EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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102 EW RESIDENTS October 2012 EyeWorld journal club Review of "Immediately sequential bilateral cataract surgery: Safety by Karolinne Maia Rocha, M.D., and Jeffrey Goshe, M.D., Cole Eye Institute, Cleveland Clinic Jeffrey Goshe, M.D. This month, JCRS unveils a random- ized prospective trial evaluating bilateral immediate sequential cataract surgery. I asked the Cleveland Clinic residency to assess this study. —David F. Chang, M.D., EyeWorld chief medical editor T CHICAGO 2012 Register Today Saturday, November 10 Hyatt McCormick Place – Regency Ballroom AB 2233 S. Dr. Martin Luther King Jr. Dr. Complex Cataracts, The Simple Truths IV Sponsored by MST Make the most of your time while in Chicago and attend this EyeWorld program for an educational opportunity to network with your colleagues. he goals of modern cataract surgery include predictable outcomes, quick recovery, and visual func- tion restoration. Innovative technologies with advanced phacoemulsification devices, small incisions, foldable and customized intraocular lenses, intraoperative aberrometry, and prophylactic antibiotic treatment have made modern cataract surgery safe and effective. Recently, there's been a great debate worldwide about the CME credit is not available for this program. socioeconomic benefits, faster recov- ery, and health-related quality of life improvement of immediately sequential bilateral cataract surgery. However, serious complications such as the risk of bilateral endoph- thalmitis and potential residual refractive error are major concerns of bilateral same day phacoemulsifi- cation. In the October issue of the Jour- nal of Cataract & Refractive Surgery, Serrano-Aguiar et al. published "Immediately sequential versus delayed sequential bilateral cataract surgery: Safety and effectiveness," a randomized multicenter clinical trial that included five health centers in Las Palmas de Gran Canaria, Spain. Patients with bilateral visually significant cataracts and no ocular diseases were randomized to imme- diately sequential bilateral cataract surgery (ISBCS) versus delayed sequential bilateral cataract surgery (DSBCS) groups. The clinical trial was approved by the Institutional Review Board, Official College of Surgeons of Gran Canaria, Spain. Phacoemulsification with topical anesthesia was performed by five different surgeons from each partici- pating clinic. The surgeries were performed in an ambulatory surgery center. Ciprofloxacin or ofloxacin was administered in combination Immediately sequential versus delayed sequential bilateral cataract surgery: Safety and effectiveness Pedro Serrano-Aguilar, M.D., Ph.D., M.P.H., Yolanda Ramallo-Fariña, B.Ec., B.Stat., José María Cabrera-Hernández, B.N., David Perez-Silguero, M.D., Ph.D., Miguel Angel Perez-Silguero, M.D., Ph.D., Francisco Henríquez-de la Fe, M.D., Javier Goás-Iglesias de Ussel, M.D. J Cataract Refract Surg (October) 2012; 38:1734–1742. Purpose: To assess the safety and effectiveness of immediately sequential (ISBCS) versus delayed sequential (DSBCS) bilateral cataract surgery. Setting: Multiple clinics, Canary Islands, Spain. Design: Multicenter randomized clinical trial. Methods: Patients with cataracts requiring bilateral surgery were random- ized to ISBCS or DSBCS. Outcome measures were the incidence of intraoperative and post-operative surgical complications, corrected and uncorrected visual acuities, and self-perceived visual function (VF-14 questionnaire). All outcomes were measured 30 days post-operatively. Self-perceived visual function was also assessed after 1 year. Data were analyzed with repeated measures to assess temporal effects on surgical complications, visual acuity, and function. Effect size was also estimated for self-perceived visual function. Results: There were no differences in intraoperative or post-operative surgical complications, visual acuity 30 days post-operatively, or self-per- ceived visual function after 1 year between the 2 techniques. Effect size for visual function 30 days post-operatively was moderate in the ISBCS group (n=834) and small in the DSBCS group (n=780). This difference disappeared at 1-year follow-up after second-eye surgery in the delayed group. www.EyeWorld.org Conclusions: There were no relevant surgical complications in 1614 operated eyes and no significant difference in surgical complications, visual acuity, or long-term self-perceived visual function between ISBCS and DSBCS. These safety and effectiveness outcomes were related to careful patient selection, surgical expertise, and the systematic use of standardized surgical guidelines to ensure aseptic and independent surgery in each eye. Financial disclosure: No author has a financial or proprietary interest in any material or method mentioned.