Immediate vs delayed sequential cataract surgery: A comparative study

Purpose: Immediate sequential cataract surgery (ISCS) is still a controversial procedure. We compared the clinical and patient-reported outcomes of ISCS vsthe usual delayed sequential cataract surgery (DSCS). Methods: Selected patients with bilateral cataracts were assigned nonrandomly and according to their preferences to either ISCS in one session (intervention group) or DSCS over two sessions with a 2-month interval between sessions (control group). Binocular visual acuity, binocular contrast sensitivity, stereopsis, and self-reported visual function (VF-14) were measured preoperatively and postoperatively for up to 4 months after the second-eye surgery. Mann-Whitney U-test was used to compare quantitative variables, while the χ² and Fisher's exact tests were used for qualitative variables. Results: Of the 220 eligible patients, 74 (33.6%) chose ISCS, and 137 (62.3%) selected DSCS. The remaining patients (4.1%) were allocated randomly to either group. For 2 months, the outcome measures were significantly worse in the DSCS group than in the ISCS group. However, after 4 months (2 and 4 months after second-eye surgery in the DSCS and ISCS groups, respectively) the differences became insignificant except for VF-14 (P<0.05). The mean post-operative objective measures and their differences from baseline were not significantly different between the groups. Nevertheless, postoperatively, VF-14 improved more (P<0.05) and attained a higher value (P<0.05) in the ISCS group. Conclusions: In experienced hands, with stringent patient selection criteria and with a strict aseptic protocol, ISCS can safely provide a more rapid rehabilitation of VF than DSCS.