Bilateral cataract surgery in children: immediate sequential versus delayed sequential surgery
Helen Wondem1, Sheldon Stohl2, Zoma Tede3
1Faculty of Medicine, Hebrew University, Jerusalem, Israel.
Insights
Immediate sequential bilateral cataract surgery (ISBCS) in children is as safe as delayed surgery (DSBCS), with fewer anesthesia exposures and shorter hospital stays. This approach offers a safe alternative for pediatric cataract treatment.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Anesthesiology
Background:
- Bilateral cataract surgery in infants presents surgical timing choices.
- Immediate sequential bilateral cataract surgery (ISBCS) and delayed sequential bilateral cataract surgery (DSBCS) are two such approaches.
- Comparing complication rates and resource utilization is crucial for optimizing pediatric care.
Purpose of the Study:
- To compare ocular and anesthesia-related complications between ISBCS and DSBCS in pediatric patients.
- To evaluate differences in anesthesia time, surgical interventions, and hospital admissions.
Main Methods:
- Retrospective review of medical records for children aged 0-24 months undergoing bilateral cataract surgery between 2012 and 2021.
- Inclusion criteria: aphakia and at least 1 year of follow-up.
- Comparison of complication rates, anesthesia duration, procedure time, and hospital resource use between ISBCS and DSBCS groups.
Main Results:
- 56 children included: 23 ISBCS, 33 DSBCS. Mean age at surgery was similar (2.6 vs. 2.8 months).
- ISBCS group had shorter mean anesthesia time (P < 0.001) and fewer hospital nights (P < 0.001).
- Ocular and anesthesia complication rates were similar; no endophthalmitis cases. Total procedure time and follow-up visits were comparable.
Conclusions:
- ISBCS in children is not associated with increased ocular or anesthesia-related complications compared to DSBCS.
- ISBCS offers benefits by avoiding repeat anesthesia and reducing total anesthesia exposure time.
- This suggests ISBCS is a safe and potentially more efficient option for pediatric bilateral cataract surgery.
Purpose:
To compare ocular and anesthesia-related complications in a cohort of patients having undergone either delayed sequential bilateral cataract surgery (DSBCS) or immediate sequential bilateral cataract surgery (ISBCS).
Methods:
The medical records of children who underwent bilateral cataract surgery at our institution between 2012 and 2021were reviewed retrospectively. Included patients were 0-24 months of age, aphakic, and followed for at least 1 year after surgery.
Results:
A total of 56 children were included: 23 underwent ISBCS; 33, DSBCS. Mean age at surgery was 2.6 ± 2.5 months for ISBCS patients and 2.8 ± 3.0 months for DSBCS patients (P = 0.752). Association with systemic diseases was more common in the ISBCS group. The mean anesthesia time per child was shorter in the ISBCS group (P < 0.001), although the mean total procedure time was similar in both groups. The rate of intraoperative anesthesia-related complications and intraocular complications was similar in both groups. There were no cases of endophthalmitis. The mean number of additional surgical interventions per child and the mean number of follow-up visits within 1 year were similar between groups. Children in the ISBCS group required fewer nights of hospital admission (P < 0.001).
Conclusions:
ISBCS in children in this series did not lead to an increased incidence of ocular or anesthesia-related complications compared with DSBCS. ISBCS avoids repeated anesthesia and shortens the total time that the child is under anesthesia.
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