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Outcomes and complications of immediate versus delayed sequential bilateral cataract surgery in children
Vishaal Bhambhwani1, Sina Khalili2, Nasrin Tehrani3
1Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Northern Ontario School of Medicine and Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada.
Insights
Immediate sequential bilateral cataract surgery (ISBCS) is comparable to delayed sequential bilateral cataract surgery (DSBCS) in children, avoiding repeat anesthesia and reducing follow-up visits without increasing complications.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Surgical Outcomes
Background:
- Cataract surgery in children requires careful consideration of surgical timing and potential complications.
- Bilateral cataract surgery can be performed either immediately or sequentially with a delay between eyes.
- Comparing outcomes of immediate sequential bilateral cataract surgery (ISBCS) versus delayed sequential bilateral cataract surgery (DSBCS) in pediatric populations is crucial for optimizing patient care.
Purpose of the Study:
- To compare the outcomes and complications of ISBCS versus DSBCS in children under two years of age.
- To present the largest single-center series to date evaluating these surgical approaches over a 10-year period.
Main Methods:
- Retrospective review of medical records for children under two years old who underwent ISBCS or DSBCS.
- Data collection focused on ophthalmological and anesthesia-related outcomes and complications up to 8 weeks postoperatively.
- Comparison of complication rates, operating room time, and follow-up visits between the two surgical groups.
Main Results:
- A total of 53 children (37 ISBCS, 16 DSBCS) were analyzed, with no significant differences in sex, age at surgery, or surgery type.
- The ISBCS group had more comorbidities (35% vs 6%, P=0.029) but significantly lower mean operating room time (3.61 vs 4.09 hours, P=0.037).
- Postoperative complications occurred in 7% of ISBCS eyes versus 25% of DSBCS eyes (P=0.009), and ISBCS required fewer follow-up visits (4 vs 6, P=0.0002).
Conclusions:
- ISBCS is a safe and effective alternative to DSBCS in pediatric cataract surgery.
- ISBCS avoids the need for multiple anesthesia sessions and reduces the number of required follow-up visits.
- Complication rates for ISBCS are comparable to DSBCS, with a lower incidence of postoperative complications observed in this study.
Purpose:
To present the largest series to date comparing outcomes and complications of immediate versus delayed sequential bilateral cataract surgery (ISBCS vs DSBCS) in children at a single center over a 10-year period.
Methods:
The medical records of children <2 years of age who underwent ISBCS and DSBCS were reviewed retrospectively. Data was collected on outcomes and complications (ophthalmological and anesthesia-related) up to 8 weeks postoperatively.
Results:
A total of 53 children were included: 37 ISBCS and 16 DSBCS. There were no differences between groups with regard to sex, age at surgery, and type of surgery. The ISBCS group had significantly more patients with systemic or ocular comorbidities than the DSBCS group (35% vs 6%; P = 0.029). Mean operating room time was significantly lower for the ISBCS group (3.61 vs 4.09 hours; P = 0.037), whereas total surgical time was similar. No major intraoperative surgical complications or anesthesia-related adverse events occurred in either group. Postoperative complications (most commonly, raised intraocular pressure) occurred in 5 eyes (7%) in the ISBCS group and 8 eyes (25%) in the DSBCS group (P = 0.009). Patients in the ISBCS group required significantly fewer follow-up visits compared to the DSBCS group (4 vs 6; P = 0.0002).
Conclusions:
ISBCS avoids multiple anesthesia sessions and reduces follow-up visits, with intra- and postoperative ophthalmological or anesthesia-related complications comparable to DSBCS.
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