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.
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.
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.
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