Performing Simultaneous Cataract Surgery

Age-related cataracts can affect both eyes, requiring the endogenic lens to be replaced with an artificial Intraocular Lens (IOL) surgically. Generally, there is a lapse in time between surgeries for each eye, but the surgery can be performed on both eyes on the same day.

A study by Cochrane suggests that there are unlikely to be any large, clinically significant differences between both approaches, though the overall quality was assessed as moderate to very low.

Several advantages to performing the surgery in both eyes simultaneously include fewer hospital visits, faster bilateral vision recovery, and lower procedure costs. 

Risks of simultaneously performing cataract surgery in both eyes consist of developing a postoperative complication in both eyes, and not being able to use the visual acuity from the first operation during the second procedure, since there would only be one. 

The Cochrane review authors noted that the complications generally occurred up to three months post-op, and there were little- to no differences noted between the two methods. Most of the study results were limited by an overall small number of endophthalmitis, postoperative complications, and a lack of specific data, among other variables. 

Thomas Kohnen, MD, PhD, chair of the German Commission for Refractive Surgery (KRC), set up by the German Society of Ophthalmology (DOG), and the Professional Association of German Ophthalmologists (BVA) at the University Clinic Frankfurt, said, “In Germany, there is only very little data on ISBCS because it is barely a topic here. "We have very good medical infrastructure with widespread and prompt ophthalmological care, such that even people living in the countryside do not have to travel great distances or experience long waiting times for a first or second cataract surgery, which is different from many places abroad. The procedure with bilateral operations on the same day is not recommended in the guidelines from our professional societies, [because] any complications that occur postoperatively could potentially entail lengthy legal liability procedures for the surgeons."

In Germany, sequential bilateral cataract surgery is typically performed with two outpatient operations spaced several days (or weeks) apart. Medical, social, or personal reasons can create exceptions to the rule, requiring both eyes to be operated on with a shorter amount of time between each procedure, under general anesthesia in one sitting, or with an overnight gap.

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