Immediately sequential bilateral cataract surgery: an academic teaching center's experience

Operating Room Waste Generated From Corneal and Conjunctival Surgeries

PURPOSE

The purposes of this study were to bring awareness to the surgical waste generated from corneal and conjunctival surgeries and to compare those findings with the waste generated from cataract surgeries.

METHODS

This was an observational prospective pilot cohort study at a tertiary corneal/anterior segment private practice. All waste related to cataract, cornea, and conjunctival surgical procedures (including anesthesia waste and corneal tissue storage) was weighed. The primary outcome was total waste generated while other outcomes included surgical setting (ambulatory surgical center, hospital, and minor operating room) and comparison of corneal/conjunctival surgeries with cataract surgery.

RESULTS

Surgical waste data were collected from 119 surgeries (82 corneal/conjunctival surgeries and 37 cataract surgeries). Hospital surgeries produced more waste than ambulatory surgical center and minor operating room surgeries. Penetrating keratoplasty (2.22 kg, P = 0.483) and Descemet stripping only (2.11 kg, P = 0.326) procedures generated comparable mean waste with cataract surgery (2.07 kg) while endothelial keratoplasties produced more ( P < 0.001, 0.002). (Deep) anterior lamellar keratoplasty results depended on the surgical setting. All conjunctival surgeries produced less waste than cataract surgery.

CONCLUSIONS

In comparison with cataract surgery, keratoplasties overall produced comparable or more waste while conjunctival surgeries produced less waste. The surgical setting and type of anesthesia played a substantial role in the amount of waste generated. Assessing waste production from different ophthalmic surgeries may increase awareness of the negative environmental impact of surgical waste and promote practice or legal changes to improve environmental sustainability.

Perception of Canadian ophthalmologists on immediately sequential bilateral cataract surgery: insights and implications

OBJECTIVE

To evaluate the perception of immediately sequential bilateral cataract surgery (ISBCS) among Canadian ophthalmologists.

DESIGN

An anonymous survey was sent to all active members of the Canadian Ophthalmological Society.

METHODS

Basic demographic information, cataract surgery practice patterns, and perceived advantages, disadvantages, and concerns regarding ISBCS were collected from respondents.

RESULTS

A total of 352 ophthalmologists answered the survey. Among these, 94 respondents (27%) practice ISBCS routinely, 123 (35%) practice ISBCS in exceptional cases, and 131 (37%) do not practice ISBCS. ISBCS practitioners were significantly younger than nonpractitioners (p < 0.001) and had a shorter duration of practice (p < 0.001). The prevalence of ISBCS practitioners also varied significantly by province (p < 0.001): most practitioners who routinely practice ISBCS were from Quebec (n = 44; 48%), where financial disincentives are lowest in the country. The main work setting of ISBCS practitioners was academic centres (n = 39; 42%) as opposed to private or community settings (p < 0.001). The main reason for performing ISBCS was more efficient operating theatre use (n = 142; 65%). The main concerns regarding ISBCS were the risk of bilateral complications (n = 193; 57%) and the lack of refractive outcomes for second-eye surgery (n = 184; 52%). The COVID-19 pandemic positively influenced the view of 152 respondents (43%), but this was mostly among practitioners who already performed ISBCS routinely (n = 77; 84%).

CONCLUSIONS

ISBCS practitioners are more likely younger ophthalmologists working in academic centres. Quebec has the highest prevalence of ISBCS practitioners. ISBCS practitioners were positively influenced by the COVID-19 pandemic to offer ISBCS more often compared with non-ISBCS practitioners.

Practice of immediate sequential bilateral cataract surgery (ISBCS): A teaching hospital experience in United Kingdom

BACKGROUND / OBJECTIVES

Utilisation of ISBCS has been encouraged since COVID-19 in line with the RCOphth recommendations. This study aims to share experience from a UK teaching hospital on ISBCS and to evaluate pre-, intra- and post-operative outcomes from the ISBCS cohort.

METHODS

Of 3402 cataract surgeries performed between July 2020 and July 2021 (1 year since the reopening of the cataract service from COVID-19), 208 eyes of 104 patients (6.1%) undergoing ISBCS were retrospectively studied on their demographics, biometry, surgeon grades, and pre-, intra- and post-operative data.

RESULTS

The mean age was 74.5 ± 9.4 years and 62% were female. Eighty-nine percent of the eyes were performed under local anaesthesia and 70% were 'routine' cases. Other risk factors included: short eyes requiring pre-operative mannitol infusion (10%), high myopia (8%), poor dilation (2%) and a 'glaucoma' cohort [angle closure (2%) and prior trabeculectomy (1%)]. Three eyes (1%) had complications intra-operatively in second eye (1 case each: posterior capsule rupture, corneal oedema and zonular dehiscence). Two patients (1%) had complications in the first eye (1 case each: suprachoroidal haemorrhage, conjunctival & iris haemorrhage), hence had their second eye postponed. Twelve months post-operatively, 20 eyes (10%) had recorded post-op complications with cystoid macular oedema being the commonest (4.5%) and no endophthalmitis. Eighty-six percent were discharged with satisfaction. No significant differences were found in pre-operative features, complication rates and post-operative outcomes between consultant and non-consultant surgeons (p > 0.05).

CONCLUSIONS

Our experience which included a cohort of high-risk patients showed safe and successful practice of ISBCS without having a negative impact on training.

Immediately sequential bilateral cataract surgery (ISBCS) adapted protocol during COVID-19: quality-improvement initiative

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.