Abstract
Background: To evaluate the predictability of refraction following immediate sequential bilateral cataract surgery
(ISBCS) performed under general anaesthesia.
Methods: This is a retrospective review of all ISBCS performed at Kantonsspital Winterthur, Switzerland, between
April 2000 and September 2013. The case notes of 250 patients were reviewed. Patients having full refraction
reported (110 patients/220 eyes) were included. 210 (95 %) eyes had a straight forward phacoemulsification with
posterior chamber intraocular lens implantation, seven eyes had a planned extracapsular cataract extraction (ECCE);
three eyes had an intracapsular cataract extraction.
Results: Both eyes of 110 patients (64 women, 46 men) with a mean age of 79.0 years, standard deviation (SD) ±11.4
(range 26 to 97 years) were included. Median preoperative best corrected visual acuity (BCVA) was 0.5 LogMAR in the
first eye, the interquartile range (IQR) was [0.4, 1.2]; 0.7 LogMAR in the second eye with IQR [0.4, 1.8]. At one month, the
median BCVA was 0.2 LogMAR, IQR [0.1, 0.3] in the first eye, median BCVA was 0.1 LogMAR and IQR [0.0, 0.5] in the
second eye. There were 3 eyes (3 %) that lost 3 lines or more in BCVA at one month (control vs. pre-operatively). In all
three cases, poor visual acuity had been recorded pre-operatively (>1 LogMAR). Achieved refraction was within ±1.0 D
of the target in 83 % of eyes. There were only 5 % (n = 6) of cases where if delayed sequential bilateral extraction had
been performed could potentially intraocular lens (IOL) choice have been adjusted, in four of these cases, target
refraction was within ±1.0 D in the second eye.
Conclusions: ISBCS performed under general anaesthesia achieves target refraction in 83 % of eyes after consideration
of complications, ocular co-morbidities and systemic restrictions. In the majority of cases where IOL power calculation
could be considered, the achieved refraction of the second surgical eye was within ±1.0 D of intended refraction. This
undermines the utility of IOL power adjustments in the second surgical eye.
Keywords: Cataract, Cataract surgery, Immediate sequential bilateral cataract surgery