Immediate sequential bilateral cataract surgery in children in a government medical university in India

• Main Authors: Siddharth Agrawal, Vinita Singh, B M Vinod Kumar, Manisha Meena, Rajat M Srivastava, Vishal Katiyar
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2020-01-01
• Series: Journal of Clinical Ophthalmology and Research
• Subjects: children; immediate sequential bilateral cataract surgery; simultaneous bilateral cataract surgery
• Online Access: http://www.jcor.in/article.asp?issn=2320-3897;year=2020;volume=8;issue=1;spage=14;epage=17;aulast=Agrawal

Aim: The aim of this study is to assess the advantages and possible risks of single sitting bilateral cataract surgery over one eye at a time approach in children with developmental cataract. Settings and Design: Children (below 12 years) with bilateral developmental cataract with consenting parents were randomized to undergo either immediate sequential bilateral cataract (ISBC) surgery (both eyes at the same time) or delayed sequential bilateral cataract (DSBC) surgery (one eye at a time) over 4 years for logistics and complications. It was a prospective, randomized control trial. Methods: Two groups of patients (below 12 years) undergoing bilateral cataract surgery were compared for number of visits, duration of hospital stay, cost of procedure, duration of operating room (OR) occupancy, and refractive outcome. The first group underwent ISBC and the second group underwent DSBC surgery. A note was also made of complications related to anesthesia and/or the surgery in both the groups. Time interval between two eye surgeries and patients not returning for second eye surgery in DSBC group were also noted. Central tendency and degree of dispersion of continuous variables were expressed as mean and standard deviation for both (ISBC and DSBC) groups. The difference between the two groups was analyzed with independent “t”-test and the level of significance taken as 95% or a P < 0.05. Results: Forty-seven patients (94 eyes) in the ISBC group and 41 (82 eyes) in the DSBC group were compared. ISBC group patients had 43.2% fewer hospital visits, 39.4% lesser duration of total hospital stay, spent 36.6% lesser, and occupied the OR for 39.0% lesser duration compared to DSBC patients. All these differences were statistically significant (P < 0.001). The refractive outcomes in both the groups were comparable (P = 0.916 for the eye operated first andP= 0.814 for the eye operated later). There were no major complications related to anesthesia or surgery in either group. The median interval between the surgeries of the two eyes in the DSBC group was 8 weeks (range: 4–73 weeks). Besides these, 11 patients (21.1%) in the DSBC group did not return for second eye surgery. Conclusions: Bilateral single sitting cataract surgery in children seems logical, patient-friendly, cost-effective, and without any significant disadvantages when performed with adequate precautions before, during, and after the procedure.