Safety and effectiveness of immediately and delayed sequential bilateral phacoemulsification.

Abstract

Background : Immediately sequential bilateral phacoemulsification (ISBP) performed worldwide has not been accepted a standard treatment for bilateral age-related cataracts because of complications especially endophthalmitis.So far, there has not been any definite conclusion reached in this issue.

Objectives : To assess the safety and effectiveness of immediately sequential bilateral phacoemulsification (ISBP) in comparison to delayed sequential bilateral phacoemulsification (DSBP).

Design : A systematic review and meta-analysis

Setting : King Chulalongkorn Memorial Hospital

Materials and Methods : Randomized controlled trials (RCTs) and non-randomized controlled trials (NRCTs) comparing immediately sequential bilateral phacoemulsification with delayed sequential bilateral phacoemulsification performed under topical anesthesia in patients with bilateral age-related cataracts were included. We also included observational studies. Two authors independently reviewed the selected studies. Outcomes included intraoperative and postoperative complications, visual acuity before and after the surgery. Heterogeneity was measured using I2. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for dichotomous data.

Results : Eight studies fulfilled our inclusion criteria. Three RCTs, two NRCTs, and three case-series were included, involving 2,161 participants in ISBP and 933 in DSBP. Intraoperative complications included posterior capsule rupture. Postoperative complications included uveitis, increased IOP, and cystoid macular edema. No endophthalmitis was found in any of the studies. Visual acuity could not be compared between the studies because of inconsistency of the measurement. Nonetheless, no significant difference was found in visual acuity between ISBP and DSBP in any study.

Conclusions : No significant difference was found between the two surgical interventions in terms of intraoperative, postoperative complication and visual acuity.