The Royal College of Ophthalmologists’ National Ophthalmology Database study of cataract surgery: Report 7, Immediate Sequential Bilateral Cataract Surgery in the UK: Current practice and patient selection

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Problem

Cataract extraction is the most frequently performed surgical intervention in the world and demand is increasing due to an ageing demography. One option to address this challenge in the UK is to offer selected patients immediate sequential bilateral cataract surgery (ISBCS) instead of conventional delayed bilateral cataract surgery (DSCS).

Purpose

To investigate potential differences in clinical factors between ISBCS and DSCS using data submitted to the Royal College of Ophthalmologists’ National Ophthalmology Database Audit.

Methods

Eligible patients were those undergoing ISBCS or DSCS from centres with a record of at least one ISBCS operation between 01/04/2010 and 31/08/2018.

Results

During the study period, 1,073 patients had ISBCS and 248,341 DSCS from 73 centres. A higher proportion of ISBCS patients were unable to lie flat (11.3% vs. 1.8%; p <0.001), unable to cooperate (9.7% vs. 2.7%; p <0.001); underwent general anaesthesia (58.7% vs. 6.6% (p < 0.001)); had brunescent/white/mature cataracts (odds ratio (OR) 5.118); no fundal view / vitreous opacities (OR 8.381); had worse pre-operative acuity 0.60 LogMAR ISBCS vs. 0.50 (first) and 0.40 (second eye) DSCS and were younger (mean ages, 71.5 vs. 75.6 years; p < 0.001). Case complexity adjusted posterior capsular rupture (PCR) rates were comparable (0.98% ISBCS and 0.78% DSCS).

Conclusions

ISBCS was performed on younger patients, with difficulty cooperating and lying flat, worse pre-operative vision, higher rates of known PCR risk factors and more frequent use of general anaesthesia than DSCS.