Immediate Sequential Bilateral Cataract Surgery (ISBCS) means that you are doing cataract surgery for both eyes of your patient on the same day. Each eye is treated as a separate “patient” and different instruments, scrubbing, gloves/gown, and draping will be done for each eye. This is to minimize the risk of cross contamination. In our center, we even go so far as to use different lot numbers of the supplies for each eye just in case the manufacturer has an issue with a particular lot. This video is inspired from the 2024 AECOS Europe meeting in Prague, Czech Republic where I was able to present a pro vs con debate with Omid Kermani MD from Germany. Please watch the video and then vote / comment below and let me know if you are for or against ISBCS.
Definitely for it!
Against ISBCS
Totally against it. I would even dare to say that this procedure represents borderline unethical medical practice
I am for them with veteran experienced surgeons with proper OR regulations and trained staff. Can you post (or did I miss?) the Gary Wortzz Omega Ophthalmics cataractcosch.com presentation of an insertion of the device? I saw his interview but would like to see his device in the bag.
I know that the chance of getting endophthalmitis is very low 0.02(1 in 17.000), but for the patient that gets it, the % is 100%. It is not worth the risk
Increases risk
Financially down in reimbursement
Plus I learn a lot how the eye optically reacts to my goals
Have practiced for about 30 years, and technology has made striking increases in overall safety. Think this is a decision for surgeon and patient to make together but it is difficult for patients to understand risks apart from theoretical “it wont happen to me” so some medicolegal risk present. Lest we forget that cataract surgery is a real surgery and in most cases elective- Unexpected things happen with perfect surgery. I had a patient drive herself 2 days on the road into town from Florida having had uncomplicated sequential (not same day) cataract surgery and now could not see out of either eye. Diabetic- new bilateral DME, 20/80 acuity- stuck in town and wanted me to “fix” it right away. Hopefully we will have more data re: outcomes, but singular surgery small studies in literature also do support ability to use 1st eye data to adjust outcomes in second eye, especially in cases of prior refractive surgery despite using ORA and other intraoperative technology. We may eventually be required to do bilateral same day surgery by insurers to save costs so they don’t have to reimburse us for the additional second eye work/risk….patient expectations remain high, even with high end IOL and technologies—- would you do a bilateral same day IOL exchange in an unhappy patient? How about a bilateral tube shunt- they have low infections risks?