MAY 2013

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

Issue link: https://digital.eyeworld.org/i/129516

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28 EW CATARACT May 2013 Cataract editor's corner of the world The debate around immediate sequential bilateral cataract surgery by Ellen Stodola EyeWorld Staff Writer E fficiency is a sought after attribute in many aspects of ophthalmology. We strive to improve the wait times, turnover, and even the recovery period for the patient. However, sometimes being too efficient can have drawbacks. This may be the case for the new approach of immediate sequential bilateral cataract surgery (ISBCS). In this issue, Dr. Claoué describes the benefits of same day bilateral cataract surgery. While ISBCS is practiced in many countries, it is rare in the United States. We asked cataract surgeons in the U.S. and Canada their opinions about the advantages and disadvantages of ISBCS. Bonnie An Henderson, MD, cataract editor I mmediate sequential bilateral cataract surgery (ISBCS) has elicited debate over how the advantage of operating on both eyes at the same time weighs against possible concerns and complications. When considering the benefits of both immediate sequential bilateral cataract surgery and delayed sequential bilateral cataract surgery, there are a number of factors to be examined. While addressing both eyes at the same time may be beneficial, there are also concerns for refractive results, safety, and a risk of infection. In addition, operating on both eyes at the same time is not routine in many places, with lack of reimbursement on the second eye playing a role. is also his own personal preference to stick with delayed sequential bilateral cataract surgery because of the risk of a complication. He noted that there are some exceptions where it may be the best option to go with ISBCS. For example, for someone with mental deficiencies or with severe cataracts, it may be beneficial to do both eyes at the same time. However, he said if this is the case, the plan is well Thoughts on immediate sequential bilateral cataract surgery Brock Bakewell, MD, Fishkind, Bakewell and Maltzman Eye Care and Surgery Center, Tucson, Ariz., and clinical assistant professor of ophthalmology, University of Utah, said he is in favor of doing separate cataract surgery when both eyes are in need of the procedure. He thinks it best to separate the procedures by some period of time, although he recognizes that from a convenience standpoint, some patients might prefer to be more efficient and make only one trip to the OR. "I still don't think it's ideal from the standpoint of the refractive outcome," Dr. Bakewell said. He said doing separate procedures often helps to calm a patient's nerves for the second eye, and it would also give the patient a chance to see what happens with the first eye. Potential complications are a concern with immediate sequential bilateral cataract surgery, but Dr. Bakewell said to avoid some of these problems, he would use a completely different set of instruments on each eye. "We would just treat the second eye like it's a completely different patient." He said this approach makes infection less of a concern. Vance Thompson, MD, director of refractive surgery, Sanford Clinic, Sioux Falls, S.D., said he does not usually do ISBCS. "The standard of care in our country is to wait between eyes, in case there is a vision threatening complication like infection," Dr. Thompson said. He said it Initial phaco quick chop in cataract surgery Second chop in cataract surgery Final quadrant removal in cataract surgery using phaco chop Source (all): Brock Bakewell, MD

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