EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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104 EW RESIDENTS Review continued from page 103 cataract surgery has decreased the rate of culture-confirmed endoph- thalmitis to 0.0439%.6 The major limitation of this study is the too small sample size to provide sufficient statistical power to analyze the safety of ISBCS versus DSBCS. As suggested by the authors, a sample size of more than 3,000 patients would be necessary to assess the incidence of intraoperative and post-op complications (e.g., endoph- thalmitis) in both groups. Another limitation of this study is the lack of visual function measurements and refractive outcomes after 1 month post-op. Furthermore, it is unusual that no cases of cystoid macular edema were reported in the entire population, suggesting that some subtle cases may have been over- looked. This randomized clinical trial including 807 patients with bilateral visually significant cataracts indi- cated very low adverse events and similar long-term surgical outcomes of ISBCS when compared to DSBCS. This study has special relevance with the ongoing initiative to decrease healthcare spending both in the U.S. and abroad. Immediate sequential cataract surgery may have signifi- cant advantages both in terms of faster visual rehabilitation and reduced indirect costs (e.g., fewer post-op examinations, reduced transportation costs). The most feared complication, endophthalmi- tis, did not occur in this study. It will be up to patients and physicians to determine if the logistical advan- tages of immediate sequential cataract surgery outweigh the small risk of bilateral visual loss. This risk has been willingly accepted among the refractive surgery population, but the risks associated with bilateral intraocular surgery may warrant further caution. EW References Javitt JC, Vitale S, Canner JK, et al. National outcomes of cataract extraction: endoph- thalmitis following inpatient surgery. Archives of Ophthalmology. 1991;109(8):1085–1089. Norregaard JC, Thoning H, Bernth P, Andersen TF, Javitt JC, Anderson GF. Risk of endoph- thalmitis after cataract extraction: results from the International Cataract Surgery Outcomes study. British Journal of Ophthalmology. 1997;81(2):102–106. Aaberg TM, Flynn HW, Jr., Schiffman J, Newton J. Nosocomial acute-onset postopera- tive endophthalmitis survey: a 10-year review of incidence and outcomes. Ophthalmology. 1998;105(6):1004–1010. Doft B, Nakamura T, Walonker AF, et al. Results of the endophthalmitis vitrectomy study: a randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis. Archives of Ophthalmology. 1995;113(12):1479–1496. Herretes S, Stark WJ, Pirouzmanesh A, Reyes JM, McDonnell PJ, Behrens A. Inflow of ocular surface fluid into the anterior chamber after phacoemulsification through sutureless corneal cataract wounds. Am J Ophthalmol. 2005;140(4):737-40. Barry P, Seal DV, Gettinby G, Lees F, Peterson M, Revie CW. ESCRS Endophthalmitis Study Group. ESCRS study of prophylaxis of postop- erative endophthalmitis after cataract surgery: Preliminary report of principal results from a European multicenter study. J Cataract Refract Surg. 2006;32(3):407-410. Editors' note: The authors have no financial interests related to this article. Contact information Rocha: rochak@ccf.org Goshe: goshej@ccf.org October 2012