Immediately Sequential Bilateral Cataract Surgery for the Treatment of Bilateral Cataracts: A Review of Safety and Guidelines

Key Message

One systematic review with meta-analysis, three primary non-randomized studies, and one evidence-based guideline regarding the safety or use of immediately sequential bilateral cataract surgery (ISBCS) for the treatment of bilateral cataracts were included in this report. The identified literature revealed varied, but largely neutral, conclusions regarding the safety of ISBCS for the treatment of bilateral cataracts. Specifically, the systematic review with meta-analysis suggested that there were no significant differences in postoperative quality of life scores including Visual Function 7- and 14-item questionnaire, EuroQOL Five Dimensions questionnaire, and Health Utility Index Mark 3 score between those who underwent ISBCS versus delayed sequential bilateral cataract surgery (DSBCS). However, patients who underwent ISBCS exhibited significantly greater improvements in postoperative Catquest scores compared to those who underwent DSBCS. Findings from a primary non-randomized study suggested that there were no significant differences in the rates of intraoperative complications including posterior capsular rupture and vitrectomy, while another non-randomized study observed numerically similar rates of posterior capsular rupture after adjustments for case complexity between ISBCS and DSBCS patients. One primary non-randomized study detected no significant differences in rates of postoperative endophthalmitis between ISBCS and DSBCS patients. However, patients who underwent ISBCS exhibited significantly lower rates of macular edema compared to those who underwent DSBCS. Based on variable quality evidence, the NICE guideline recommends that patients need to be informed of the risks versus benefits of ISBCS (recommendation strength not assigned). In addition, ISBCS should be considered for patients with a low complication risk, or for those needing general anesthesia but anesthesia may increase their complication risk (evidence of benefit is less certain). Overall, the body of evidence used to inform this report was limited in quantity and was largely low to moderate in quality. Additionally, the high degree of heterogeneity of studies in the systematic review and lack of randomization in the primary clinical studies should be taken into consideration when interpreting these results. Finally, since the sample populations consisted of patients living in the US, United Kingdom, Spain, New Zealand, Australia, Japan, Finland, Sweden, or Switzerland, these findings may not be generalizable to the Canadian setting.