Immediately sequential phacoemulsification performed under topical anaesthesia as day case procedures. (Scientific Correspondence).

Aims: To evaluate the visual outcome, safety, and economic benefits of immediately sequential phacoemulsification performed under topical anaesthesia as a day case procedure.

Methods: Immediately sequential phacoemulsification under topical anaesthesia was performed as a day case procedure on 218 eyes of 109 patients over 21 months by a single senior surgeon using intracameral antibiotics. Case notes were retrospectively analysed.

Results: The final best corrected visual acuity (BCVA) was 6/9 or better in 86% of eyes with 47% achieving 6/6 or better. The incidence of intraoperative complications was 0.45%. Postoperative complications occurred in 13.8% of eyes and included refractive error > 1.00D from refractive aim (6.9%). Bilateral complications occurred in 5.5% of the patients. There were no cases of endophthalmitis. The mean time from surgery to discharge was 24 days.

Conclusion: Immediately sequential phacoemulsification under topical anaesthesia performed as a day case procedure is not associated with an increased number of complications when compared to unilateral phacoemulsification. Under strict surgical protocol with the use of intracameral antibiotics and performed by an experienced surgeon with a good track record this procedure is safe.

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Bilateral intraocular surgery causes ongoing debate and perpetual disagreement between ophthalmologists. Previously published papers on the subject all comment on its controversial and emotive nature. (1-5) The main apprehension is the risk of bilateral catastrophic complications such as endophthalmitis.

The currently accepted term of "simultaneous bilateral cataract extraction" is a misnomer for the simple reason that both eyes are not operated on at the same time. Smith and Liu penned the term "immediately sequential cataract surgery" (5) and we have applied this term to our series: "immediately sequential phacoemulsification." Although not performed routinely this type of surgery is becoming more accepted owing to the benefits to the patient, hospital, and society. (5) In previous reports on this subject strict inclusion criteria have been alluded to. (1-5) Inclusion criteria for our cohort of patients were not as stringent with a large percentage of patients having immediately sequential phacoemulsification because it was requested by them. We present the first series of patients undergoing immediately sequential phacoemulsification under topical anaesthesia performed as day case procedures.

PATIENTS AND METHODS

This was a retrospective study of 109 patients (218 eyes) who underwent immediately sequential phacoemulsification (ISP) under topical anaesthesia. The procedures were performed at the Norfolk and Norwich, Cromer, and Norwich BUPA hospitals over a 21 month period from May 1999 to February 2002. A single senior surgeon performed all the procedures. Data collected …