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Immediate sequential slightly better than delayed sequential bilateral cataract surgery

08 Aug 2017

Immediate sequential (ISBCS) compared with delayed sequential (DSBCS) bilateral cataract surgery does not appear to result in worse postoperative best-corrected visual acuity (BCVA) or refractive error, or with an elevated complication risk, suggests a recent study.

In this retrospective comparative-effectiveness study involving patients who underwent noncomplex bilateral cataract surgery from 1 January 2013 to 30 June 2015, researchers performed an intention-to-treat analysis comparing ISBCS to DSBCS using conditional logistic regression analysis, accounting for surgeon and patient-level factors.

Visual outcomes were analysed in both eyes of 13,711 DSBCS and 3,561 ISBCS patients. The large sample size contributed to some statistical differences lacking clinical significance.

DSBCS patients had slightly more ocular comorbidities compared with ISBCS patients. Postoperative BCVA was 20/20 or better in 53 and 51 percent of ISBCS right and left eyes as well as in 48 and 49 percent of DSBCS first and second eyes, respectively.

“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,” researchers said.

ISBCS patients had better average postoperative BCVA after adjustment, but the difference was not statistically significant (compared with 20/20 or better: odds ratio [OR] for worse than 20/20, 0.91; 95 percent CI, 0.83 to 1.01).

Sixty-one percent of DSBCS eyes (both first and second eyes) and 63 percent of ISBCS eyes (both right and left eyes) achieved emmetropia (spherical equivalent ‒0.5 to 0 dioptre). There was no between-group difference in average postoperative refractive error after adjustment (compared with emmetropia: OR for ametropia, 1.02; 0.92 to 1.12).

There were two cases of postoperative endophthalmitis in 38,736 DSBCS eyes (0.5 per 10,000 eyes) and one case in 10,494 ISBCS eyes (1.0 per 10,000 eyes; p=0.6). Bilateral endophthalmitis did not occur in any patient.

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