over the 12 months (P < .001). Only minor adverse events, including early cataract formation (1 case), secondary toric ICL rotation (3 cases), and ICL exchange due to inappropriate vaulting (6 cases), were noted.

CONCLUSIONS

The findings corroborate the safety and efficacy of immediate sequential bilateral phakic lens surgery and indicate its potential as a treatment option. The low incidence of minor adverse events further reinforces its favorable safety profile. [J Refract Surg. 2024;40(5):e313-e320.].