Surgeon makes case for same-day bilateral cataract surgery
ROME — The benefits of same-day bilateral cataract surgery are significant, and the time has come to switch to this approach, according to one presenter at OSN Italy.
“I have been doing SDBCS for 10 years in my clinic, and I found that this approach is highly appreciated by my patients and my staff,” Rolando Toyos, MD, said.
Benefits include a more rapid visual recovery, fewer postop visits, less time away from work, less burden on the support network of family and friends, as well as a reduced risk for accidents due to poor vision, he told the audience.
“Savings for the health care system can be huge, close to $500 million per year. With the introduction of COVID-19 protocols, the advantages of operating bilaterally are even more significant because we save on COVID tests and reduce the number of hospital visits and related risks of infection,” he said.
The theoretically higher risks for endophthalmitis and wrong IOL power, and consequent medicolegal issues, are still holding back the transition to same-day bilateral cataract surgery (SDBCS).
“I don’t think every surgeon should be doing it. Review your results with delayed sequential surgery, and see what your complication rates are. If your rate is lower than the national average, you can actually switch to the same-day procedure,” Toyos said.
Several studies confirmed the safety of SDBCS. Among them, a retrospective review by Herrinton and colleagues of 21,501 eyes of 13,507 patients who underwent SDBCS at Kaiser Permanente Northern California showed no cases of bilateral endophthalmitis. The overall safety profile was comparable to delayed sequential cataract surgery, as were best corrected visual acuity outcomes.
“In our own study of 560 eyes of 280 patients, we found no cases of endophthalmitis, no intraoperative complications and less than a 1% rate of treatable CME. Patients were between 18 and 86 years of age, and we used successfully all kinds of lenses, 50% of which were multifocal,” Toyos said.
Noticeably, the study population included patients with ocular comorbidities such as age-related macular degeneration, glaucoma, diabetic retinopathy, pathologic myopia, Fuchs’ dystrophy, keratoconus, herpes zoster keratitis as well as prior laser refractive surgery.
“Further advice to new SDBCS adopters is to invest on advanced technology. We acquired the Zeiss Callisto system with integrated IOLMaster 700 Opmi Lumera. Finally, videotape your surgery, but also videotape your staff to see if they are making any errors that might be a risk for complications. And do not launch into doing 10 cases — start with one bilateral case, see how it goes and build up gradually,” Toyos said.