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Kogawa S, Suzuki Y, Furukawa A, Kurosaka N, Nozuki N, Ueno S. Bilateral simultaneous endophthalmitis after immediately sequential bilateral cataract surgery. Am J Ophthalmol Case Rep 2023; 32:101886. [PMID: 37533701 PMCID: PMC10393531 DOI: 10.1016/j.ajoc.2023.101886] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 06/15/2023] [Accepted: 07/02/2023] [Indexed: 08/04/2023] Open
Abstract
Purpose Immediately sequential bilateral cataract surgery (ISBCS) has recently been considered effective due to faster visual rehabilitation and further improvements in quality of life. We report on the treatment course of a case of early postoperative endophthalmitis in both eyes after ISBCS. Observations The patient was a 75-year-old woman undergoing anticancer treatment for lung cancer, who had been receiving eye drops for bilateral uveitis and secondary glaucoma since 2019. She underwent ISBCS at another hospital in 2022. In that surgery, the same instruments were used for the surgery of both eyes, without resterilization between eyes. On the night of the following day, she became aware of vision loss in both eyes, and at the examination the next day, hypopyon and corneal edema were found and she was diagnosed with bilateral postoperative endophthalmitis, and referred to our hospital. On the same day, anterior chamber irrigation, posterior capsulotomy, and vitrectomy were performed on both eyes, and the intraocular lenses were preserved. There was no recurrence of postoperative inflammation, and visual acuity was 20/30 in both eyes 6 months after vitrectomy. Conclusion ISBCS is recommended to be performed with complete aseptic separation of the patient's two procedures. This important rule was not followed in this case. ISBCS should be performed in accordance with accepted protocols, such as those of the International Society of Bilateral Cataract Surgeons, the Royal College of Ophthalmologists, and the Canadian Ophthalmological Society.
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Affiliation(s)
- Satomi Kogawa
- Department of Ophthalmology, Hirosaki University Graduate School of Medicine, Japan
| | - Yukihiko Suzuki
- Department of Ophthalmology, Hirosaki University Graduate School of Medicine, Japan
| | - Ami Furukawa
- Department of Ophthalmology, Hirosaki University Graduate School of Medicine, Japan
| | - Naruki Kurosaka
- Department of Ophthalmology, Hirosaki University Graduate School of Medicine, Japan
| | - Narumi Nozuki
- Department of Ophthalmology, Hirosaki University Graduate School of Medicine, Japan
| | - Shinji Ueno
- Department of Ophthalmology, Hirosaki University Graduate School of Medicine, Japan
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Naderi K, Lam CFJ, Low S, Bhogal M, Jameel A, Theodoraki K, Lai L, Garcia LO, Roberts H, Robbie S, O'Brart D. Time and Motion Studies to assess surgical productivity in cataract theatre lists within the National Health Service: Immediate Sequential Bilateral Cataract Surgery versus Delayed Sequential Bilateral Cataract Surgery. Eye (Lond) 2023; 37:3751-3756. [PMID: 37277612 PMCID: PMC10239710 DOI: 10.1038/s41433-023-02593-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 05/09/2023] [Accepted: 05/17/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND To compare productivity of National Health Service cataract lists performing unilateral cataract (UC) surgery vs Immediate Sequential Bilateral Cataract Surgery (ISBCS). METHODS Five 4-hour lists with ISBCS cases and five with UC were observed using time and motion studies (TMS). Individual tasks and timings of each staff member in theatre was recorded by two observers. All operations were performed by consultant surgeons under local anaesthesia (LA). RESULTS Median number of eyes operated per 4-hour list was 8 (range 6-8) in the ISBCS group and 5 (5-7) in the UC group (p = 0.028). Mean total theatre time (defined as time between the entry of the first patient and the exit of the last patient from theatre) was 177.12 (SD 73.62) minutes in the ISBCS group and 139.16 (SD 47.73) minutes in the UC group (p = 0.36). Mean time to complete two consecutive unilateral cataract surgery operations was 48.71 minutes compared to 42.23 minutes for a single ISBCS case (13.30% time saved). Based on our collected TMS data, a possible 5 consecutive ISBCS cases and 1 UC (total 11 cataract surgeries) could be performed during a four-hour theatre session, with a theatre utilisation quotient of 97.20%, contrasting to nine consecutive UC, with a theatre utilisation quotient of 90.40%. DISCUSSION Performing consecutive ISBCS cases under LA on routine cataract surgery lists can increase surgical efficiency. TMS are a useful way to investigate surgical productivity and test theoretical models for efficiency improvements.
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Affiliation(s)
- Khayam Naderi
- Department of Ophthalmology, St. Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH, UK.
- King's College London, London, WC2R 2LS, UK.
| | - Chun Fung Jeffrey Lam
- Department of Ophthalmology, St. Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH, UK
- King's College London, London, WC2R 2LS, UK
| | - Sancy Low
- Department of Ophthalmology, St. Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH, UK
| | - Mani Bhogal
- Department of Ophthalmology, St. Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH, UK
| | - Ashmal Jameel
- Department of Ophthalmology, St. Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH, UK
- King's College London, London, WC2R 2LS, UK
| | - Korina Theodoraki
- Department of Ophthalmology, St. Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH, UK
| | - Lily Lai
- Department of Ophthalmology, St. Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH, UK
| | - Luis Onrubia Garcia
- Department of Ophthalmology, St. Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH, UK
| | - Harry Roberts
- West of England Eye Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, EX2 5DW, UK
| | - Scott Robbie
- Department of Ophthalmology, St. Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH, UK
| | - David O'Brart
- Department of Ophthalmology, St. Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH, UK.
- King's College London, London, WC2R 2LS, UK.
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Bjerager J, Leegaard Holm DM, Holm L, Faber C, Bate A, Christakopoulos C, Solborg Bjerrum S. Outbreak of Bilateral Endophthalmitis After Immediate Sequential Bilateral Cataract Surgery. JAMA Ophthalmol 2023; 141:1075-1078. [PMID: 37856103 PMCID: PMC10587825 DOI: 10.1001/jamaophthalmol.2023.4637] [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] [Received: 06/20/2023] [Accepted: 08/26/2023] [Indexed: 10/20/2023]
Abstract
Importance Since bilateral simultaneous postoperative endophthalmitis (BSPOE) after immediate sequential bilateral cataract surgery (ISBCS) can be devastating for the patient, evaluating such cases in depth is important to maintaining patient safety. Objective To evaluate whether a systemic breach of sterility was associated with an outbreak of BSPOE after ISBCSs performed on the same day at a single community-based eye clinic. Design, Setting, and Participants This retrospective case series included all patients diagnosed with BSPOE at ophthalmology departments in Denmark following an infectious outbreak after ISBCSs performed at a single community-based eye clinic in December 2022. Exposure Bilateral simultaneous postoperative endophthalmitis acquired after ISBCS. Main Outcome and Measures Patient recovery from BSPOE after ISBCS was evaluated based on clinical and microbiological reports. Results A woman aged 71 years, a man aged 84 years, and a woman aged 79 years consecutively presented with symptoms of endophthalmitis at regional eye departments 4 to 8 days after ISBCS performed on the same date at the same eye clinic. Five of 6 infected eyes underwent vitrectomy, and all eyes received an intravitreous injection of antibiotics. The same strain of Staphylococcus epidermidis was isolated in 4 of 5 eyes that underwent vitrectomy. Contamination of viscoelastics was ruled out with repeated cultures. One eye was eviscerated due to phthisis. In another patient, the final visual acuity of the eye most severely affected was 20/63 Snellen equivalents. Visual acuity of the remaining eyes recovered to 20/25 (3 eyes in 2 patients) and 20/20 (1 eye) Snellen equivalents. Conclusions and Relevance The finding of the same strain of S epidermidis in all patient cultures suggests a systemic breach of sterility at the clinic on the day of ISBCS. The outcome of these cases emphasizes the need to adhere to a strict surgical methodology and sterile principles during ISBCS.
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Affiliation(s)
- Jakob Bjerager
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
| | | | - Lars Holm
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
| | - Carsten Faber
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
| | - Anja Bate
- Department of Ophthalmology, Zealand University Hospital, Næstved, Denmark
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Hong S, Park W, Eom Y, Kim HM, Song JS. Comparisons of outcomes and complications of immediate sequential bilateral cataract surgery and unilateral cataract surgery in a tertiary hospital in South Korea. Sci Rep 2022; 12:22382. [PMID: 36572699 DOI: 10.1038/s41598-022-26851-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/21/2022] [Indexed: 12/27/2022] Open
Abstract
We investigated the proportions of immediate sequential bilateral cataract surgery (ISBCS) and unilateral cataract surgery during the coronavirus disease 2019 pandemic and compared visual outcomes between the two groups in a tertiary hospital in South Korea. We reviewed 441 cataract surgeries performed between March 1, 2021, and October 31, 2021, at Korea University Guro Hospital by a single surgeon (J.S.S). Medical records of demographics, preoperative visual acuity, corneal astigmatism, axial length, preoperative spherical equivalent, preoperative target (using Barrett's Universal 2 formula), postoperative visual acuity, postoperative refractive error, and postoperative complications were evaluated. Among all patients, 322 (73.0%) eyes underwent ISBCS, and 119 (27.0%) eyes underwent unilateral cataract surgery. The preoperative corrective distance visual acuity (CDVA) was lower in the unilateral cataract surgery group (0.40 ± 0.45 logMAR) than the ISBCS group (0.28 ± 0.16 logMAR, P = 0.008), whereas there was no significant difference in postoperative CDVA between the two groups (0.06 ± 0.10 logMAR vs. 0.07 ± 0.16 logMAR, P = 0.63). There was also no difference in the absolute refractive error between the two groups (0.46 ± 0.37 diopters [D] vs. 0.42 ± 0.38 D, P = 0.63). The preoperative CDVA (P = 0.000) was the significant factor influencing absolute refractive error (r = 0.191, P < 0.001). There was no difference in complications between the two groups, although two patients in the ISBCS group complained of postoperative strabismus.
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Srinivasan S. Immediate sequential bilateral cataract surgery: time for wider adoption. J Cataract Refract Surg 2022; 48:1231-2. [PMID: 36315625 DOI: 10.1097/j.jcrs.0000000000001070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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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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Lacy M, Kung TPH, Owen JP, Yanagihara RT, Blazes M, Pershing S, Hyman LG, Van Gelder RN, Lee AY, Lee CS. Endophthalmitis Rate in Immediately Sequential versus Delayed Sequential Bilateral Cataract Surgery within the Intelligent Research in Sight (IRIS®) Registry Data. Ophthalmology 2022; 129:129-138. [PMID: 34265315 PMCID: PMC8755857 DOI: 10.1016/j.ophtha.2021.07.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 06/11/2021] [Accepted: 07/06/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To compare the rate of postoperative endophthalmitis after immediately sequential bilateral cataract surgery (ISBCS) versus delayed sequential bilateral cataract surgery (DSBCS) using the American Academy of Ophthalmology Intelligent Research in Sight (IRIS®) Registry database. DESIGN Retrospective cohort study. PARTICIPANTS Patients in the IRIS Registry who underwent cataract surgery from 2013 through 2018. METHODS Patients who underwent cataract surgery were divided into 2 groups: (1) ISBCS and (2) DSBCS (second-eye surgery ≥1 day after the first-eye surgery) or unilateral surgery. Postoperative endophthalmitis was defined as endophthalmitis occurring within 4 weeks of surgery by International Classification of Diseases (ICD) code and ICD code with additional clinical criteria. MAIN OUTCOME MEASURES Rate of postoperative endophthalmitis. RESULTS Of 5 573 639 IRIS Registry patients who underwent cataract extraction, 165 609 underwent ISBCS, and 5 408 030 underwent DSBCS or unilateral surgery (3 695 440 DSBCS, 1 712 590 unilateral surgery only). A total of 3102 participants (0.056%) met study criteria of postoperative endophthalmitis with supporting clinical findings. The rates of endophthalmitis in either surgery eye between the 2 surgery groups were similar (0.059% in the ISBCS group vs. 0.056% in the DSBCS or unilateral group; P = 0.53). Although the incidence of endophthalmitis was slightly higher in the ISBCS group compared with the DSBCS or unilateral group, the odds ratio did not reach statistical significance (1.08; 95% confidence interval, 0.87-1.31; P = 0.47) after adjusting for age, sex, race, insurance status, and comorbid eye disease. Seven cases of bilateral endophthalmitis with supporting clinical data in the DSBCS group and no cases in the ISBCS group were identified. CONCLUSIONS Risk of postoperative endophthalmitis was not statistically significantly different between patients who underwent ISBCS and DSBCS or unilateral cataract surgery.
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Affiliation(s)
- Megan Lacy
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Timothy-Paul H. Kung
- Department of Ophthalmology, University of Washington, Seattle, Washington.,Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, New York
| | - Julia P. Owen
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Ryan T. Yanagihara
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Marian Blazes
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Suzann Pershing
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California.,Veterans Affairs Palo Alto Health California System, Palo Alto, California
| | - Leslie G. Hyman
- The Vision Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Russell N. Van Gelder
- Department of Ophthalmology, University of Washington, Seattle, Washington.,Roger and Angie Karalis Johnson Retina Center, Seattle, Washington
| | - Aaron Y. Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington.,Roger and Angie Karalis Johnson Retina Center, Seattle, Washington
| | - Cecilia S. Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington.,Roger and Angie Karalis Johnson Retina Center, Seattle, Washington
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Zarei-ghanavati S, Monfared N, Heravian J, Momeni-moghaddam H, Hemmatian Z, Wolffsohn JS. Randomized contralateral comparison of visual outcomes following implantation of two monofocal aspherical intraocular lenses after cataract surgery. Int Ophthalmol. [DOI: 10.1007/s10792-021-02150-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 12/17/2021] [Indexed: 10/19/2022]
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Chen MY, Qi SR, Arshinoff S. Bilateral simultaneous postoperative endophthalmitis (BSPOE): Review of cases reported over the past 50 years. J Cataract Refract Surg 2021. [PMID: 34890384 DOI: 10.1097/j.jcrs.0000000000000875] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/05/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT A detailed retrospective analysis and literature review were conducted for all previously published reports of bilateral simultaneous postoperative endophthalmitis (BSPOE) since 1970. There have been seven (nine including the companion paper, and 1 reported elsewhere) cases of BSPOE after immediately sequential bilateral cataract surgery (ISBCS) reported over 50 years. Generally, in these cases, the surgical protocol recommended by the International Society of Bilateral Cataract Surgeons (iSBCS) was breached or uncertain. Bacterial causes were Pseudomonas aeruginosa (3), Staphylococcus epidermidis (3), Burkholderia cepacia complex (1), negative (1) and not determined (1). Visual recovery was light perception, or worse, for Pseudomonas cases, generally good for Staphylococcus and Burkholderia cases, and mixed in cases of unknown etiology. Therefore, BSPOE is rare, and causes vary. Strict adherence to the iSBCS General Principles of Excellence in ISBCS, 2009 surgical protocol and care with operating room construction seem to considerably lessen the risk.
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Sandhu S, Liu D, Mathura P, Palakkamanil M, Kurji K, Rudnisky CJ, Kassiri K. Immediately sequential bilateral cataract surgery (ISBCS) adapted protocol during COVID-19: quality-improvement initiative. Can J Ophthalmol 2021; 58:171-178. [PMID: 34919840 PMCID: PMC8576115 DOI: 10.1016/j.jcjo.2021.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 10/04/2021] [Accepted: 10/14/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To describe the steps, hurdles, and recommendations for implementation of the immediately sequential bilateral cataract surgery (ISBCS) evidence-based protocol at a high-volume Canadian tertiary care centre. DESIGN Quality-improvement study. PARTICIPANTS A total of 406 patients who underwent ISBCS from July 2020 to December 2020. Patients were selected based on specific inclusion and exclusion criteria including psychosocial factors, refractive error and consent. This initiative impacted staff at all levels involved with cataract surgery. METHODS The Model of Improvement framework was used and involved numerous discussions with multidisciplinary teams of ophthalmologists, nursing and support staff, management, pharmacists, and medical device reprocessing teams. This initiative was created and refined via a thorough review of the literature and current best practices. It was implemented in July 2020 after a nursing "huddle." Any adverse outcomes and overall impact were collected from various levels of staff involved. RESULTS Each eye was treated as a separate surgery with a double time-out per bilateral case. Additional measures were taken to ensure different lot numbers for medications, equipment, and materials. This practice increased surgical volume by approximately 25% and reduced the number of patient visits by 50%, reducing potential COVID-19 exposure. CONCLUSIONS The resulting protocol from our study may be useful to other centres wishing to integrate ISBCS as one example of successful implementation. Of the 406 cases of ISBCS performed, we report zero cases of toxic anterior segment syndrome or endophthalmitis. In times of decreased elective surgeries, ISBCS is a safe and effective option to supplement surgical volume and provide significant patient benefits.
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Affiliation(s)
| | - Daisy Liu
- Department of Ophthalmology, University of Alberta, Edmonton, AB
| | - Pamela Mathura
- Department of Ophthalmology, University of Alberta, Edmonton, AB
| | | | - Khaliq Kurji
- Department of Ophthalmology, University of Alberta, Edmonton, AB
| | | | - Kam Kassiri
- Department of Ophthalmology, University of Alberta, Edmonton, AB.
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Friling E, Johansson B, Lundström M, Montan P. Postoperative Endophthalmitis in Immediate Sequential Bilateral Cataract Surgery: A Nationwide Registry Study. Ophthalmology 2021:S0161-6420(21)00517-0. [PMID: 34246658 DOI: 10.1016/j.ophtha.2021.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 06/27/2021] [Accepted: 07/02/2021] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To report the incidence of postoperative endophthalmitis (PE) after immediate sequential bilateral cataract surgery (ISBCS) in Sweden. DESIGN Retrospective cohort registry study. PARTICIPANTS Patient data from 1 457 172 cataract extractions, including 1 364 934 unilateral surgeries and 92 238 ISBCSs. METHODS Endophthalmitis cases reported to the Swedish National Cataract Register (NCR) during a 16-year period (2002-2017) were analyzed in comparison to all control cases with regard to patient characteristics, surgical technique, and capsule complication. MAIN OUTCOME MEASURE Incidence and determinants for PE in ISBCS compared with unilateral surgeries. RESULTS A total of 422 cases of PE were identified in 1 457 172 cataract extractions, yielding an overall incidence of 0.029% (95% confidence interval [CI], 0.0262-0.0317). For unilateral procedures, the rate was 0.0299% (95% CI, 0.0270-0.0328) or 408 cases in 1 364 934 operations, whereas that for ISBCS was 0.0152% (95% CI, 0.0072-0.0231) or 14 incidents in 92 238 operations (P = 0.01). In a logistic regression model including all cataract procedures, nonuse of intracameral (IC) antibiotics (ABs), capsule complication, age 85 years or more, male gender, and ocular comorbidity were found to be independent risk factors for PE. All these parameters were less frequent in ISBCS. Notwithstanding, in the same multivariate analysis, ISBCS in itself was associated with a significantly lower risk for PE. At follow-up, 5 of the 14 PE cases in the ISBCS cohort had a visual acuity (VA) of 20/200 or worse. Of these, one 93-year-old ISBCS patient developed bilateral infection. CONCLUSIONS After ISBCS in Sweden, PE occurred once in 6600 surgeries. The risk of sustaining a final VA of 20/200 or less was 1 incident in 18 000 operated eyes. When counseling potential ISBCS patients about the risk of PE, it seems reasonable to state that the reported risk in the literature is lower than that with unilateral surgery but not negligible. Precautions remain necessary.
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Pagano L, Gadhvi KA, Borroni D, Iselin KC, Vinciguerra R, Tzamalis A, Kaye SB, Romano V. Bilateral Keratoconus Progression: Immediate Versus Delayed Sequential Bilateral Corneal Cross-linking. J Refract Surg 2021; 36:552-556. [PMID: 32785729 DOI: 10.3928/1081597x-20200629-01] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/12/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare immediate sequential bilateral corneal cross-linking (CXL), wherein both eyes are treated on the same day, to delayed sequential bilateral CXL, where each eye is treated on different days for bilateral progressive keratoconus. METHODS This was a retrospective case note review of all patients who underwent sequential CXL or delayed CXL for keratoconus at Royal Liverpool University Hospital, United Kingdom. Parameters assessed were the change in maximum keratometry and minimum central corneal thickness on corneal tomography scan, corrected distance visual acuity, and cost estimates of treatment. RESULTS A total of 38 patients (31 men and 7 women) with keratoconus with a mean age of 25.3 ± 7.0 years were included. Twenty patients received sequential CXL and 18 received delayed CXL treatment. In both the sequential CXL and delayed CXL groups, the treated eye(s) showed no evidence of progression after the corneal CXL treatment at last follow-up visit after 358 ± 158 days for sequential CXL and 451 ± 205 days for delayed CXL. There were no complications from the treatment in either group. In the delayed CXL group, the mean time interval between the two CXL procedures was 146 ± 129 days. Five of 18 patients (27%) showed progression of keratoconus in their second eye during the waiting time. Economical evaluation showed that four visits were saved for each sequential CXL treatment compared to delayed CXL. CONCLUSIONS Delayed CXL carries a risk of progression in the second eye and is associated with a higher economic burden. [J Refract Surg. 2020;36(8):552-556.].
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Chandra S, Sivaprasad S, Ursell PG, Naderi K, O'Brart D, Alwitry A, Zahra Ashena, Nanavaty MA. Recurring themes during cataract assessment and surgery. Eye (Lond) 2021; 35:2482-98. [PMID: 33927353 DOI: 10.1038/s41433-021-01548-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 03/01/2021] [Accepted: 04/09/2021] [Indexed: 02/06/2023] Open
Abstract
The aim of this review was to discuss frequently encountered themes such as cataract surgery in presence of age-related macular degeneration (AMD), dementia, Immediate Sequential Bilateral Cataract Surgery (ISBCS), discussing non-standard intraocular lens (IOL) options during consultation in the National Health Services (NHS) and the choice of the biometric formulae based on axial length. Individual groups of authors worked independently on each topic. We found that cataract surgery does improve visual acuity in AMD patients but the need for cataract surgery should be individualised. In patients with dementia, cataract surgery should be considered 'sooner rather than later' as progression may prevent individuals presenting for surgery. This should be planned after discussion of patients' best interests with any carers; multifocal IOLs are not proven to be the best option in these patients. ISBCS gives comparable outcomes to delayed sequential surgeries with a low risk of bilateral endophthalmitis and it can be cost-saving and efficient. Patients are entitled to know all suitable IOL options that can improve their quality of life. Deliberately withholding this information or pressuring patients to choose a non-standard IOL is inappropriate. However, one should be mindful of the not spending inappropriate amounts of time discussing these in the NHS setting which may affect care of other NHS patients. Evidence suggests Hoffer Q, Haigis, Hill-RBF and Kane formulae for shorter eyes; Barrett Universal II (BU II), Holladay II, Haigis and Kane formulae for longer eyes and BU II, Hill-RBF and Kane formulae for medium axial length eyes.
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Abstract
The debate on role of ‘simultaneous bilateral cataract surgery’ (SBCS) continues. The world population has exponentially increased during last fifty years and average human lifespan has increased by a decade during the last century. This translates to ever increasing geriatric population with its inherent problem of preventable blindness because of cataract formation in the elderly. We are adding to the backlog of cataract surgeries not only in the ‘developing world’ but also in the ‘developed world.’ Times demand that we reconsider our old fashioned approach of staggering bilateral cataract surgeries. Serious, but a potential, risk of simultaneous bilateral infection/endophthalmitis has been the biggest deterrent in acceptance of SBCS as a routine procedure. The opponents of SBCS strongly believe in this argument that has not been documented when strictly followed the recommendations regarding separate procedures of each eye. The advantages of reducing the ever-increasing backlog of preventable/treatable blindness, faster visual recovery, economic benefits to patients as well as health care providers, lesser risk of amblyopia in pediatric population, and decreased risk of as serious a complication as death by exposure to general anesthesia in pediatric and adult population, etc. outweigh the disadvantages of SBCS when compared with ‘delayed bilateral cataract surgery’ (DBCS). SBCS is favored over DBCS in pediatric population and in uncooperative, mentally retarded and physically disabled adults needing general anesthesia to reduce the risks and complications of general anesthesia. Considering such factors and review of available literature strongly support that SBCS has a definite role where indicated, under certain circumstances, and in certain select group of patients in both developing as well as developed countries.
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Affiliation(s)
- Gurinder Singh
- The University of Kansas Medical Center, Kansas City, KS, USA.,The University of Missouri - Kansas City, Kansas City, MO, USA
| | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland.,Institute for Research in Ophthalmology, Poznan, Poland
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Shah V, Naderi K, Maubon L, Jameel A, Patel DS, Gormley J, Heemraz S, Azan E, Verma S, Low S, O'Brart D. Acceptability of immediate sequential bilateral cataract surgery (ISBCS) in a public health care setting before and after COVID-19: a prospective patient questionnaire survey. BMJ Open Ophthalmol 2020; 5:e000554. [PMID: 34192150 PMCID: PMC7482101 DOI: 10.1136/bmjophth-2020-000554] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/14/2020] [Accepted: 08/28/2020] [Indexed: 01/19/2023] Open
Abstract
Objective To ascertain patient acceptance of immediate sequential bilateral cataract surgery (ISBCS) in the National Health Service (NHS). Methods A survey was devised using a 5-point Likert scale for questions related to ISBCS, which patients undertook during their cataract outpatient appointment pre-COVID-19 lockdown and by telephone during the lockdown. Results Questionnaires were completed for 267 patients. Most respondents were aged over 71 (51%) and were female individuals (60%). Forty-five per cent agreed/strongly agreed with opting for ISBCS. A positive correlation was identified between opting for ISBCS and convenience to the patient (r=0.76, p<0.01) and family/carer/partner (r=0.71, p<0.01) and wanting to limit numbers of hospital visits (r=0.57, p<0.01). Fifty per cent agreed/strongly agreed that they were worried about the risk of simultaneous bilateral ocular complications, with this correlating with being less likely to opt for ISBCS (r=-0.49, p<0.01) and being scared of ISBCS (r=0.67, p<0.01). During COVID-19 lockdown, patients were less likely to want to minimise the time taken off work (p<0.05) and less intolerant of a prolonged hospital visit (p<0.05). Only 23% of respondents agreed/strongly agreed that they had familiarity with ISBCS. Conclusions ISBCS was acceptable to 45% of our sampled population, suggesting limited routine implementation in the NHS is possible. Convenience and reduction in hospital visits appeared to contribute to this acceptance. Half of the patients expressed concern regarding bilateral complications and such concerns need addressing. Some attitudes did appear to change during the COVID-19 lockdown period. The familiarity of the concept of ISBCS is low suggesting the need for patient education.
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Affiliation(s)
- Vishal Shah
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Khayam Naderi
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,King's College London, London, UK
| | - Laura Maubon
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ashmal Jameel
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Darshak S Patel
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jack Gormley
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sanjeev Heemraz
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Elodie Azan
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Seema Verma
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sancy Low
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - David O'Brart
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,King's College London, London, UK
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O'Brart DP, Roberts H, Naderi K, Gormley J. Economic modelling of immediately sequential bilateral cataract surgery (ISBCS) in the National Health Service based on possible improvements in surgical efficiency. BMJ Open Ophthalmol 2020; 5:e000426. [PMID: 32617415 PMCID: PMC7319779 DOI: 10.1136/bmjophth-2019-000426] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 05/14/2020] [Accepted: 05/17/2020] [Indexed: 11/17/2022] Open
Abstract
Objective To test a hypothesis that operating room (OR) productivity in the National Health Service (NHS) can be improved with the introduction of immediately sequential bilateral cataract surgery (ISBCS). Methods and analysis Previously published time and motion data of 140 unilateral cataract surgeries conducted at five different NHS locations were reanalysed to construct a hypothetical model where only ISBCS (±one unilateral case) were conducted while maintaining time durations of all key tasks previously studied. Possible time efficiency savings were calculated for the ISBCS model and percentage increases in numbers of eyes operated per 4-hour theatre session calculated. Gains in efficiency were correlated with factors from the baseline data to predict which settings could improve efficiency most by undertaking ISBCS. Results Based on remodelling our time and motion study (TMS) data as hypothetical ISBCS cases, we could expect a mean 16% reduction (range 9.8%–17.8%) in the time taken for two cataract operations, translating into a mean 54% improvement (range 38%–67%) in number of cases currently performed per list and an 18% improvement (range 9%–28%) even if the number of unilateral cases per list had been fully maximised. An average number of four ISBCS cases per list (range 3–6) were required to achieve sufficient time savings to allow an extra unilateral surgery to be conducted. Conclusion The introduction of routine ISBCS has the potential to improve the productivity of cataract surgery within the NHS, with efficiencies being possible in both high-volume and low-volume surgical models.
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Affiliation(s)
- David P O'Brart
- Guy's and Saint Thomas' NHS Foundation Trust, London, UK.,King's College London, London, UK
| | - Harry Roberts
- Guy's and Saint Thomas' NHS Foundation Trust, London, UK.,King's College London, London, UK
| | - Khayam Naderi
- Guy's and Saint Thomas' NHS Foundation Trust, London, UK.,King's College London, London, UK
| | - Jack Gormley
- Guy's and Saint Thomas' NHS Foundation Trust, London, UK
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Lee E, Balasingam B, Mills EC, Zarei-Ghanavati M, Liu C. A survey exploring ophthalmologists' attitudes and beliefs in performing Immediately Sequential Bilateral Cataract Surgery in the United Kingdom. BMC Ophthalmol 2020; 20:210. [PMID: 32487105 PMCID: PMC7265252 DOI: 10.1186/s12886-020-01475-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 05/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The standard approach to treat cataracts is Delayed Sequential Bilateral Cataract Surgery (DSBCS), during which patients have a separate operation date for each eye. An alternative method of delivery is Immediately Sequential Bilateral Cataract Surgery (ISBCS). The aim of this project was to examine the attitudes and beliefs of UK ophthalmologists towards ISBCS, explore their reasons to either practise or not practise ISBCS and identify barriers hindering its implementation in the UK. METHODS A questionnaire was distributed to consultant members of The Royal College of Ophthalmologists (RCOphth, UK) and collected electronically. An initial screening question in regards to prior experience with ISBCS directed the rest of the survey; participants were asked to rate the importance of several factors with regards to performing ISBCS. Free text options were also available. Descriptive analysis was subsequently performed. RESULTS Of the 1357 recipients, 130 (9.6%) ophthalmologists completed the survey. Of those, 13.9% were currently performing ISBCS, 83.1% had never performed, and 3.1% had previously done so but since stopped. The main factors that acted as barriers were lack of: (1) College approval (20.5%); (2) medico-legal approval (20.2%); (3) evidence to support the use of ISBCS (16.0%); and (4) hospital approval (13.3%). Additionally, the perceived risk of complications for patients played an important role when considering ISBCS, with the risk of endophthalmitis being most feared. CONCLUSIONS This survey demonstrates some of the barriers that prevent ophthalmologist's performing ISBCS in the UK. There is a need for further exploration in this field to evaluate the effect of addressing any of these concerns on the implementation of ISBCS.
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Affiliation(s)
- Eunkyung Lee
- Brighton and Sussex Medical School, Brighton, UK.,Basingstoke and North Hampshire hospital, Aldermaston road, Basingstoke RG24 9NA, Basingstoke, UK
| | - Bagishan Balasingam
- Brighton and Sussex Medical School, Brighton, UK.,Basingstoke and North Hampshire hospital, Aldermaston road, Basingstoke RG24 9NA, Basingstoke, UK
| | | | | | - Christopher Liu
- Brighton and Sussex Medical School, Brighton, UK. .,Sussex Eye Hospital, Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton, BN2 5BF, UK. .,Tongdean Eye Clinic, Hove, UK.
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Bhambhwani V, Khalili S, Tehrani N, Ali A, Mireskandari K. Outcomes and complications of immediate versus delayed sequential bilateral cataract surgery in children. J AAPOS 2020; 24:137.e1-6. [PMID: 32497580 DOI: 10.1016/j.jaapos.2020.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 02/04/2020] [Accepted: 02/08/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE To present the largest series to date comparing outcomes and complications of immediate versus delayed sequential bilateral cataract surgery (ISBCS vs DSBCS) in children at a single center over a 10-year period. METHODS The medical records of children <2 years of age who underwent ISBCS and DSBCS were reviewed retrospectively. Data was collected on outcomes and complications (ophthalmological and anesthesia-related) up to 8 weeks postoperatively. RESULTS A total of 53 children were included: 37 ISBCS and 16 DSBCS. There were no differences between groups with regard to sex, age at surgery, and type of surgery. The ISBCS group had significantly more patients with systemic or ocular comorbidities than the DSBCS group (35% vs 6%; P = 0.029). Mean operating room time was significantly lower for the ISBCS group (3.61 vs 4.09 hours; P = 0.037), whereas total surgical time was similar. No major intraoperative surgical complications or anesthesia-related adverse events occurred in either group. Postoperative complications (most commonly, raised intraocular pressure) occurred in 5 eyes (7%) in the ISBCS group and 8 eyes (25%) in the DSBCS group (P = 0.009). Patients in the ISBCS group required significantly fewer follow-up visits compared to the DSBCS group (4 vs 6; P = 0.0002). CONCLUSIONS ISBCS avoids multiple anesthesia sessions and reduces follow-up visits, with intra- and postoperative ophthalmological or anesthesia-related complications comparable to DSBCS.
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Mills EC, Zarei-Ghanavati M, Liu CS. Immediate sequential bilateral cataract surgery: The rationale, implementation, and beliefs of ophthalmic surgeons across Europe. J Cataract Refract Surg 2019; 45:1725-1731. [DOI: 10.1016/j.jcrs.2019.07.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 07/15/2019] [Accepted: 07/20/2019] [Indexed: 10/25/2022]
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Chen Y, Zhang Y, Li X, Yan H. Incidence of acute-onset endophthalmitis after separate bilateral cataract surgeries less than 5 days apart. BMC Ophthalmol 2019; 19:32. [PMID: 30683069 PMCID: PMC6347771 DOI: 10.1186/s12886-019-1028-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 01/03/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose To assess the incidence of acute-onset endophthalmitis after separate bilateral cataract surgeries less than 5 days apart (SBCS5). Methods The medical records of all patients who underwent SBCS5 at a single medical center between October 10, 2012 and July 31, 2017 were retrospectively reviewed. Results The medical records for treatment of 5374 eyes of 2687 patients were examined. The mean interval between the first and second surgeries was 3 days. No case of bilateral simultaneous endophthalmitis was observed. Unilateral endophthalmitis developed in five eyes of five patients. Thus, the incidence of endophthalmitis after SBCS5 was 0.093%. All cases of endophthalmitis occurred in the first operated eye. SBCS5 was 15% less expensive than unilateral cataract surgery. Conclusion The incidence of endophthalmitis after SBCS5 was acceptably low with topical but not intracamaral antibiotic prophylaxis. SBCS5 was also less expensive than unilateral cataract surgery.
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Affiliation(s)
- Ying Chen
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing, 400016, China
| | - Yu Zhang
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing, 400016, China
| | - Xiaodan Li
- Department of Ophthalmology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, 400021, China
| | - Hong Yan
- Department of Ophthalmology, Xi'an No. 4 Hospital, Shaanxi Eye Hospital, Affiliated Guangren Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, 710004, Shaanxi Province, China.
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Ganesh S, Brar S, Sreenath R. Immediate sequential bilateral cataract surgery: A 5-year retrospective analysis of 2470 eyes from a tertiary care eye center in South India. Indian J Ophthalmol 2017; 65:358-364. [PMID: 28573990 PMCID: PMC5489653 DOI: 10.4103/ijo.ijo_947_16] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: The purpose of this study is to evaluate the safety and benefits of immediate sequential bilateral cataract surgery. Patients and Methods: Retrospective data analysis of patients who underwent immediate sequential bilateral phacoemulsification with foldable intraocular lens (IOL) implantation under topical anesthesia from January 2011 to September 2016 was performed. Patients with visually significant bilateral cataract within the axial length range of 21.0–26.5 mm were included in the study. Intraoperative and postoperative complications were evaluated. Results: Two thousand four hundred and seventy eyes from 1235 patients with a mean age of 68.34 years (range: 4–90 years) were analyzed. Best-corrected visual acuity improved from 0.40 ± 0.17 to 0.08 ± 0.10 (logarithm of the minimum angle of resolution). Nearly 92.05% eyes achieved a target postoperative refraction of ± 0.5 D spherical equivalent. Main complications observed were prolonged postoperative inflammation in 25% (n = 31), posterior capsular tears in 0.45% (n = 11), and unilateral cystoid macular edema in 0.08% (n = 2) eyes. No sight-threatening complications such as endophthalmitis, retinal detachment, corneal decompensation and intraocular hemorrhage occurred in any of the eyes. Out of the 288 (23.2%) patients who underwent bilateral multifocal IOL implantation, 23 patients (46 eyes) had femtolaser-assisted cataract surgery procedure. Two pediatric and one Downs syndrome patient underwent bilateral cataract surgery under general anesthesia and intravenous sedation, respectively. Conclusion: IBSCS may be considered as a preferred practice in eligible cases considering significant patient benefits such as early visual rehabilitation, time and cost-effectiveness, and better compliance with postoperative medications. In debilitated patients and special situations, such as pediatric cataract and Downs syndrome requiring general anesthesia it may be the ideal procedure.
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Affiliation(s)
- Sri Ganesh
- Department of Phaco and Refractive, Nethradhama Superspeciality Eye Hospital, Bengaluru, Karnataka, India
| | - Sheetal Brar
- Department of Phaco and Refractive, Nethradhama Superspeciality Eye Hospital, Bengaluru, Karnataka, India
| | - Rohit Sreenath
- Department of Phaco and Refractive, Nethradhama Superspeciality Eye Hospital, Bengaluru, Karnataka, India
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Grzybowski A, Wasinska-Borowiec W, Claoué C. Pros and cons of immediately sequential bilateral cataract surgery (ISBCS). Saudi J Ophthalmol 2016; 30:244-9. [PMID: 28003784 DOI: 10.1016/j.sjopt.2016.09.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 07/28/2016] [Accepted: 09/20/2016] [Indexed: 12/31/2022] Open
Abstract
Immediately sequential bilateral cataract surgery (ISBCS) is currently a "hot topic" in ophthalmology. There are well-documented advantages in terms of quicker visual rehabilitation and reduced costs. The risk of bilateral simultaneous endophthalmitis and bilateral blindness is now recognized to be minuscule with the advent of intracameral antibiotics and modern management of endophthalmitis. Refractive surprises are rare for normal eyes and with the use of optical biometry. Where a general anesthetic is indicated for cataract surgery, the risk of death from a second anesthetic is much higher than the risk of blindness. A widely recognized protocol from the International Society of Bilateral Cataract Surgeons needs to be adhered to if surgeons wish to start practicing ISBCS.
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Rajavi Z, Javadi MA, Daftarian N, Safi S, Nejat F, Shirvani A, Ahmadieh H, Shahraz S, Ziaei H, Moein H, Motlagh BF, Feizi S, Foroutan A, Hashemi H, Hashemian SJ, Jabbarvand M, Jafarinasab MR, Karimian F, Mohammad-Rabei H, Mohammadpour M, Nassiri N, Panahi-Bazaz M, Rohani MR, Sedaghat MR, Sheibani K. Customized Clinical Practice Guidelines for Management of Adult Cataract in Iran. J Ophthalmic Vis Res 2016; 10:445-60. [PMID: 27051491 PMCID: PMC4795396 DOI: 10.4103/2008-322x.176913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose: To customize clinical practice guidelines (CPGs) for cataract management in the Iranian population. Methods: First, four CPGs (American Academy of Ophthalmology 2006 and 2011, Royal College of Ophthalmologists 2010, and Canadian Ophthalmological Society 2008) were selected from a number of available CPGs in the literature for cataract management. All recommendations of these guidelines, together with their references, were studied. Each recommendation was summarized in 4 tables. The first table showed the recommendation itself in clinical question components format along with its level of evidence. The second table contained structured abstracts of supporting articles related to the clinical question with their levels of evidence. The third table included the customized recommendation of the internal group respecting its clinical advantage, cost, and complications. In the fourth table, the internal group their recommendations from 1 to 9 based on the customizing capability of the recommendation (applicability, acceptability, external validity). Finally, customized recommendations were sent one month prior to a consensus session to faculty members of all universities across the country asking for their comments on recommendations. Results: The agreed recommendations were accepted as conclusive while those with no agreement were discussed at the consensus session. Finally, all customized recommendations were codified as 80 recommendations along with their sources and levels of evidence for the Iranian population. Conclusion: Customization of CPGs for management of adult cataract for the Iranian population seems to be useful for standardization of referral, diagnosis and treatment of patients.
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Affiliation(s)
- Zhaleh Rajavi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Javadi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Narsis Daftarian
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sare Safi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Nejat
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Armin Shirvani
- Office for Healthcare Standards, Deputy of Curative Affairs, Ministry of Health and Medical Education, Tehran, Iran; Department of Medical Education, Faculty of Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Ahmadieh
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Hossein Ziaei
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamidreza Moein
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Sepehr Feizi
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Foroutan
- Department of Ophthalmology, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Hassan Hashemi
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Javad Hashemian
- Department of Ophthalmology, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Jabbarvand
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Jafarinasab
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farid Karimian
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Mohammad-Rabei
- Department of Ophthalmology, Imam Hussein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrdad Mohammadpour
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nader Nassiri
- Department of Ophthalmology, Imam Hussein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Reza Rohani
- Department of Ophthalmology, Al-Zahra Eye Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | | | - Kourosh Sheibani
- Basir Eye Safety Research Center, Basir Eye Clinic, Tehran, Iran
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Falavarjani KG, Alemzadeh SA, Habibi A, Hadavandkhani A, Askari S, Pourhabibi A. Pseudomonas aeruginosa Endophthalmitis: Clinical Outcomes and Antibiotic Susceptibilities. Ocul Immunol Inflamm 2016; 25:377-381. [DOI: 10.3109/09273948.2015.1132740] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Khalil Ghasemi Falavarjani
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
- Doheny Eye Institute, University of California Los Angeles, Los Angeles, California, USA
| | | | - Abbas Habibi
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Hadavandkhani
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Sareh Askari
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Arash Pourhabibi
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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Kessel L, Andresen J, Erngaard D, Flesner P, Tendal B, Hjortdal J. Immediate Sequential Bilateral Cataract Surgery: A Systematic Review and Meta-Analysis. J Ophthalmol 2015; 2015:912481. [PMID: 26351576 DOI: 10.1155/2015/912481] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 06/30/2015] [Accepted: 07/02/2015] [Indexed: 11/17/2022] Open
Abstract
The aim of the present systematic review was to examine the benefits and harms associated with immediate sequential bilateral cataract surgery (ISBCS) with specific emphasis on the rate of complications, postoperative anisometropia, and subjective visual function in order to formulate evidence-based national Danish guidelines for cataract surgery. A systematic literature review in PubMed, Embase, and Cochrane central databases identified three randomized controlled trials that compared outcome in patients randomized to ISBCS or bilateral cataract surgery on two different dates. Meta-analyses were performed using the Cochrane Review Manager software. The quality of the evidence was assessed using the GRADE method (Grading of Recommendation, Assessment, Development, and Evaluation). We did not find any difference in the risk of complications or visual outcome in patients randomized to ISBCS or surgery on two different dates. The quality of evidence was rated as low to very low. None of the studies reported the prevalence of postoperative anisometropia. In conclusion, we cannot provide evidence-based recommendations on the use of ISBCS due to the lack of high quality evidence. Therefore, the decision to perform ISBCS should be taken after careful discussion between the surgeon and the patient.
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Hernández Da Mota SE, Béjar Cornejo F. Endoftalmitis bilateral por Pseudomonas aeruginosa secundaria a cirugía de catarata simultánea. Reporte de caso. Revista Mexicana de Oftalmología 2015; 89:116-9. [DOI: 10.1016/j.mexoft.2014.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Henderson BA, Schneider J. Same-day cataract surgery should not be the standard of care for patients with bilateral visually significant cataract. Surv Ophthalmol 2012; 57:580-3. [PMID: 22995968 DOI: 10.1016/j.survophthal.2012.05.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 04/26/2012] [Accepted: 05/01/2012] [Indexed: 11/24/2022]
Abstract
Benefits of sequential surgery include assessment of the outcome of the first surgery to tailor the surgical technique, intraocular lens (IOL) power, and choice of IOL for the second surgery. Additionally, recovery may be prolonged from corneal edema, anterior chamber inflammation, or cystoid macular edema. Allowing the patient to maintain visual function in one eye during the recovery of the other eye can be important. Therefore, the few benefits of simultaneous surgery are greatly outweighed by risks of bilateral complications, inability to foresee refractive outcome, inability to alter IOL choice, potential loss of physician reimbursement, and possible increased legal ramifications.
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Gradin D, Mundia D. Simultaneous bilateral cataract surgery with IOL implantation in children in Kenya. J Pediatr Ophthalmol Strabismus 2012; 49:139-44. [PMID: 21800783 DOI: 10.3928/01913913-20110726-01] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2011] [Accepted: 06/17/2011] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate the cost implications, safety, and refractive outcomes of simultaneous bilateral cataract surgery (SBCS) with intraocular lens implantation in pediatric patients in a developing world setting. METHODS Children aged 3 months to 10 years with bilateral congenital or developmental cataracts who underwent surgery between January 1, 2007, and December 31, 2009, were eligible for inclusion in this retrospective study. Cost data were compared for simultaneous and sequential cases. Postoperative complications and refraction data were analyzed. RESULTS Ninety-six children (192 eyes) were included, 48 in the SBCS group and 48 in the sequential group. The mean age of the SBCS group and the sequential group was 3.4 and 4.7 years, respectively (P = .04). The total estimated surgical cost was $274 per child for SBCS and $344 for sequential surgery, a reduction of 20.3% for cases of SBCS. Fibrin formation of any amount occurred in 52 of 192 eyes (27.1%), 25 in the SBCS group and 27 in the sequential group (P = .75). Twenty-one eyes (10.9%) had additional surgery to remove visual axis obstruction, 14 in the SBCS group and 7 in the sequential group (P = .11). The incidence of early endophthalmitis in all cases of pediatric cataract surgery in an 11-year period was 0.16%. The incidence of anesthetic-related death during the same period was 0.11%. CONCLUSION Bilateral simultaneous pediatric cataract surgery with intraocular lens implantation may be a safe alternative to sequential surgery, with advantages in cost reduction and no difference in sight-threatening complications.
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Affiliation(s)
- Dan Gradin
- Eye Unit, PCEA Kikuyu Hospital, Nairobi, Kenya.
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Arshinoff SA, Bastianelli PA. Incidence of postoperative endophthalmitis after immediate sequential bilateral cataract surgery. J Cataract Refract Surg 2011; 37:2105-14. [DOI: 10.1016/j.jcrs.2011.06.036] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2011] [Revised: 06/06/2011] [Accepted: 06/09/2011] [Indexed: 11/29/2022]
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Packer M, Chang DF, Dewey SH, Little BC, Mamalis N, Oetting TA, Talley-Rostov A, Yoo SH. Prevention, diagnosis, and management of acute postoperative bacterial endophthalmitis. J Cataract Refract Surg 2011; 37:1699-714. [PMID: 21782382 DOI: 10.1016/j.jcrs.2011.06.018] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Accepted: 04/03/2011] [Indexed: 11/29/2022]
Abstract
This distillation of the peer-reviewed scientific literature on infection after cataract surgery summarizes background material on epidemiology, etiology, and pathogenesis, describes the roles of surgical technique and antibiotic prophylaxis in prevention, and discusses diagnostic and therapeutic interventions in cases of suspected endophthalmitis.
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Dave H, Phoenix V, Becker ER, Lambert SR. Simultaneous vs sequential bilateral cataract surgery for infants with congenital cataracts: Visual outcomes, adverse events, and economic costs. ACTA ACUST UNITED AC 2010; 128:1050-4. [PMID: 20697007 DOI: 10.1001/archophthalmol.2010.136] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To compare the incidence of adverse events and visual outcomes and to compare the economic costs of sequential vs simultaneous bilateral cataract surgery for infants with congenital cataracts. METHODS Retrospective review of simultaneous vs sequential bilateral cataract surgery for infants with congenital cataracts who underwent cataract surgery when 6 months or younger at our institution. RESULTS Records were available for 10 children who underwent sequential surgery at a mean age of 49 days for the first eye and 17 children who underwent simultaneous surgery at a mean age of 68 days (P = .25). We found a similar incidence of adverse events between the 2 treatment groups. Intraoperative or postoperative complications occurred in 14 eyes. The most common postoperative complication was glaucoma. No eyes developed endophthalmitis. The mean (SD) absolute interocular difference in logMAR visual acuities between the 2 treatment groups was 0.47 (0.76) for the sequential group and 0.44 (0.40) for the simultaneous group (P = .92). Payments for the hospital, drugs, supplies, and professional services were on average 21.9% lower per patient in the simultaneous group. CONCLUSIONS Simultaneous bilateral cataract surgery for infants with congenital cataracts is associated with a 21.9% reduction in medical payments and no discernible difference in the incidence of adverse events or visual outcomes. However, our small sample size limits our ability to make meaningful comparisons of the relative risks and visual benefits of the 2 procedures.
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Nallasamy S, Davidson SL, Kuhn I, Mills MD, Forbes BJ, Stricker PA, Anninger WV. Simultaneous bilateral intraocular surgery in children. J AAPOS 2010; 14:15-9. [PMID: 20227616 DOI: 10.1016/j.jaapos.2009.10.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Revised: 10/28/2009] [Accepted: 10/30/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND Simultaneous bilateral intraocular surgery (SBIS), defined as sequential bilateral intraocular surgery completed in one visit to the operating room, is a controversial topic. The reluctance of ophthalmologists to perform SBIS has been mainly attributable to concerns about bilateral catastrophic complications (endophthalmitis, expulsive hemorrhage, or retinal detachment). Herein we report our experience with SBIS in children and review the literature. METHODS The medical records of 44 patients who underwent 48 cases of SBIS between 1994 and 2009 were reviewed. Of the 48 cases, 27 were bilateral cataract extractions, 1 including intraocular lens placement; 21 were cases of bilateral glaucoma surgeries, including goniotomy, trabeculotomy, and filtering tube placement. Bilateral surgeries were performed in one session under general anesthesia with strict aseptic separation of the 2 surgeries. RESULTS All but one of the cataract cases were performed in patients <1 year of age, and the majority (15/27) were performed in patients < or =1 month of age. Postoperative complications included aphakic glaucoma (5 patients) and reproliferation of lens material (3 patients). The majority of patients who underwent glaucoma procedures were <1 year of age (19/21), with 4 of 21 <1 month of age. One eye developed hyphema that required anterior chamber wash out. There were no catastrophic complications from the surgery or anesthesia (death, asphyxia, cardiac or respiratory arrest, or seizures) in either group. CONCLUSIONS Simultaneous bilateral intraocular surgery was performed safely in 48 cases during a 15-year period. In selected pediatric cases requiring bilateral intraocular surgery for glaucoma or cataract, SBIS may reduce risks related to anesthesia and delayed surgery.
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Abstract
PURPOSE To compare resource utilization of two different strategies for bilateral cataract surgery: immediate sequential cataract surgery (ISCS) versus delayed sequential cataract surgery (DSCS). The purpose was also to analyse the value for the patient of undergoing ISCS versus DSCS. METHODS Differences in routines and resource utilization between ISCS (n = 17) and DSCS (n = 80) were studied in a cohort of cataract surgery patients at our clinic in Karlskrona, Sweden. Costs were extracted from an earlier publication by the same clinic. The value for the patient was studied using the capability index, based on published data on the benefit to the patient of ISCS or DSCS using the Catquest questionnaire. RESULTS Operating both eyes of a patient was 1.14 times more expensive with DSCS than with ISCS including all surgical costs. The value to the patient of undergoing ISCS depended on the time between first- and second-eye surgery in DSCS and the remaining lifetime after both-eye surgery. A long waiting time for second-eye surgery and a short remaining lifetime decreased the patient value of DSCS compared to ISCS. CONCLUSION DSCS is 14% more expensive than ISCS. The value for the patient of ISCS compared to DSCS depends on how long the period will be between first- and second-eye surgery in DSCS and also on the patient's survival time after surgery.
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Arshinoff S. Bilateral endophthalmitis after simultaneous bilateral cataract surgery. J Cataract Refract Surg 2008; 34:2006-8; author reply 2008. [DOI: 10.1016/j.jcrs.2008.08.036] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Accepted: 08/21/2008] [Indexed: 11/16/2022]
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Canadian Ophthalmological Society evidence-based clinical practice guidelines for cataract surgery in the adult eye. Canadian Journal of Ophthalmology 2008; 43:S7-S33. [DOI: 10.3129/i08-133] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Guide de pratique clinique factuelle de la Société canadienne d’ophtalmologie pour la chirurgie de la cataracte de l’œil adulte. Canadian Journal of Ophthalmology 2008; 43:S35-S57. [DOI: 10.1016/s0008-4182(08)80002-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Puvanachandra N, Humphry RC. Bilateral endophthalmitis after bilateral sequential phacoemulsification. J Cataract Refract Surg 2008; 34:1036-7. [DOI: 10.1016/j.jcrs.2008.01.032] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2007] [Accepted: 01/08/2008] [Indexed: 11/29/2022]
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Abstract
A bilateral simultaneous cataract surgery (BSCS) was performed on a 67-year-old man. The surgeon had not changed the surgical settings in between the two procedures for the two eyes. The patient developed fulminant bilateral endophthalmitis a day following the BSCS. Intravitreal culture grew Pseudomonas aeruginosa . The source of infection was not found. Immediate bilateral vitrectomy and intravitreal, subconjunctival, topical and systemic antibiotic did not save the eyes. Patient ended up with bilateral visual loss.
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Arshinoff SA. Need for strict aseptic separation of the 2 procedures in simultaneous bilateral cataract surgery. J Cataract Refract Surg 2006; 32:376-7. [PMID: 16631032 DOI: 10.1016/j.jcrs.2005.12.085] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2005] [Indexed: 11/19/2022]
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