An appreciable number of cases of immediate sequential bilateral cataract surgery is being performed nationally each year.
"Data from the Swedish NCR show the number of ISBCS cases performed annually has increased slowly over the past 5 years and that infections occur more seldom after ISBCS than after unilateral cataract surgery," said Dr. Johansson, cataract surgeon, Linköping University Hospital, Linköping, Sweden, and secretary of the International Society of Bilateral Cataract Surgeons.
"Special strategies are important for minimizing the risk of infection after ISBCS and patient selection is critical as well," he said. "When proper preoperative evaluation is performed, patients selected for ISBCS as a group would be less prone to postoperative infection than their counterparts who have surgery in only one eye at a time."
Trends in ISBCS rates were investigated from Jan. 1, 1999 to June 30, 2009, and showed that the number of procedures performed annually increased from about 1,000 in 1999 to between 3,000 and 4,000 in the latter years. Currently, about 4% to 5% of patients having cataract surgery in Sweden undergo ISBCS, although the rate of ISBCS cases at individual clinics ranges between 0% and 35%, Dr. Johansson said.
The potential for bilateral endophthalmitis is a concern surrounding same-day bilateral cataract surgery. Risk of infection after ISBCS was analyzed using data for the period between 2003 and 2009, considering that beginning in 2003, there was a homogeneous strategy nationwide for post-cataract surgery prophylaxis.
"In 2002, my clinic in Linköping became the last center in Sweden to introduce routine use of intracameral cefuroxime, which to date is the only prophylactic regimen that has been shown in a published, prospective randomized controlled trial to decrease the risk of endophthalmitis after cataract surgery," he said.
During the study period, 24,214 ISBCS cases and 489,325 unilateral cases were reported to the Swedish NCR. Two unilateral infections occurred in the ISBCS group, translating into a rate of 0.08 per 1,000 operations. A total of 184 infections occurred after unilateral surgery, for a rate of 0.38 per 1,000 operations (p < 0.02 versus ISBCS).
"Many centers in Sweden now also are injecting ampicillin (Doktacillin, Astra) intracamerally in addition to cefuroxime [because] ampicillin covers enterococci and certain other bacteria that are resistant to cefuroxime," Dr. Johansson concluded.
Björn Johansson, MD, PhD E-mail:firstname.lastname@example.org
Dr. Johansson has no financial interest in the subject matter.