Comparative study of the clinical outcomes of immediate sequential bilateral cataract surgery and delayed sequential bilateral cataract surgery

BACKGROUND: In the last decade, the number of randomized controlled trials indicating the safety and efficacy of immediate sequential bilateral cataract surgery (ISBCS) comparable to the results of delayed sequential bilateral cataract surgery (DSBCS) has been increasing. However, these studies are practically absent in the practice of domestic ophthalmology.

AIM: To comparatively assess the clinical results of ISBCS and DSBCS.

METHODS: Our observation revealed that 1000 patients (2000 eyes) with binocular cataracts aged 37–68 years (mean age: 56.9±1.3 years), including 82% of males and 18% of females. Patients were divided into two groups: the main group (500 patients, 1000 eyes), who underwent ISBCS according to the developed modified algorithm (ma ISBCS), and the control group (500 patients, 1000 eyes), who underwent DSBCS technology with a break after the first surgical intervention 7–10 days. The study was conducted from January 2017 to September 2021. All patients were operated on by one surgeon. The following monofocal intraocular lenses (IOLs) were implanted to correct aphakia: Acrysof Natural IQ (Alcon, USA), Akreos AO (Bausch & Lomb, USA), and Biflex (Medicontur, Hungary). Biometrics and IOL calculation were performed using an optical biometer IOL Master (Zeiss, Germany). The following clinical efficacy criteria were assessed (before and 3 months postoperatively): the presence of intra- and postoperative complications, measurement of the maximum correctable distance visual acuity (BCVA), and deviation from the target (±0.5 D) refraction.

RESULTS: maISBCS provides almost identical (with DSBCS) clinical results of surgical intervention, which is confirmed by the minimum (0.1%–0.6%, n=1000) level of postoperative complications (in the absence of endophthalmitis), the average values of BCVA (0.94±0.02; 0.95±0.02, p=0.724) and «target» refraction (0.30±0.05; 0.28±0.04, p=0.723), achieving BCVA of 1.0 rel unit (87%–88% of cases), and emmetropic refraction (28%–29% of cases).

CONCLUSION: maISBCS is a promising direction in cataract surgery, especially considering the established (compared to DSBCS) advantages associated with higher efficiency in terms of anisometropia development and the priority of performing in a difficult epidemiological environment, as well as a significant reduction in the financial costs of surgery.