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Immediate versus Delayed Sequential Bilateral Cataract Surgery: A Systematic Review and Meta-Analysis.

Monali S Malvankar-Mehta1, Yufeng Nancy Chen2, Sangita Patel3

  • 1Department of Ophthalmology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.

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Summary
This summary is machine-generated.

Immediately sequential bilateral cataract surgery (ISBCS) and delayed sequential bilateral cataract surgery (DSBCS) both enhance quality of life and vision. ISBCS may offer additional benefits for patients and society.

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Area of Science:

  • Ophthalmology
  • Health Economics
  • Evidence-Based Medicine

Background:

  • Immediately sequential bilateral cataract surgery (ISBCS), performed simultaneously on both eyes, is increasingly preferred over delayed sequential bilateral cataract surgery (DSBCS), performed on separate days.
  • ISBCS offers benefits such as reduced hospital visits, faster rehabilitation, and prevention of visual deficits between surgeries.
  • ISBCS may also lead to cost savings for healthcare systems and reduce risks associated with anisometropia.

Purpose of the Study:

  • To conduct a systematic review and meta-analysis comparing ISBCS and DSBCS.
  • To evaluate the impact of both surgical approaches on patient utility scores and best-corrected visual acuity (BCVA).

Main Methods:

  • Comprehensive literature search across multiple databases (MEDLINE, EMBASE, etc.) and grey literature.
  • Systematic literature review using EPPI-Reviewer 4 and meta-analysis using STATA v. 13.0.
  • Calculation of standardized mean differences (SMD) and 95% confidence intervals (CI), assessing heterogeneity with I2 statistics.

Main Results:

  • Eleven studies with 3,657 participants were included; both ISBCS and DSBCS significantly improved post-operative utility scores and BCVA.
  • Meta-analysis showed non-significant differences in utility scores between ISBCS and DSBCS across most measures (TTO, EQ5D, HUI3, VF-7), except for the Catquest questionnaire where ISBCS showed significant improvement.
  • BCVA improved significantly with both procedures, with a non-significant trend favoring ISBCS over DSBCS (SMD = -0.18; 95% CI: -0.37, 0.01).

Conclusions:

  • Both ISBCS and DSBCS are effective in improving patient quality of life and visual acuity.
  • ISBCS may provide additional advantages at both individual and societal levels compared to DSBCS.
  • Further research may be needed to clarify the nuances of utility score improvements across different measurement instruments.