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Is it time for a new attitude to “simultaneous” bilateral cataract surgery?
  1. Sussex Eye Hospital, Eastern Road, Brighton BN2 5BF, UK
  1. Mr Christopher Liu CSCLiu{at}

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Almost every discussion on simultaneous bilateral cataract surgery (SBCS) for senescent cataracts begins with a comment on its controversial nature.1-3 The question is can the benefits of bilateral surgery justify the risk of simultaneous bilateral complications, in particular endophthalmitis? Operating on the second eye immediately after the first is an option that does have potential advantages. These can be separated into the clinical benefits to the patient and economic benefits to the patient, hospital, and society. It is the benefits and risks to the patient that are our primary duty as clinicians, and they will be the focus of this discussion. In this perspective we present an approach to “simultaneous” bilateral cataract extraction, and examine the risk of unilateral or bilateral complications following cataract extraction in light of the perceived benefits as they apply at the beginning of the 21st century. The aim of the perspective is to remove the stigma from “simultaneous” bilateral cataract surgery, so that suitable patients may be offered this method of delivery of treatment.

Our approach to simultaneous bilateral cataract surgery

We begin by assuming that all patients are suitable for simultaneous bilateral cataract surgery (SBCS), unless they have a specific contraindication that increases the risk of complications (Table 1). These are broadly divided into conditions that increase the risk of endophthalmitis, lenticular abnormalities, extremes of axial length, and keratometry that may make the biometry unreliable and conditions that may predispose to postoperative corneal oedema or decompensation, raised intraocular pressure, ocular inflammation, and retinal detachment. An informal survey of patients seen at our cataract clinic would suggest that up to one third of patients would be excluded by these criteria. Currently we do not carry out extensive preoperative systemic investigations on our patients and, therefore, there does remain an element of risk that there may be an undiagnosed condition such as …

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