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Immediate sequential bilateral surgery versus delayed sequential bilateral surgery for cataracts.

Mor M Dickman1, Lindsay S Spekreijse1, Bjorn Winkens2

  • 1University Eye Clinic Maastricht, Maastricht University Medical Centre, Maastricht, Netherlands.

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Immediate sequential bilateral cataract surgery (ISBCS) likely offers similar outcomes to delayed sequential bilateral cataract surgery (DSBCS) but at a lower cost. However, evidence quality is limited, necessitating further research on cost-effectiveness.

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Area of Science:

  • Ophthalmology and Vision Science
  • Health Economics and Outcomes Research

Background:

  • Age-related cataract commonly affects both eyes, often necessitating bilateral surgery.
  • Delayed sequential bilateral cataract surgery (DSBCS) is standard, while immediate sequential bilateral cataract surgery (ISBCS) offers potential benefits like reduced hospital visits and costs.
  • Concerns regarding sight-threatening bilateral adverse effects with ISBCS warrant comparative safety and effectiveness evaluations.

Purpose of the Study:

  • To assess the safety and effectiveness of ISBCS compared to DSBCS for bilateral age-related cataracts.
  • To summarize evidence on the resource use, costs, and cost-effectiveness of ISBCS versus DSBCS.
  • To evaluate visual and patient-reported outcomes between ISBCS and DSBCS.

Main Methods:

  • Systematic review including randomized controlled trials (RCTs) and non-randomized studies (NRSs) for safety and outcomes.
  • Inclusion of economic evaluations (full/partial, trial/model-based) for cost-effectiveness analysis.
  • Searches conducted across multiple databases (CENTRAL, MEDLINE, Embase, etc.) from 2007 onwards, with risk of bias and certainty of evidence assessments (ROBINS-I, CHEC-list, CHEERS, NICE, GRADE).

Main Results:

  • Fourteen studies (2 RCTs, 7 NRSs, 6 economic evaluations) involving 276,260 participants were included.
  • No significant difference in endophthalmitis risk, refractive outcomes, or postoperative complications between ISBCS and DSBCS was found, though evidence certainty was low to moderate.
  • ISBCS appeared to have lower total costs, but cost-effectiveness data was limited and of low quality; patient-reported outcomes showed no significant differences.

Conclusions:

  • Current evidence suggests probable clinical equivalence in outcomes between ISBCS and DSBCS, with ISBCS demonstrating lower costs.
  • The limited amount and low certainty of the evidence necessitate caution in interpretation.
  • Further well-designed cost-effectiveness studies are required to definitively establish the value of ISBCS.