Implementing immediate sequential bilateral cataract surgery at Buckinghamshire Healthcare NHS Trust

Area of Science:

• Ophthalmology
• Surgical Innovation
• Patient Safety

Background:

• Immediate sequential bilateral cataract surgery (ISBCS) involves operating on both eyes on the same day.
• Despite NICE guidelines since 2017, ISBCS accounts for only 0.5% of national cataract operations.
• The study reports initial experiences from a UK NHS provider that redesigned its service to routinely offer ISBCS.

Purpose of the Study:

• To audit cataract operations in 2022 to evaluate the safety and outcomes of a redesigned service offering routine ISBCS.
• To assess the complication rates associated with ISBCS.
• To evaluate the impact of ISBCS on trainee experience and theatre utilization.

Main Methods:

• A service redesign to routinely offer ISBCS on the NHS.
• Audit of all NHS cataract operations performed in the calendar year 2022.
• Analysis of intraoperative and postoperative complications, trainee involvement, and patient conversions.

Main Results:

• 4652 NHS cataract operations were performed, with 498 (10.7%) utilizing the ISBCS approach.
• Trainee surgeons performed 32.5% of ISBCS cases.
• Two intraoperative complications (suprachoroidal haemorrhage, posterior capsular rupture) and one postoperative retinal detachment were reported. Five cases of Irvine-Gass syndrome were managed medically.

Conclusions:

• ISBCS does not increase patient risk compared to unilateral surgery.
• ISBCS provides valuable training opportunities for surgeons.
• The ISBCS approach allows for flexible patient conversion and optimized theatre capacity, improving efficiency.