Abstract:
Introduction: Cataract is one of the leading causes of blindness, most often affecting
both eyes in elderly patients. The level of modern surgery allows for complete
binocular rehabilitation of a patient with bilateral cataracts, but it requires
determining a safe and comfortable interval between the surgeries on the two eyes:
simultaneously, in a short time, or over a month or more.
Immediate Sequential Bilateral Cataract Surgery (ISBCS) involves performing
cataract surgery on both eyes during the same surgical session. This method offers
the advantage of faster visual rehabilitation since both eyes recover simultaneously.
However, it carries a slightly higher risk of bilateral complications, although strict
aseptic techniques significantly mitigate this risk.
Delayed Sequential Bilateral Cataract Surgery (DSBCS) involves performing cataract
surgery on one eye, followed by the second eye after a delay, usually ranging from
a few weeks to a few months. This approach allows surgeons to assess the outcome
of the first surgery before proceeding with the second, reducing the risk of bilateral
complications. While safer, this method requires two surgical sessions and longer
total recovery time.
Aim of the Study: To highlight the benefits of ISBCS and outline the essential steps
required to achieve optimal outcomes.
Materials and Methods: The bibliographic sources from the PubMed and Google
Scholar databases were reviewed using the keywords: ISBCS, DSBCS, bilateral
cataract extraction surgery, sequential bilateral cataract surgery, simultaneous
bilateral cataract surgery, same day cataract surgery, and approximately 60 articles
were selected. The final bibliography contains 21 relevant sources that were
considered representative.
Results: The potential benefits of ISBCS include quicker visual recovery without the
visual imbalance that can occur between surgeries on the first and second eyes. It
also eliminates the need for additional day-care admissions, reduces reliance on
home care, and decreases the number of hospital visits.
The ISBCS also helps avoid significant issues that can arise after unilateral surgery,
such as anisometropia and neuroadaptation problems. Clinics with extensive
experience in performing simultaneous binocular surgeries report that minor errors
are rare and, when they do occur, they are almost always symmetrical and do not
lead to problems like anisometropia.
Another significant benefit of ISBCS is its economic advantage: it results in reduced
hospital expenses and more efficient use of operating room time. Additionally,
patients experience financial benefits through a quicker return to work and fewer
hospital visits. Conclusion: Advancements in surgical techniques, equipment, and modern
medications have made ophthalmic surgeries quicker, with fewer complications and
shorter hospital stays. These improvements have encouraged the adoption of ISBCS
for appropriate cases. With proper patient selection and strict protocol adherence,
ISBCS carries minimal risk of binocular blindness. Success, however, depends on an
experienced surgeon. As a result, the operational risk of ISBCS is equal to or even
lower than that of DSBCS.
