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Suzanne Albrecht of Blekinge Hospital, Karlskrona, Sweden presented a very interesting study of SBCS in Sweden, demonstrating improved patient outcomes, increased patient satisfaction, and reduced cost of immediately sequential surgery.

This article is a summary of current (January 2009) SBCS experience and practices.
curr-opin-ophth-2009-20-3-12-saa-s-odorcic-same-day-sequential-cataract-surgery

Purpose
Immediate sequential cataract surgery (ISCS) is still a controversial procedure. We compared the clinical and patient-reported outcomes of ISCS vs the usual delayed sequential cataract surgery (DSCS).

Methods
Selected patients with bilateral cataracts were assigned nonrandomly and according to their references to either ISCS in one session (intervention group) or DSCS over two sessions with a 2-month interval between sessions (control group). Binocular visual acuity, binocular contrast sensitivity, stereopsis, and self-reported visual function (VF-14) were measured preoperatively and postoperatively for up to 4 months after the second-eye surgery. Mann–Whitney U-test was used to compare quantitative variables, while the v2 and Fisher’s exact tests were used for qualitative variables.

Results
Of the 220 eligible patients, 74 (33.6%) chose ISCS, and 137 (62.3%) selected DSCS. The remaining patients (4.1%) were allocated randomly to either group. For 2 months, the outcome measures were significantly worse in the DSCS group than in the ISCS group. However, after 4 months (2 and 4 months after second-eye surgery in the DSCS and ISCS groups, respectively) the differences became insignificant except for VF-14 (Po0.05). The mean post-operative objective measures and their differences from baseline were not significantly different between the groups. Nevertheless, postoperatively, VF-14 improved more (Po0.05) and attained a higher value (Po0.05) in the ISCS group.

Conclusions
In experienced hands, with stringent patient selection criteria and with a strict aseptic protocol, ISCS can safely provide a more rapid rehabilitation of VF than DSCS.

Simultaneous bilateral cataract surgery, also referredto as immediately sequential cataract surgery, is controversial, but surgeons in developed countries are performing this procedure with increasing frequency.
Part of their motivation derives from the marked advances in microsurgical techniques over the past 2 decades that have relaxed patients’ attitudes about cataract surgery while also increasing their expectations of the procedure. It is no longer unusual for patients to request bilateral surgery in order to avoid the delayed recovery, intervening anisometropia, repeated visits, and prolonged follow-up that occur when each eye is treated individually. Nevertheless, many ophthalmologists remain reluctant to perform simultaneous bilateral cataract surgery, because they are concerned about possible bilateral, postoperative, sight-threatening, adverse events such as endophthalmitis and retinal detachment. I agree that these risks must be addressed and minimized before a surgeon considers performing the procedure. Some surgeons also claim that an unexpected refractive error might frequently occur in both eyes, whereas it could be avoided by reevaluating biometry after an unexpected result in the patient’s first eye. This concern may be less significant than the potential adverse events described earlier, and the problem never occurred in my series of 1,020 consecutive simultaneous bilateral cataract surgery patients, in
my subsequent hundreds of cases, or in other large, reported series.Moreover, the advent of the IOLMaster (Carl Zeiss Meditec Inc., Dublin, CA) and newer biometric equations such as the Haigis formula further reduce the likelihood of significant biometric errors.

During the past decade, advances in techniques and technology have led to major changes in cataract surgical practice patterns. The complete transition from large incision extracapsular cataract extraction (ECCE) to phacoemulsification was driven by the ability to accelerate the visual and physical rehabilitation of cataract patients. The subsequent innovations of foldable intraocular lenses (IOLs) and small, clear corneal incisions followed. As a result, previously unimaginable practices— topical anaesthesia, sutureless surgery, and the elimination of patching and physical restrictions—have now become commonplace. In this progression towards ever faster rehabilitation, simultaneous bilateral cataract surgery (SBCS) may be the next and ultimate step.

Almost every discussion on simultaneous bilateral cataract surgery (SBCS) for senescent cataracts begins with a comment on its controversial nature.1–3 The question is can the benefits of bilateral surgery justify the risk of simultaneous bilateral complications, in particular endophthalmitis? Operating on the second eye immediately after the first is an option that does have potential advantages. These can be separated into the clinical benefits to the patient and economic benefits to the patient, hospital, and society. It is the benefits and risks to the patient that are our primary duty as clinicians, and they will be the focus of this discussion. In this perspective we present an approach to “simultaneous” bilateral cataract extraction,
and examine the risk of unilateral or bilateral complications following cataract extraction in light of the perceived benefits as they apply at the beginning of the 21st century. The aim of the perspective is to remove the stigma from “simultaneous” bilateral cataract surgery, so that suitable patients may be offered this method of delivery of treatment.

Cataract extraction was performed on 734 patients. These were followed up postoperatively for up to 1 year. In 448 cases the extraction was performed in both eyes during 1 operating session (896 eyes) and in 1 eye in 286 cases, a total of 1182 cataract extractions. Preoperatively more than 75 % of the eyes in both groups had perception of light only. Postoperatively more than 85 % of eyes in both groups achieved a visual acuity of 6/30 or better. The postoperative visual performance of an eye was not influenced by the mode of operation, bilateral or unilateral. The overall incidence of complications among the 1182 operated eyes was: accidental extra-capsular cataract extraction 10-2%, vitreous loss 11.0%, hyphaema 1-4%, flat anterior chamber 09%, dehiscence of the wound 0-5%, uveitis 1-2%, endophthalmitis 0-3%, secondary glaucoma 09 %, severe bullous keratopathy 1 4 %, oedema of the macula 0 5 %, and retinal detachment 0-3 %. The complications in both groups of patients were comparable. Only in 1 case operated in both eyes vision was not restored following a bilateral endophthalmitis.