Should we do bilateral same-day cataract surgery?

On rare occasions, I will do immediate, bilateral sequential cataract surgery so that a patient can have both right eye and left eye cataract surgeries done in a single visit to our ophthalmic surgery center. These patients have done well and this is a viable option given the appropriate patient and circumstances.

There are many proponents of bilateral sequential cataract surgery and there is even the International Society of Bilateral Cataract Surgeons.

The potential advantages of immediate bilateral sequential cataract surgery are:

  • one trip to the surgery center (patient convenience)
  • less anesthesia exposure
  • less time with issues of anisometropia
  • cost savings to the health plan or payor

The potential disadvantages of immediate bilateral sequential cataract surgery are:

  • inability to use the results of the first eye to help hone the IOL calcs of the second eye
  • very rare, but possible risk of bilateral endophthalmitis or bilateral contamination
  • bilateral complications which delay recovery such as cystoid macular edema

It should be noted that the key word in the description is “sequential.” Each eye is treated like a separate patient, so that new drapes, gowns, gloves, and supplies are used for each eye. In the case shown here, the left eye surgery is completed, then the drapes are removed, the left eye medicated and shielded. Then the right eye is prepped for surgery, appropriated cleaned and draped, a new phaco pack and tubing and new instruments and supplies are used for the right eye. And the surgeon re-scrubs and puts on a new gown and gloves. Even the viscoelastics, IOLs, medications, and all other supplies are coming from different manufacturer lot numbers to further reduce the risk of contamination, endophthalmitis, or TASS (toxic anterior segment syndrome).

The video below was originally about 18 minutes: 6 minutes for the left eye cataract surgery, then 6 minutes for the turn-over, and then another 6 minutes for the right eye cataract surgery. We have sped up the video to play at 3x speed in order to show you the bilateral sequential cataract surgeries uninterrupted.

click below to see this bilateral sequential cataract surgery:

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