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Nowrouzi A, Alió JL. Immediately sequential bilateral cataract surgery. Curr Opin Ophthalmol 2024; 35:17-22. [PMID: 38390776 DOI: 10.1097/icu.0000000000001003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
PURPOSE OF REVIEW This review aims to clarify the advantages and disadvantages of immediately sequential bilateral cataract surgery (ISBCS) based on recent studies, illustrate the safety of this approach, the cost-effectiveness, and present the importance of inclusion protocols for the best results. RECENT FINDINGS In recent studies, the authors found no evidence of an increased risk of bilateral devastating complications such as endophthalmitis with ISBCS based on descriptive evidence compared to delayed sequential bilateral cataract surgery (DSBCS). Furthermore, recent studies on cost analyses showed that ISBCS resulted in fewer costs and significant cost savings to third-party payers, patients, and society compared to DSBCS. SUMMARY The ISBCS surgical approach decreases hospital visits, reduces costs, and provides rapid visual rehabilitation and neuro adaptation. The risk of bilateral simultaneous complications is now recognized to be very rare with intracameral antibiotics and compliance with correct protocols. With new generations of optical biometry and lens calculation formulas, refractive surprises are occasional for normal eyes. However, refractive surprise is controversial, especially in the implantation of presbyopia correction intra-ocular lenses, which must be evaluated carefully in the ISBCS approach.
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Affiliation(s)
- Ali Nowrouzi
- Cornea, Cataract and Refractive Surgery Unit, Department of Ophthalmology, Hospital Quironsalud Marbella, Marbella
| | - Jorge L Alió
- Research and Development Department, and Refractive Surgery Department, VISSUM, VISSUM Instituto Oftalmológico de Alicante, Grupo Miranza
- Department of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
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Sim PY, Day AC, Leak C, Buchan JC. Cochrane Corner: immediate sequential bilateral surgery versus delayed sequential bilateral surgery for cataracts. Eye (Lond) 2023; 37:2841-2843. [PMID: 36765268 PMCID: PMC10517021 DOI: 10.1038/s41433-023-02436-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 01/31/2023] [Accepted: 01/31/2023] [Indexed: 02/12/2023] Open
Affiliation(s)
| | - Alexander C Day
- Moorfields Eye Hospital, London, UK
- UCL Institute of Ophthalmology, London, UK
| | | | - John C Buchan
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Spekreijse L, Simons R, Winkens B, van den Biggelaar F, Dirksen C, Bartels M, de Crom R, Goslings O, Joosse M, Kasanardjo J, Lansink P, Ponsioen T, Reus N, Schouten J, Nuijts R. Safety, effectiveness, and cost-effectiveness of immediate versus delayed sequential bilateral cataract surgery in the Netherlands (BICAT-NL study): a multicentre, non-inferiority, randomised controlled trial. Lancet 2023; 401:1951-1962. [PMID: 37201546 DOI: 10.1016/s0140-6736(23)00525-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND In an ageing population, efficiency improvements are required to assure future accessibility of cataract care. We aim to address remaining knowledge gaps by evaluating the safety, effectiveness, and cost-effectiveness of immediate sequential bilateral cataract surgery (ISBCS) versus delayed sequential bilateral cataract surgery (DSBCS). We hypothesised that ISBCS is non-inferior to DSBCS, regarding safety and effectiveness, and being superior in cost-effectiveness. METHODS We did a multicentre, non-inferiority, randomised controlled trial, which included participants from ten Dutch hospitals. Eligible participants were 18 years or older, underwent expected uncomplicated surgery, and had no increased risk of endophthalmitis or refractive surprise. Participants were randomly assigned (1:1) to either the ISBCS (intervention) group or DSBCS (conventional procedure) group, using a web-based system stratified by centre and axial length. Participants and outcome assessors were not masked to the treatment groups because of the nature of the intervention. The primary outcome was the proportion of second eyes with a target refractive outcome of 1·0 dioptre (D) or less 4 weeks postoperatively, with a non-inferiority margin of -5% for ISBCS versus DSBCS. For the trial-based economic evaluation, the primary endpoint was the incremental societal costs per quality-adjusted life-year. All analyses were done by a modified intention-to-treat principle. Costs were calculated by multiplying volumes of resource use with unit cost prices and converted to 2020 Euros (€) and US$. This study was registered with ClinicalTrials.gov, number NCT03400124, and is now closed for recruitment. FINDINGS Between Sept 4, 2018, and July 10, 2020, a total of 865 patients were randomly assigned to either the ISBCS group (427 [49%] patients; 854 eyes) or DSBCS group (438 [51%] patients; 876 eyes). In the modified intention-to-treat analysis, the proportion of second eyes with a target refraction of 1·0 D or less was 97% (404 of 417 patients) in the ISBCS group versus 98% (407 of 417) in the DSBCS group. The percentage difference was -1% (90% CI -3 to 1; p=0·526), thereby establishing non-inferiority for ISBCS compared with DSBCS. Endophthalmitis was not observed or reported in either group. Adverse events were comparable between groups, with only a significant difference in disturbing anisometropia (p=0·0001). Societal costs were €403 (US$507) lower with ISBCS than with DSBCS. The cost-effectiveness probability of ISBCS versus DSBCS was 100% across the willingness-to-pay range of €2500-80 000 (US$3145-100 629) per quality-adjusted life-year. INTERPRETATION Our results showed non-inferiority of ISBCS versus DSBCS regarding effectiveness outcomes, comparable safety, and superior cost-effectiveness of ISBCS. National cost savings could amount to €27·4 million (US$34·5 million) annually, advocating for ISBCS if strict inclusion criteria are applied. FUNDING Research grant from The Netherlands Organization for Health Research and Development (ZonMw) and Dutch Ophthalmological Society.
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Affiliation(s)
- Lindsay Spekreijse
- University Eye Clinic Maastricht, Maastricht University Medical Center+, Maastricht, Netherlands; School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands.
| | - Rob Simons
- University Eye Clinic Maastricht, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands; Department of Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Frank van den Biggelaar
- University Eye Clinic Maastricht, Maastricht University Medical Center+, Maastricht, Netherlands; School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Carmen Dirksen
- Department of Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Marjolijn Bartels
- Department of Ophthalmology, Deventer Hospital, Deventer, Netherlands
| | - Ronald de Crom
- University Eye Clinic Maastricht, Maastricht University Medical Center+, Maastricht, Netherlands; Department of Ophthalmology, Zuyderland Medical Center, Heerlen, Netherlands
| | - Oege Goslings
- Department of Ophthalmology, Elisabeth TweeSteden Hospital, Tilburg, Netherlands
| | - Maurits Joosse
- Department of Ophthalmology, Medical Center Haaglanden, Den Haag, Netherlands
| | | | - Peter Lansink
- Department of Ophthalmology, Medical Spectrum Twente, Enschede, Netherlands
| | | | - Nic Reus
- Department of Ophthalmology, Amphia Hospital, Breda, Netherlands
| | - Jan Schouten
- Department of Ophthalmology, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | - Rudy Nuijts
- University Eye Clinic Maastricht, Maastricht University Medical Center+, Maastricht, Netherlands; School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands; Department of Ophthalmology, Zuyderland Medical Center, Heerlen, Netherlands
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Abstract
PURPOSE OF REVIEW The aim of this study was to present an overview of recent publications and opinions in the field of same-day bilateral cataract surgery. RECENT FINDINGS A Cochrane review was published comparing immediate sequential bilateral cataract surgery (ISBCS) and delayed sequential bilateral cataract surgery (DSBCS) with regard to safety outcomes, costs and cost-effectiveness. In addition, several large database studies provided more information on incidences of rare complications such as unilateral and bilateral endophthalmitis rates. SUMMARY Recently available evidence showed that ISBCS is an effective and cost-effective alternative to DSBCS. Nonetheless, additional (randomized) registry studies, randomized controlled trials and cost-effectiveness studies are needed to evaluate bilateral endophthalmitis rates, refractive outcomes and cost-effectiveness of ISBCS compared with DSBCS.
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Affiliation(s)
- Lindsay S Spekreijse
- Maastricht University Medical Center+, University Eye Clinic Maastricht, Maastricht, the Netherlands
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Alió JL, Nowrouzi A. Immediately sequential bilateral cataract surgery importance during the COVID-19 pandemic. Saudi J Ophthalmol 2022; 36:124-128. [PMID: 36211314 PMCID: PMC9535909 DOI: 10.4103/sjopt.sjopt_44_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 08/17/2021] [Accepted: 11/18/2021] [Indexed: 11/11/2022] Open
Abstract
Cataract surgery is one of the most frequently performed types of surgery in the world. Most patients suffer from bilateral cataract and while cataract surgery of only one eye is effective in restoring functional vision, second eye surgery leads to further improvements in health-related quality of life, and is cost effective. At present, most patients undergo cataract surgery in both eyes on separate days, referred to as delayed sequential bilateral cataract surgery (DSBCS). An alternative procedure involves operating both eyes on the same day, but as separate procedures, known as immediately sequential bilateral cataract surgery (ISBCS). The aim of this study is to evaluate the effectiveness and costs of ISBCS compared to DSBCS. ISBCS is an important topic in ophthalmology, especially during the recent COVID-19 pandemic as it is necessary to decrease the hospital visits in order to prevent the contagious risk of this disease. There are well-documented advantages in terms of reduced costs for patients and health-care systems as well as more rapid visual rehabilitation and neuroadaptation. Based on recent studies, the risk of bilateral simultaneous complications is now recognized to be rare with the advent of intracameral antibiotics and strict protocols in this surgical approach. With the use of more sophisticated optical biometry and the newest generation lens calculation, refractive surprises are rare for normal eyes. A widely recognized protocol from the International Society of Bilateral Cataract Surgeons needs to adhere in order to prevent any further complications and obtaining better outcomes.
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Affiliation(s)
- Jorge L. Alió
- Department of Research and Development, and Refractive Surgery, VISSUM, VISSUM Instituto Oftalmológico de Alicante, Grupo Miranza,Department of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain,Address for correspondence: Prof. Jorge L. Alió, Street Cabañal1, Alicante 03016, Spain. E-mail:
| | - Ali Nowrouzi
- Department of Ophthalmology, Hospital Quironsalud, Marbella, Spain
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Alio JL, Gessa-Sorroche M, Nowrouzi A, Maldonado MJ. Immediate bilateral sequential cataract surgery. Arch Soc Esp Oftalmol (Engl Ed) 2022; 97:402-408. [PMID: 35459602 DOI: 10.1016/j.oftale.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/16/2021] [Indexed: 06/14/2023]
Abstract
PURPOSE There is a constant controversy between performing cataract surgery for one eye or for both eyes in the same surgical session. The objective of this study is to review the scientific evidence on the efficacy and safety, determine the reduction of costs of sequential bilateral cataract surgery on the same day compared to unilateral cataract surgery, as well as to compare the rate of associated complications. METHODS A comprehensive search of the PubMed and Web of Science databases has been conducted to identify relevant articles on sequential bilateral cataract surgery from 2000 to 31 of December of 2020. RESULTS Literature shows that there is strong evidence demonstrating the efficacy and safety of same-day sequential bilateral cataract surgery. Studies have not found a higher rate of postoperative complications compared to unilateral cataract surgery. CONCLUSIONS Same-day sequential bilateral cataract surgery is a good surgical option for the resolution of the cataract, provides rapid visual rehabilitation and without greater risks than unilateral surgery. It also provides a reduction in sanitary costs. There is a psychological fear of performing bilateral surgery due to the potential risk of complications that would affect both operated eyes. In this article we discuss the efficacy, safety, complications rate and associated costs in sequential bilateral cataract surgery in the same surgical act.
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Affiliation(s)
- J L Alio
- Unidad de córnea, catarata y cirugía refractiva, Vissum Miranza, Alicante, Spain; Catedrático Universidad Miguel Hernández, Alicante, Spain.
| | - M Gessa-Sorroche
- Unidad de córnea y superficie ocular, Hospital Universitario Virgen Macarena, Sevilla, Spain; Unidad de córnea, catarata y cirugía refractiva, Clínica Miranza Virgen de Luján, Sevilla, Spain
| | - A Nowrouzi
- Clinical Research Fellow, Vissum, Grupo Miranza, Alicante, Spain; Departamento de Oftalmología, Hospital Universitario Jerez de la Frontera, Jerez de la Frontera (Cádiz), Spain
| | - M J Maldonado
- Unidad de córnea, catarata y cirugía refractiva, Instituto de Oftalmobiología Aplicada (IOBA), Catedrático Universidad de Valladolid, Valladolid, Spain
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Sheppard WEA, McCarrick D, Wilkie RM, Baraas RC, Coats RO. A Systematic Review of the Effects of Second-Eye Cataract Surgery on Motor Function. Front Aging 2022; 3:866823. [PMID: 35821847 PMCID: PMC9261376 DOI: 10.3389/fragi.2022.866823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/16/2022] [Indexed: 11/16/2022]
Abstract
Cataract removal surgery is one of the most commonly performed surgical procedure in developed countries. The financial and staff resource cost that first-eye cataract surgery incurs, leads to restricted access to second-eye cataract surgery (SES) in some areas, including the United Kingdom. These restrictions have been imposed despite a lack of knowledge about the impact of not performing SES on visuo-motor function. To this end, a systematic literature review was carried out, with the aim of synthesising our present understanding of the effects of SES on motor function. Key terms were searched across four databases, PsycINFO, Medline, Web of Science, and CINAHL. Of the screened studies (K = 499) 13 met the eligibility criteria. The homogeneity between participants, study-design and outcome measures across these studies was not sufficient for meta-analyses and a narrative synthesis was carried out. The evidence from objective sources indicates a positive effect of SES on both mobility and fall rates, however, when considering self-report measures, the reduction in falls associated with SES becomes negligible. The evidence for any positive effect of SES on driving is also mixed, whereby SES was associated with improvements in simulated driving performance but was not associated with changes in driving behaviours measured through in vehicle monitoring. Self-report measures of driving performance also returned inconsistent results. Whilst SES appears to be associated with a general trend towards improved motor function, more evidence is needed to reach any firm conclusions and to best advise policy regarding access to SES in an ageing population. Systematic Review Registration:https://osf.io/7hne6/, identifier INPLASY2020100042.
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Spekreijse LS, Bauer NJC, van den Biggelaar FJHM, Simons RWP, Veldhuizen CA, Berendschot TTJM, Nuijts RMMA. Predictive accuracy of an intraoperative aberrometry device for a new monofocal intraocular lens. J Cataract Refract Surg 2022; 48:542-8. [PMID: 34433779 DOI: 10.1097/j.jcrs.0000000000000791] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/15/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE To evaluate refractive outcomes for the Clareon monofocal intraocular lens (IOL) in terms of achieved target refraction for the ORA (ALCON) intraoperative wavefront aberrometry device and preoperative noncontact biometry. SETTING University Eye Clinic Maastricht, Maastricht University Medical Center+, the Netherlands. DESIGN Prospective observational clinical trial. METHODS Patients with bilateral age-related cataracts undergoing phacoemulsification, either by delayed sequential surgery or on the same day, were included in the study. Exclusion criteria were an increased risk for refractive surprise or complicated surgery. Implanted IOL power was based on noncontact optical biometry data using the Barrett Universal II (BU-II) formula, optimized for the Clareon IOL. Postoperative subjective refraction was measured 4 to 6 weeks after surgery. Catquest-9SF questionnaires were completed preoperatively and 3 months after surgery. RESULTS 100 eyes (51 patients) were included. The percentages of eyes within 1.0 diopters (D), 0.75 D, 0.50 D, and 0.25 D of target for ORA vs BU-II were 84% (84 eyes), 72% (72 eyes), 57% (57 eyes), and 21% (21 eyes) vs 97% (97 eyes), 88% (88 eyes), 77% (77 eyes), and 53% (53 eyes), respectively. Mean absolute prediction error was significantly higher for ORA vs preoperative biometry (P < .001). After global optimization, the prediction accuracy of ORA improved significantly (P < .001). Catquest-9SF questionnaires showed improved levels of ability at 3 months after surgery (P < .001). CONCLUSIONS This study showed lower percentages of eyes within target refraction for ORA (prior to lens constant optimization) compared with the BU-II formula when implanting the Clareon IOL. However, prediction accuracy of ORA improved significantly after global optimization. Therefore, further intraoperative measurements, postoperative measurements, and optimization are needed to improve the ORA prediction for this IOL.
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