Comparative Outcomes of Immediate Versus Delayed Sequential Bilateral Cataract Surgery: A Narrative Review

Immediate sequential bilateral cataract surgery (ISBCS) has gained increasing international acceptance as a safe and efficient alternative to delayed sequential bilateral cataract surgery (DSBCS), yet adoption remains heterogeneous. This narrative review aims to provide an updated academic review of the comparative outcomes and safety profiles of ISBCS versus DSBCS, with emphasis on parameters most relevant to clinical decision-making and surgical policy development. A narrative review was conducted following a predefined electronic search strategy. Priority was given to national registry datasets, randomized controlled trials (RCTs), and high-volume cohort studies. Endophthalmitis rates were consistently <1/1,000 for both approaches; refractive predictability was essentially equivalent; and cystoid macular edema (CME) incidence overlapped between groups. ISBCS demonstrated shorter functional recovery and reduced healthcare resource utilization. Additionally, ISBCS was associated with up to a 50% reduction in CO₂ footprint per patient, while also improving healthcare system efficiency. ISBCS is a clinically safe and system-efficient alternative to DSBCS when performed under strict aseptic protocols. It offers significant patient, economic, and environmental advantages.