Implementing immediate sequential bilateral cataract surgery at Buckinghamshire Healthcare NHS Trust

Abstract

Abstract Background/Objectives: Immediate sequential bilateral cataract surgery (ISBCS) is a relatively new approach to bilateral cataract surgery that can be offered under NICE guidelines 2017. Although increasingly popular only 0.5% of cataract operations are performed nationally using this approach. We redesigned our service to routinely offer ISBCS and are now one of the leading NHS providers of ISBCS in the UK. We audited our cataract operations for 2022 and report here our initial experiences with ISBCS. Subjects/Methods: We redesigned our cataract service to routinely offer ISBCS on the NHS. We audited all cataract operations performed in calendar year 2022. Results We performed 4652 NHS cataract operations including 498 (10.7%) operations on 298 patients using the ISBCS approach. Trainee surgeons performed 32.5% of these cases. There were two intraoperative complications. One was a suspected suprachoroidal haemorrhage and the other was a posterior capsular rupture post lens implantation. Post-operatively there was one case of retinal detachment requiring vitrectomy following uncomplicated ISBCS surgery and five cases or Irvine-Gass syndrome that were managed medically. Conclusions From this data ISBCS does not pose a greater risk to patients in terms of complications. Allowing trainees to operate on ISBCS cases improves the trainee experience. With appropriate pre-operative counselling, patients listed for unilateral surgery can be upgraded to ISBCS on the day of operation to fully utilise theatre capacity. Patients listed for ISBCS can also be downgraded to unilateral surgery on the day of operation when surgeons need time to deal with complications safely.