Simultaneous Bilateral Cataract Surgery

SUMMARY

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.