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Editorial
Simultaneous bilateral cataract surgery
  1. D F Chang
  1. University of California, San Francisco, CA, USA; dceye@earthlink.net

    https://doi.org/10.1136/bjo.87.3.253

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      An idea whose time has come?

      During the past decade, advances in techniques and technology have led to major changes in cataract surgical practice patterns. The complete transition from large incision extracapsular cataract extraction (ECCE) to phacoemulsification was driven by the ability to accelerate the visual and physical rehabilitation of cataract patients. The subsequent innovations of foldable intraocular lenses (IOLs) and small, clear corneal incisions followed. As a result, previously unimaginable practices—topical anaesthesia, sutureless surgery, and the elimination of patching and physical restrictions—have now become commonplace. In this progression towards ever faster rehabilitation, simultaneous bilateral cataract surgery (SBCS) may be the next and ultimate step.

      As evidenced in a consultation forum involving international experts in 1997, simultaneous bilateral cataract surgery remains controversial, and is rarely performed in the United States.1 In fact, the recently updated American Academy of Ophthalmology Preferred Practice Pattern (Rev 2001) states that “Surgery should not be routinely performed in both eyes at the same time because of the potential for bilateral visual impairment and loss of the ability to adjust surgical plans for the second eye that are based on results from first eye surgery.”2 There are obvious reasons for the historical reluctance to perform bilateral surgery.

      When standard ECCE was the most popular procedure, patients often waited for up to several months between their first and second cataract surgeries. Large incisions were associated with a low, but significant, incidence of early wound problems, and suture induced astigmatism often resulted in poor uncorrected vision for 1–2 months. Visual recovery was more often delayed by prolonged corneal oedema or clinically significant cystoid macular oedema. Refractions often took months to stabilise.

      Simultaneous bilateral ocular surgery of any kind cannot be considered if there is either a high complication rate, or if it causes a prolonged period …

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