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Lundström M, Kugelberg M, Zetterberg M, Nilsson I, Viberg A, Bro T, Behndig A. Ten-year trends of immediate sequential bilateral cataract surgery (ISBCS) as reflected in the Swedish National Cataract Register. Acta Ophthalmol 2024; 102:68-73. [PMID: 37133405 DOI: 10.1111/aos.15688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/14/2023] [Accepted: 04/21/2023] [Indexed: 05/04/2023]
Abstract
PURPOSE To analyse trends of ISBCS reported to the Swedish National Cataract Register (NCR) over a 10-year period. METHODS Since 2010 the NCR contains social security number of all individuals in the list of parameters reported to NCR after each cataract procedure. Bilateral surgeries were mapped out using social security numbers. When dates of both-eye surgeries are identical for an individual it is classified as an immediate sequential bilateral cataract surgery (ISBCS). This study includes all data reported during the period 1st of January 2010 to 31st of December 2019. During the study period 113 cataract surgery clinics affiliated to the NCR reported their data on consecutive cataract cases. RESULTS For the whole period 54 194 ISBCS were reported. The total number of bilateral cataract extractions was 422 300. There was a significant trend of increasing ISBCS over time with linear regression (Beta = 1.75, p < 0.001). In ISBCS the occurrence of an ocular comorbidity decreased over time. The use of a capsular tension ring was significantly more common in ISBCS than in delayed sequential bilateral cataract surgery (DSBCS). All other measures taken during surgery were more common in DSBCS. The use of multifocal IOL was significantly more frequent in ISBCS compared to DSBCS (p < 0.001). CONCLUSIONS The use of ISBCS has increased over the study period. The operated eyes have less risk factors than eyes going through a DSBCS, but both ocular comorbidities and surgical complications occur in ISBCS eyes.
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Affiliation(s)
- Mats Lundström
- Department of Clinical Sciences, Ophthalmology, Faculty of Medicine, Lund University, Lund, Sweden
| | - Maria Kugelberg
- SöderÖgon, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Andreas Viberg
- Department of Clinical Sciences, Ophthalmology, Umea University, Umeå, Sweden
| | - Tomas Bro
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Anders Behndig
- Department of Clinical Sciences, Ophthalmology, Umea University, Umeå, Sweden
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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] [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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Aiello F, Gallo Afflitto G, Leviste K, Swaminathan SS, Yoo SH, Findl O, Maurino V, Nucci C. Immediate sequential vs delayed sequential bilateral cataract surgery: systematic review and meta-analysis. J Cataract Refract Surg 2023; 49:1168-1179. [PMID: 37276258 DOI: 10.1097/j.jcrs.0000000000001230] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/29/2023] [Indexed: 06/07/2023]
Abstract
The main aim of this systematic review and meta-analysis was to evaluate the safety and efficacy profile of immediate sequential bilateral cataract surgery (ISBCS) compared with delayed sequential bilateral cataract surgery (DSBCS). MEDLINE Ovid, EMBASE, and CENTRAL databases were searched. Outcome measures were postoperative visual acuity, postoperative spherical equivalent (refractive outcome), endophthalmitis, corneal edema, pseudophakic macular edema, and posterior capsule rupture (PCR). 13 articles met criteria for final inclusion. A total of 11 068 622 participants (18 802 043 eyes) were included. No statistically significant differences between ISBCS and DSBCS were identified in all the postoperative outcomes evaluated. However, a higher risk for PCR was identified in the ISBCS group from the pooled analysis of nonrandomized studies (risk ratio, 1.34, 95% CI, 1.08-1.67, P = .0081). In our view, the ISBCS approach has an acceptable safety-efficacy profile, comparable with DSBCS. Future investigations are warranted, with a focus on the analysis of risk factors for surgical complications, patient-reported outcome-measures, and cost effectiveness.
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Affiliation(s)
- Francesco Aiello
- From the Ophthalmology Unit, Department of Experimental Medicine, University of Rome "Tor Vergata," Rome, Italy (Aiello, Gallo Afflitto, Nucci); Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida (Gallo Afflitto, Leviste, Swaminathan, Yoo); Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom (Maurino); Vienna Institute for Research in Ocular Surgery (VIROS), Hanusch Hospital, Vienna, Austria (Findl)
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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: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [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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Ruiz-Lozano RE, Ramos-Davila EM, Garza-Garza LA, Gonzalez-Godinez S, Rodriguez-Garcia A. Challenges in the diagnosis and management of simultaneous, bilateral, toxic anterior segment syndrome after phacorefractive surgery. Digit J Ophthalmol 2023; 29:40-44. [PMID: 37727462 PMCID: PMC10506611 DOI: 10.5693/djo.02.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
A 59-year-old woman presented with a 24-hour history of severe, bilateral, painless vision loss starting 1 day after immediately sequential, bilateral, phacorefractive surgery with multifocal intraocular lens (IOL) implantation at another institution. Best-corrected visual acuity was counting fingers at 1 foot in the right eye and 20/100 in the left eye. Slit-lamp evaluation showed a dense fibrin membrane on the anterior surface of the IOL and significant anterior chamber inflammation in both eyes. B-scan ultrasound revealed bilateral vitreous haze, without membrane formation. The rapid onset, absence of sharp pain, ciliary injection, conjunctival chemosis, eyelid edema, and erythema raised suspicion for bilateral toxic anterior segment syndrome. Significant clinical improvement after high-dose prednisone and hourly prednisolone acetate eye drops supported the diagnosis. After 6 months of tapering anti-inflammatory therapy, optical coherence tomography of the macula showed no pathologic changes, and the patient's best-corrected visual acuity improved to 20/25 in both eyes.
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Affiliation(s)
- Raul E. Ruiz-Lozano
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
| | - Eugenia M. Ramos-Davila
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
| | - Lucas A. Garza-Garza
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
| | - Sara Gonzalez-Godinez
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
| | - Alejandro Rodriguez-Garcia
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
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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 PMCID: PMC9791972 DOI: 10.1038/s41598-022-26851-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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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Rush SW, Guerrero Criado AE, Kezirian GM, Durrie D. Immediate Sequential Bilateral Cataract Surgery: Opinions among Refractive Surgeons in the United States and a Comparative Analysis with European Consultants. J Ophthalmol 2022; 2022:8310921. [PMID: 36105792 PMCID: PMC9467787 DOI: 10.1155/2022/8310921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/17/2022] [Accepted: 08/23/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose To analyze the perspectives of practicing refractive surgeons regarding the implementation of Immediate Sequential Bilateral Cataract Surgery (ISBCS) in the United States (US) and to compare their perspectives with those of European colleagues. Setting. Online refractive surgery forum. Design A survey-based questionnaire. Methods An electronic survey was emailed to all surgeon members of the Refractive Surgery Alliance (RSA) in the US. Participants were prompted to score their impressions regarding various aspects regarding ISBCS. Responses were compared to published reports conducted among European surgeons. Results The electronic link to the survey was emailed to US-based surgeon members of the RSA, where 107 participated (44.6%). Twenty-seven (25.2%) reported that they currently perform ISBCS. Twenty-three (22.5%) of the respondents indicated they felt ISCBCS should be offered as a standard of care for routine cataract surgery. For surgeons that do not perform ISBCS, the most important factors were related to medicolegal issues and decreased reimbursement, whereas evidence of effectiveness and complications related to ISBCS were less important. Compared to practitioners abroad, 67.2% of European ophthalmic surgeons, compared to 25.2% of US surgeons, perform ISBCS (p < 0.0001). Conclusions While US refractive surgeons often perform bilateral corneal procedures, many significant barriers exist to the widespread adoption of ISBCS. Concerns reported by US surgeons mirror those reported by surgeons in Europe. The majority of the US refractive surgeons in this survey indicate that ISBCS should not be the standard of care in routine cases, with the prevailing reason being concerns about decreased physician reimbursement and potential medicolegal issues, not safety.
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Affiliation(s)
- Sloan W. Rush
- Panhandle Eye Group, 7400 Fleming, Amarillo 79106, TX, USA
- Texas Tech University Health Science Center, 1400 S. Coulter, Amarillo 79106, TX, USA
| | | | - Guy M. Kezirian
- SurgiVision Consultants, 28071 N. 90 Way, Scottsdale 85262, AZ, USA
| | - Daniel Durrie
- Durrie Vision, 8300 College Blvd Suite 201, Overland Park 66210, KS, USA
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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] [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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Dickman MM, Spekreijse LS, Winkens B, Schouten JS, Simons RW, Dirksen CD, Nuijts RM. Immediate sequential bilateral surgery versus delayed sequential bilateral surgery for cataracts. Cochrane Database Syst Rev 2022; 4:CD013270. [PMID: 35467755 PMCID: PMC9037598 DOI: 10.1002/14651858.cd013270.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Age-related cataract affects both eyes in most cases. Most people undergo cataract surgery in both eyes on separate days, referred to as delayed sequential bilateral cataract surgery (DSBCS). An alternative procedure involves operating on both eyes on the same day, but as two separate procedures, known as immediate sequential bilateral cataract surgery (ISBCS). Potential advantages of ISBCS include fewer hospital visits for the patient, faster visual recovery, and lower healthcare costs. Nevertheless, concerns exist about possible bilateral, postoperative, sight-threatening adverse effects with ISBCS. Therefore, there is a clear need for evaluating evidence regarding the safety, effectiveness, and cost-effectiveness of ISBCS versus DSBCS. OBJECTIVES To assess the safety of ISBCS compared to DSBCS in people with bilateral age-related cataracts and to summarise current evidence for the incremental resource use, utilities, costs, and cost-effectiveness associated with the use of ISBCS compared to DSBCS in people with bilateral age-related cataracts (primary objectives). The secondary objective was to assess visual and patient-reported outcomes of ISBCS compared to DSBCS in people with bilateral age-related cataracts. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register; 2021, Issue 5); Ovid MEDLINE; Ovid Embase; the ISRCTN registry; ClinicalTrials.gov; the WHO ICTRP; and DARE and NHS EED on the CRD Database on 11 May 2021. There were no language restrictions. We limited the searches to a date range of 2007 onwards. SELECTION CRITERIA We included randomised controlled trials (RCTs) to assess complications, refractive outcomes, best-corrected distance visual acuity (BCDVA) and patient-reported outcome measures (PROMs) with ISBCS compared to DSBCS. We included non-randomised (NRSs), prospective, and retrospective cohort studies comparing ISBCS and DSBCS for safety assessment, because of the rare incidence of important adverse events. To assess cost-effectiveness of ISBCS compared to DSBCS, we included both full and partial economic evaluations, and both trial-based and model-based economic evaluations. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures and assessed risk of bias for NRSs using the ROBINS-I tool. For cost-evaluations, we used the CHEC-list, the CHEERS-checklist, and the NICE-checklist to investigate risk of bias. We assessed the certainty of evidence with the GRADE tool. We reported results for economic evaluations narratively. MAIN RESULTS We included 14 studies in the review; two RCTs, seven NRSs, and six economic evaluations (one study was both an NRS and economic evaluation). The studies reported on 276,260 participants (7384 for ISBCS and 268,876 for DSBCS) and were conducted in Canada, the Czech Republic, Finland, Iran, (South) Korea, Spain (Canary Islands), Sweden, the UK, and the USA. Overall, we considered the included RCTs to be at 'high to some concerns' risk of bias for complications, 'some concerns' risk of bias for refractive outcomes and visual acuity, and 'high' risk of bias for PROMs. The overall risk of bias for NRSs was graded 'serious' regarding complications and 'serious to critical' regarding refractive outcomes. With regard to endophthalmitis, we found that relative effects were estimated imprecisely and with low certainty, so that relative estimates were not reliable. Nonetheless, we found a very low risk of endophthalmitis in both ISBCS (1/14,076 participants) and DSBCS (55/556,246 participants) groups. Based on descriptive evidence and partially weak statistical evidence we found no evidence of an increased risk of endophthalmitis with ISBCS. Regarding refractive outcomes, we found moderate-certainty (RCTs) and low-certainty (NRSs) evidence there was no difference in the percentage of eyes that did not achieve refraction within 1.0 dioptre of target one to three months after surgery (RCTs: risk ratio (RR) 0.84, 95% confidence interval (CI) 0.57 to 1.26; NRSs: RR 1.02, 95% CI 0.60 to 1.75). Similarly, postoperative complications did not differ between groups (RCTs: RR 1.33, 95% CI 0.52 to 3.40; NRSs: 1.04, 95% CI 0.47 to 2.29), although the certainty of this evidence was very low for both RCTs and NRSs. Furthermore, we found low-certainty (RCTs) to very low-certainty (NRSs) evidence that total costs per participant were lower for ISBCS compared to DSBCS, although results of individual studies could not be pooled. Only one study reported on cost-effectiveness. This study found that ISBCS is cost-effective compared to DSBCS, but did not measure quality-adjusted life years using preferred methods and calculated costs erroneously. Finally, regarding secondary outcomes, we found limited evidence on BCDVA (data of two RCTs could not be pooled, although both studies individually found no difference between groups (very low-certainty evidence)). Regarding PROMs, we found moderate-certainty evidence (RCTs only) that there was no difference between groups one to three months after surgery (standardised mean difference -0.08, 95% CI -0.19 to 0.03). AUTHORS' CONCLUSIONS Current evidence supports there are probably no clinically important differences in outcomes between ISBCS and DSBCS, but with lower costs for ISBCS. However, the amount of evidence is limited, and the certainty of the evidence was graded moderate to very low. In addition, there is a need for well-designed cost-effectiveness studies.
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Affiliation(s)
- Mor M Dickman
- University Eye Clinic Maastricht, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Lindsay S Spekreijse
- University Eye Clinic Maastricht, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, Faculty of Health Medicine and Life Sciences (FHML), Maastricht University, Maastricht, Netherlands
| | - Johannes Sag Schouten
- University Eye Clinic Maastricht, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Rob Wp Simons
- University Eye Clinic Maastricht, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Carmen D Dirksen
- Clinical Epidemiology and Medical Technology Assessment Department, Maastricht University (CAPHRI), Maastricht, Netherlands
| | - Rudy Mma Nuijts
- University Eye Clinic Maastricht, Maastricht University Medical Centre, Maastricht, Netherlands
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10
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Rush SW, Omoruyi F, Rush RB. Patient Attitudes and Desirability Regarding Immediate Sequential Bilateral Cataract Surgery. Clin Ophthalmol 2022; 16:1375-1381. [PMID: 35520108 PMCID: PMC9064052 DOI: 10.2147/opth.s363327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 04/20/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose To analyze patient attitudes and desirability regarding routine immediate sequential bilateral cataract surgery (ISBCS). Methods This study was conducted as a prospective, consecutive survey-based case series from a single private practice institution serving a mostly rural population. A standardized phone survey assessing patient perspectives on ISBCS was administered to patients before and after routine delayed sequential bilateral cataract surgery (DSBCS) was performed. Subject responses were analyzed, including a subset analysis on patient responses under a variety of circumstances. Results There were 61 patients enrolled into the study and 47 completed the surveys before and after routine DSBCS (77.0% completion rate). Thirty-nine (83.0%) of respondents had a favorable outlook of ISBCS preoperatively, whereas 36 (76.6%) had a favorable outlook of ISBCS postoperatively (p>0.05). On the postoperative questionnaire, twenty-five (53.2%) of respondents were willing to accept additional surgical risk if necessary to receive ISBCS, and this finding was significant between the subgroup of patients with systemic health co-morbidities compared to those without systemic health co-morbidities (p=0.05). Conclusion Most patients had a favorable outlook of ISBCS before and after undergoing DSBCS. Patients with underlying systemic health co-morbidities were most likely to accept additional surgical risk if necessary to receive ISBCS. From a patient’s perspective, ISBCS may be an acceptable option to routinely implement when cataract surgery is required for both eyes.
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Affiliation(s)
- Sloan W Rush
- Rush Eye Associates, Amarillo, TX, 79106, USA
- Texas Tech University Health Science Center, Amarillo, TX, 79106, USA
| | - Felix Omoruyi
- Texas Tech University Health Science Center, Amarillo, TX, 79106, USA
| | - Ryan B Rush
- Texas Tech University Health Science Center, Amarillo, TX, 79106, USA
- Southwest Retina Specialists, Amarillo, TX, 79106, USA
- Correspondence: Ryan B Rush, Southwest Retina Specialists, 7411 Wallace Blvd, Amarillo, TX, 79106, USA, Tel +1-806 351-1870, Email
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11
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Qi SR, Arsenault R, Hébert M, You E, Légaré ME, Arshinoff SA, Mercier M. Immediately sequential bilateral cataract surgery: an academic teaching center's experience. J Cataract Refract Surg 2022; 48:310-316. [PMID: 34415861 DOI: 10.1097/j.jcrs.0000000000000750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 07/12/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the safety and outcomes of immediately sequential bilateral cataract surgery (ISBCS) at a Canadian academic teaching center. SETTING Tertiary university teaching hospital of Laval University, Quebec City, Canada. DESIGN Retrospective cohort study. METHODS 2003 consecutive patients (4006 eyes) who underwent ISBCS under topical anesthesia from January 2019 to December 2019 were included. All charts were retrospectively reviewed. Outcome measures included intraoperative and postoperative complications, postoperative uncorrected distance (UCVA) and pinhole (PHVA) visual acuities, and autorefraction measurements. RESULTS 4006 eyes from 1218 (60.8%) female and 785 (39.2%) male patients with a mean age of 74 ± 8 years had a mean preoperative visual acuity of 0.503 logMAR (Snellen 20/63). The mean axial length was 23.53 ± 1.37 mm. Most eyes had monofocal intraocular lenses (IOLs) implanted (n = 3738, 93.3%) followed by toric (n = 226, 5.6%), multifocal (n = 25, 0.6%), and multifocal toric (n = 17, 0.4%) IOLs. Intraoperative complications included 14 (0.3%) posterior capsule ruptures with 5 (0.1%) requiring sulcus IOL placement, and 7 (0.2%) partial zonulysis, with 3 requiring capsular tension rings (0.07%). There were no cases of endophthalmitis or toxic anterior segment syndrome. Mean 5-week postoperative UCVA was 0.223 (Snellen 20/33), PHVA was 0.153 (Snellen 20/28) with a mean spherical equivalent of -0.21 diopters. CONCLUSIONS ISBCS performed following International Society of Bilateral Cataract Surgeons recommended guidelines is a safe procedure. This cohort of 4006 eyes had very few complications, with none attributable to the surgery being done bilaterally. The UCVA, PHVA, and refractive outcomes were good.
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Affiliation(s)
- Susan Ruyu Qi
- From the Department of Ophthalmology, Hôpital du Saint-Sacrement, Quebec City, Canada (Qi, Hébert, You, Légaré, Mercier), the Department of Medicine, Université Laval, Quebec City, Canada (Qi, Arsenault, Hébert, You, Légaré, Mercier), and the Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canad a (Arshinoff)
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12
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Ophthalmologists' attitudes towards immediate sequential bilateral cataract surgery (ISBCS): a Dutch national survey. J Cataract Refract Surg 2022; 48:1044-1049. [PMID: 35239579 PMCID: PMC9415210 DOI: 10.1097/j.jcrs.0000000000000922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 02/03/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate current practice patterns of immediate sequential bilateral cataract surgery (ISBCS) in the Netherlands and assess ophthalmologists' attitudes towards performing ISBCS in future cataract care. SETTING Dutch ophthalmic society members. DESIGN Cross-sectional study (national survey). METHODS An electronic survey on ISBCS was sent as part of an annual survey on cataract practice patterns to members of the Dutch ophthalmic society. Questions regarding current ISBCS practice patterns, willingness to perform ISBCS routinely in future care, reasons for performing ISBCS and reasons for not performing ISBCS were included. Data were analysed using descriptive statistics. RESULTS In total, 237/520 survey recipients (45.6%) responded to the overall survey. Data on the ISBCS questions was available from 227 respondents. Sixty-two ophthalmologists (27.3%) currently performed ISBCS, predominantly in low patient-volumes (90.3% in one to five patients per month). However, 108/227 ophthalmologists (47.6%) considered performing ISBCS routinely in future practice. Procedures for which ISBCS was mainly considered included age-related cataract surgery using topical and general anaesthesia. Availability of separate products and instruments for both eyes and patient advantages were considered of high importance when performing ISBCS. Main reasons for not performing ISBCS included the risk of endophthalmitis and potential medico-legal aspects. CONCLUSIONS Although ISBCS is currently no routine procedure in the Netherlands, it is considered by almost 50% of surgeons. In order to improve implementation on a national level, potential barriers identified in this survey (fear of bilateral endophthalmitis, potential medico-legal issues, a lack of availability of separate products for both eyes) should be addressed.
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Malwankar J, Son HS, Chang DF, Dun C, Woreta F, Prescott C, Makary M, Srikumaran D. Trends, Factors, and Outcomes Associated with Immediate Sequential Bilateral Cataract Surgery (ISBCS) Among Medicare Beneficiaries. Ophthalmology 2021; 129:478-487. [PMID: 34971649 DOI: 10.1016/j.ophtha.2021.12.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/14/2021] [Accepted: 12/22/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To report the incidence of immediate (ISBCS) and delayed sequential bilateral cataract surgery (DSBCS) and identify factors associated with undergoing ISBCS. DESIGN Retrospective cohort study. SUBJECTS Medicare beneficiaries aged ≥65 who underwent ISBCS and DSBCS from 2011 to 2019. METHODS Population-based analysis of the 100% Medicare fee-for-service carrier claims data. Logistic regression models were performed to evaluate factors associated with ISBCS. MAIN OUTCOME MEASURES 1) Incidence of ISBCS and DSBCS, 2) demographic, ocular and medical characteristics associated with receipt of ISBCS, and 3) rates of endophthalmitis and cystoid macular edema (CME) after ISBCS or DSBCS. RESULTS A total of 4,014 (0.2%) ISBCS and 1,944,979 (99.8%) DSBCS patients were identified. Black (OR:2.31, 95%CI: 2.06-2.59), Asian (OR:1.82, 95%CI: 1.51-2.12), or Native American (OR:2.42, 95%CI: 1.81-3.23) patients were more likely to receive ISBCS compared to White patients. Patients residing in rural areas had higher likelihood of ISBCS (OR:1.26, 95%CI: 1.17-1.35) compared to metropolitan areas. Patients operated at a hospital compared to ambulatory setting (OR:2.71, 95%CI: 2.53-2.89) were more likely to receive ISBCS. Patients with bilateral complex vs. non-complex cataract (OR:3.23, 95%CI: 2.95-3.53) were more likely to receive ISBCS. Patients with a Charlson comorbidity index (CCI) of 1-2 (OR:1.45, 95%CI: 1.29-1.62), 3-4 (OR:1.70, 95%CI: 1.47-1.97), 5-6 (OR:1.97, 95%CI: 1.62-2.39), and CCI≥7 (OR:1.97, 95%CI: 1.55-2.50) were all more likely to receive ISBCS compared to those with CCI=0. In contrast, patients with glaucoma (OR:0.82, 95%CI: 0.76-0.89), macular degeneration (OR:0.75, 95%CI: 0.68-0.82), and macular hole/epiretinal membrane (OR:0.55, 95%CI: 0.48-0.65) were less likely to undergo ISBCS compared to those without. Cumulatively, there was no significant difference in endophthalmitis rate within 42 days between ISBCS (1.74 per 1,000 ISBCS) and DSBCS (1.01 per 1,000 DSBCS; p=0.15). Similarly, there was no significant cumulative difference between ISBCS (1.79 per 100 ISBCS) and DSBCS (1.96 per 100 DSBCS) CME rates (p=0.48). CONCLUSION Overall utilization of ISBCS among Medicare beneficiaries remains low over the past decade, though rates of endophthalmitis and CME were comparable to DSBCS. Race, geography, systemic and ocular comorbidities were associated with receiving ISBCS. ISBCS represents a potential opportunity to improve access to cataract surgery.
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Affiliation(s)
- Jui Malwankar
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Hyeck-Soo Son
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Chen Dun
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Fasika Woreta
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christina Prescott
- Department of Ophthalmology, New York University Langone Health, New York, NY
| | - Martin Makary
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Divya Srikumaran
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD.
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14
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Assi L, Chamseddine F, Ibrahim P, Sabbagh H, Rosman L, Congdon N, Evans J, Ramke J, Kuper H, Burton MJ, Ehrlich JR, Swenor BK. A Global Assessment of Eye Health and Quality of Life: A Systematic Review of Systematic Reviews. JAMA Ophthalmol 2021; 139:526-541. [PMID: 33576772 PMCID: PMC7881366 DOI: 10.1001/jamaophthalmol.2021.0146] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Question What is the association between vision impairment, eye diseases, or ophthalmic interventions and quality of life? Findings In this cross-sectional study, vision impairment and eye diseases were associated with lower quality of life. More than half of the ophthalmic interventions included had a positive association with quality of life. Meaning The associations of quality of life with vision impairment and the improvements in quality of life with ophthalmic interventions support efforts to improve access to ophthalmic treatments globally to reach the millions of people affected by eye disease each year. Importance More than 1 billion people worldwide have vision impairment or blindness from potentially preventable or correctable causes. Quality of life, an important measure of physical, emotional, and social well-being, appears to be negatively associated with vision impairment, and increasingly, ophthalmic interventions are being assessed for their association with quality of life. Objective To examine the association between vision impairment or eye disease and quality of life, and the outcome of ophthalmic interventions on quality of life globally and across the life span, through an umbrella review or systematic review of systematic reviews. Evidence Review The electronic databases MEDLINE, Ovid, Embase, Cochrane Database of Systematic Reviews, Proquest Dissertations, and Theses Global were searched from inception through June 29, 2020, using a comprehensive search strategy. Systematic reviews addressing vision impairment, eye disease, or ophthalmic interventions and quantitatively or qualitatively assessing health-related, vision-related, or disease-specific quality of life were included. Article screening, quality appraisal, and data extraction were performed by 4 reviewers working independently and in duplicate. The Joanna Briggs Institute critical appraisal and data extraction forms for umbrella reviews were used. Findings Nine systematic reviews evaluated the association between quality of life and vision impairment, age-related macular degeneration, glaucoma, diabetic retinopathy, or mendelian eye conditions (including retinitis pigmentosa). Of these, 5 were reviews of quantitative observational studies, 3 were reviews of qualitative studies, and 1 was a review of qualitative and quantitative studies. All found an association between vision impairment and lower quality of life. Sixty systematic reviews addressed at least 1 ophthalmic intervention in association with quality of life. Overall, 33 unique interventions were investigated, of which 25 were found to improve quality of life compared with baseline measurements or a group receiving no intervention. These interventions included timely cataract surgery, anti–vascular endothelial growth factor therapy for age-related macular degeneration, and macular edema. Conclusions and Relevance There is a consistent association between vision impairment, eye diseases, and reduced quality of life. These findings support pursuing ophthalmic interventions, such as timely cataract surgery and anti–vascular endothelial growth factor therapy, for common retinal diseases, where indicated, to improve quality of life for millions of people globally each year.
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Affiliation(s)
- Lama Assi
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Fatimah Chamseddine
- Clinical Research Institute, American University of Beirut Faculty of Medicine, Beirut, Lebanon
| | - Perla Ibrahim
- Department of Ophthalmology, American University of Beirut Faculty of Medicine, Beirut, Lebanon
| | - Hadi Sabbagh
- Department of Ophthalmology, American University of Beirut Faculty of Medicine, Beirut, Lebanon
| | - Lori Rosman
- Welch Medical Library, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nathan Congdon
- Centre for Public Health, Queen's University Belfast School of Medicine Dentistry and Biomedical Sciences, Belfast, United Kingdom.,Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jennifer Evans
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.,School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.,Moorfields Eye Hospital, London, United Kingdom
| | - Joshua R Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Bonnielin K Swenor
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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15
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Recurring themes during cataract assessment and surgery. Eye (Lond) 2021; 35:2482-2498. [PMID: 33927353 DOI: 10.1038/s41433-021-01548-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [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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16
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Go JA, Gupta A, Khandelwal SS. Five Pearls for Long Eyes. Ophthalmology 2021. [DOI: 10.17925/opht.2021.15.1.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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17
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Singh G, Grzybowski A. Evolution of and developments in simultaneous bilateral cataract surgery. Update 2020. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1554. [PMID: 33313299 PMCID: PMC7729368 DOI: 10.21037/atm-20-3490] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/10/2020] [Indexed: 12/31/2022]
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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18
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Quinn M, Gray D, Bardan AS, Zarei-Ghanavati M, Sparrow J, Liu C. A stakeholder meeting exploring the ethical perspectives of immediately sequential bilateral cataract surgery. JOURNAL OF MEDICAL ETHICS 2020; 47:medethics-2020-106412. [PMID: 32958695 PMCID: PMC8639900 DOI: 10.1136/medethics-2020-106412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/22/2020] [Accepted: 07/28/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE The purported benefits and risks of immediately sequential bilateral cataract surgery (ISBCS) have been well described, yet the procedure remains controversial among UK ophthalmologists. As many of the controversies of ISBCS are underpinned by ethical dilemmas, the aim of this work was to explore the ethical perspectives of ISBCS from a variety of stakeholder viewpoints. METHOD A semi-structured independent stakeholder meeting was convened at the Royal College of Ophthalmologists London headquarters in June 2018. In total, 29 stakeholders attended the meeting. The professional characteristics of stakeholders included but were not limited to: ophthalmologists (9), patients (5), religious leaders (4), ethicists (2), lawyers (2) and commissioners (1). Thematic qualitative analysis using methodology proposed by Braun and Clarke was conducted on the resultant transcript of the discussion. RESULTS Themes identified include: (1) beneficence and non-maleficence (patient benefits, patient risks, the uncertainties of risk, patient interpretation of the risk-benefit analysis); (2) autonomy (informed consent, the barriers to communication); (3) distributive justice (the allocation of resources: the individual vs the collective). CONCLUSION This analysis provides a reference point for the ethical factors surrounding ISBCS. The stakeholders concluded that this approach was an ethical undertaking provided patient autonomy was appropriately attained. This requires a patient's interpretation of the risk-benefit balance, which must include an understanding of the low but unquantifiable risk of severe complications. A surgeon must aim to minimise risks through the adaption of accepted surgical protocols and by performing appropriate patient selection. Currently, cost savings to healthcare that may occur following the implementation of ISBCS should be considered a secondary benefit of the protocol.
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Affiliation(s)
- Matthew Quinn
- Royal United Hospital Bath NHS Trust, Bath and North East Somerset, Bath, UK
| | - Daniel Gray
- School of Social Sciences, Cardiff University, Cardiff, UK
| | - Ahmed Shalaby Bardan
- Sussex Eye Hospital, Brighton and Sussex University Hospitals NHS Trust, Brighton, East Sussex, UK
| | - Mehran Zarei-Ghanavati
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, The Islamic Republic of Iran
| | - John Sparrow
- Bristol Eye Hospital, University Hospitals Bristol NHS Trust, Bristol, Somerset, UK
| | - Christopher Liu
- Sussex Eye Hospital, Brighton and Sussex University Hospitals NHS Trust, Brighton, East Sussex, UK
- Brighton and Sussex Medical School, Brighton, United Kingdom
- Tongdean Eye Clinic, Hove, United Kingdom
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19
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Spekreijse LS, Simons RWP, Winkens B, van den Biggelaar FJHM, Dirksen CD, Nuijts RMMA. Cost-effectiveness of immediate versus delayed sequential bilateral cataract surgery in the Netherlands (the BICAT-NL study): study design of a prospective multicenter randomised controlled trial. BMC Ophthalmol 2020; 20:257. [PMID: 32600295 PMCID: PMC7323372 DOI: 10.1186/s12886-020-01521-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/17/2020] [Indexed: 12/04/2022] Open
Abstract
Background Cataract surgery is one of the most frequently performed types of surgery. 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 as recommended in national guidelines, 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, in order to test the hypothesis that ISBCS is non-inferior to DSBCS in terms of effectiveness and superior to ISBCS in terms of cost-effectiveness. Methods/design Multicenter non-inferiority randomised controlled clinical trial. Patients (18 years or older) with bilateral cataract and an indication for bilateral cataract surgery with an expected uncomplicated intraoperative and postoperative course are included in the study. Patients are randomly assigned to either ISBCS or DSBCS. The primary endpoint is the proportion of patients with a refractive outcome in the second eye within 1.0 dioptre from the target refraction, at 4 weeks after surgery. Secondary outcomes include corrected and uncorrected distance visual acuity, complications, patient reported outcomes (PROMs), cost-effectiveness, and budget impact. Follow-up visits are planned at 1 week after first-eye surgery and 4 weeks after second-eye surgery. At 3 months after first-eye surgery, the occurrence of complications is checked and patients fill in a final questionnaire. Discussion This study protocol describes the design of a multicenter non-inferiority randomised controlled trial. Current studies on ISBCS often lack information on safety regarding refractive outcomes. In addition, there is a lack of well-designed cost-effectiveness studies using established methods. The BICAT-NL study will provide more insight in refractive and cost-effectiveness outcomes for ISBCS compared to DSBCS. Trial registration This study was prospectively registered at Clinicaltrials.gov on January 17th 2018. (Identifier: NCT03400124.
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Affiliation(s)
- L S Spekreijse
- Maastricht University Medical Center+, University Eye Clinic Maastricht, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands. .,School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.
| | - R W P Simons
- Maastricht University Medical Center+, University Eye Clinic Maastricht, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
| | - B Winkens
- Department of Methodology and Statistics, Faculty of Health, Medicine and Life Sciences (FHML), Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - F J H M van den Biggelaar
- Maastricht University Medical Center+, University Eye Clinic Maastricht, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
| | - C D Dirksen
- Department of Clinical Epidemiology and Medical Technology Assessment, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - R M M A Nuijts
- Maastricht University Medical Center+, University Eye Clinic Maastricht, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands.,Department of Ophthalmology, Zuyderland Medical Center, Heerlen, the Netherlands
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20
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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] [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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21
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Pros and Cons of Bilateral Immediately Sequential Cataract Surgery. CURRENT OPHTHALMOLOGY REPORTS 2020. [DOI: 10.1007/s40135-020-00237-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
PURPOSE OF REVIEW Routine prophylaxis for adverse events following cataract surgery is evolving. Prior reliance on topical eyedrop instillation by patients is giving way to surgeon directed injections at the time of cataract surgery. The benefit of this new approach is assured delivery of drugs in standardized doses which should optimize the healing process and reduce the incidence of untoward events with higher confidence. RECENT FINDINGS Adoption rates of intracameral antibiotic injection amongst European and American cataract surgeons is increasing. Techniques to inject periocular corticosteroid for routine inflammation prophylaxis are also in development. In combination with intraoperative pharmacologic dilation, a drop-free modality can be achieved. SUMMARY Intraoperative injections offer the patient and surgeon assured drug delivery and hold promise to avoid the pitfalls of patient adherence, incorrect topical instillation, and topical drop-associated corneal issues.
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Affiliation(s)
- Neal H Shorstein
- Departments of Ophthalmology and Quality, Shorstein - Kaiser Permanente, Oakland, California; Department of Ophthalmology, Myers - Northwestern University, Chicago, IL
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23
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Roberts TV, Li S. Management of bilateral cataracts when general anaesthesia is required: same-day or different-day surgery? Clin Exp Ophthalmol 2019; 45:767-769. [PMID: 29148261 DOI: 10.1111/ceo.13069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Timothy V Roberts
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Ophthalmology, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Vision Eye Institute, Sydney, New South Wales, Australia
| | - Shawn Li
- Department of Anaesthesia, Royal North Shore Hospital, Sydney, New South Wales, Australia
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Buchan JC, Amoaku W, Barnes B, Cassels-Brown A, Chang BY, Harcourt J, Shickle D, Spencer AF, Vernon SA, MacEwen C. Response to: 'Comment on: 'How to defuse a demographic time bomb: the way forward?'. Eye (Lond) 2018; 32:1154-1155. [DOI: 10.1038/s41433-017-0013-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 12/14/2017] [Indexed: 11/09/2022] Open
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Learning From the Past and Looking Toward the Future in Cataract Surgery: How to Evaluate Innovations and Incorporate Into Clinical Practice. Int Ophthalmol Clin 2017; 57:11-19. [PMID: 28885243 DOI: 10.1097/iio.0000000000000186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Herrinton LJ, Liu L, Alexeeff S, Carolan J, Shorstein NH. Immediate Sequential vs. Delayed Sequential Bilateral Cataract Surgery: Retrospective Comparison of Postoperative Visual Outcomes. Ophthalmology 2017; 124:1126-1135. [PMID: 28438415 PMCID: PMC5531866 DOI: 10.1016/j.ophtha.2017.03.034] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 03/10/2017] [Accepted: 03/14/2017] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We conducted a retrospective comparative-effectiveness study of best-corrected visual acuity (BCVA) and refractive error (RE) after immediate sequential (ISBCS) and delayed sequential (DSBCS) bilateral cataract surgery. We tested 2 hypotheses: (1) among DSBCS patients, second-eye outcomes were no different than first-eye outcomes; (2) averaged between each patient's 2 eyes, outcomes did not differ between ISBCS and DSBCS patients. DESIGN Retrospective comparative-effectiveness study. PARTICIPANTS Kaiser Permanente Northern California members who underwent noncomplex bilateral cataract surgery from January 1, 2013, through June 30, 2015. METHODS We performed an intention-to-treat analysis comparing ISBCS to DSBCS using conditional logistic regression analysis, accounting for surgeon and patient-level factors. MAIN OUTCOME MEASURES BCVA, RE. RESULTS The analysis of visual outcomes included both eyes of 13 711 DSBCS and 3561 ISBCS patients. Because of the large sample size, some statistical differences lacked clinical significance. Ocular comorbidities were slightly more prevalent in DSBCS patients. Postoperative BCVA was 20/20 or better in 48% of DSBCS first eyes, 49% of DSBCS second eyes, 53% of ISBCS right eyes, and 51% of ISBCS left eyes. The within-person difference in postoperative BCVA averaged zero (0.00) between the first and second DSBCS eyes, and between the ISBCS right and left eyes. After adjustment, average postoperative BCVA was better in ISBCS patients, although the difference was not statistically significant (compared with 20/20 or better: odds ratio for worse than 20/20 was 0.91, 95% confidence interval 0.83-1.01). Emmetropia (spherical equivalent -0.5 to 0 diopter) was achieved in 61% of first DSBCS eyes, 61% of second DSBCS eyes, 63% of ISBCS right eyes, and 63% of ISBCS left eyes. After adjustment, average postoperative RE was no different in ISBCS compared with DSBCS patients (compared with emmetropia: odds ratio for ametropia was 1.02, confidence interval 0.92-1.12). We confirmed 1 case of postoperative endophthalmitis in 10 494 ISBCS eyes (1.0 per 10 000 eyes) and 2 cases in 38 736 DSBCS eyes (0.5 per 10 000 eyes) (P = 0.6), and no patient had bilateral endophthalmitis. CONCLUSIONS Compared with DSBCS, we found no evidence that ISBCS was associated with worse postoperative BCVA or RE, or with an increased complication risk.
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Affiliation(s)
- Lisa J Herrinton
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Liyan Liu
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Stacey Alexeeff
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - James Carolan
- Department of Ophthalmology, Kaiser Permanente San Rafael, San Rafael, California
| | - Neal H Shorstein
- Departments of Ophthalmology and Quality, Kaiser Permanente, Walnut Creek, California.
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Kessel L, Erngaard D, Flesner P, Andresen J, Hjortdal J. Do evidence-based guidelines change clinical practice patterns? Acta Ophthalmol 2017; 95:337-343. [PMID: 27966271 DOI: 10.1111/aos.13314] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 09/30/2016] [Indexed: 12/24/2022]
Abstract
In 2013, the Danish Health and Medicines Authorities published a National Clinical Guideline on the treatment of age-related cataracts. The guideline provided evidence-based recommendations on the indication for cataract surgery, cataract surgery in patients with age-related macular degeneration, on the use of toric intraocular lenses (IOLs) to correct preoperative corneal astigmatism, the use of intracameral and topical antibiotics to prevent endophthalmitis, choice of anti-inflammatory medication to control postoperative inflammation and prevent cystoid macular oedema, the use of immediate sequential bilateral cataract surgery and on the postoperative check-up of patients. A questionnaire was sent to all members of the Danish Ophthalmological Society before and after publication of the guideline. The responses showed that the guideline had changed practice patterns so that surgeons were more likely to prescribe non-steroidal anti-inflammatory eye drops and to not prescribe topical antibiotic eye drops after the guideline was published. Other parameters, most notably the use of toric IOLs and use of postoperative examinations were more guided by reimbursement standards than by evidence-based medicine. Thus, evidence-based guidelines do change practice patterns unless they are counteracted by the reimbursement system.
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Affiliation(s)
- Line Kessel
- Department of Ophthalmology; Centre of Head and Orthopedics; Rigshospitalet-Glostrup; Glostrup Denmark
- Institute of Clinical Medicine; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | - Ditte Erngaard
- Department of Ophthalmology; Zealand University Hospital; Naestved Denmark
| | | | | | - Jesper Hjortdal
- Department of Ophthalmology; Aarhus University Hospital NBG; Aarhus Denmark
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Pros and cons of immediately sequential bilateral cataract surgery (ISBCS). Saudi J Ophthalmol 2016; 30:244-249. [PMID: 28003784 PMCID: PMC5161806 DOI: 10.1016/j.sjopt.2016.09.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [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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