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.