Immediate vs delayed sequential cataract surgery: a comparative study

Immediate sequential cataract surgery (ISCS) is still a controversial procedure. We compared the clinical and patient-reported outcomes of ISCS vs the usual delayed sequential cataract surgery (DSCS).

Selected patients with bilateral cataracts were assigned nonrandomly and according to their preferences to either ISCS in one session (intervention group) or DSCS over two sessions with a 2-month interval between sessions (control group). Binocular visual acuity, binocular contrast sensitivity, stereopsis, and self-reported visual function (VF-14) were measured preoperatively and postoperatively for up to 4 months after the second-eye surgery. Mann-Whitney U-test was used to compare quantitative variables, while the chi(2) and Fisher's exact tests were used for qualitative variables.

Of the 220 eligible patients, 74 (33.6%) chose ISCS, and 137 (62.3%) selected DSCS. The remaining patients (4.1%) were allocated randomly to either group. For 2 months, the outcome measures were significantly worse in the DSCS group than in the ISCS group. However, after 4 months (2 and 4 months after second-eye surgery in the DSCS and ISCS groups, respectively) the differences became insignificant except for VF-14 (P<0.05). The mean post-operative objective measures and their differences from baseline were not significantly different between the groups. Nevertheless, postoperatively, VF-14 improved more (P<0.05) and attained a higher value (P<0.05) in the ISCS group.

In experienced hands, with stringent patient selection criteria and with a strict aseptic protocol, ISCS can safely provide a more rapid rehabilitation of VF than DSCS.