- Medically Reviewed by Mr Mfazo Hove Consultant Ophthalmologist
- Author: Chris Dunnington
- Published: March 24, 2025
At Blue Fin Vision® Eye Clinic, we’re committed to providing our patients with the most advanced and effective eye care treatments available. One such procedure that has gained attention in recent years is Immediate Sequential Bilateral Cataract Surgery (ISBCS). This approach involves performing cataract surgery on both eyes during the same surgical session, offering numerous benefits to suitable patients.
Understanding ISBCS
ISBCS is a procedure where cataract surgery is performed on both eyes consecutively in a single visit to the operating theatre. This approach differs from the traditional method of delayed sequential bilateral cataract surgery (DSBCS), where surgeries on each eye are typically separated by weeks or months.
The Growing Acceptance of ISBCS
While ISBCS is recommended by the National Institute for Health and Care Excellence (NICE) guidance [NG77] for most adult cataract patients, its adoption in the United Kingdom has been slow. The most recent National Ophthalmology Database (NOD) audit in 2023 indicated that less than 0.5% of patients with bilateral cataracts undergo ISBCS.
Benefits of ISBCS
ISBCS offers several advantages over traditional approaches:
- Improved theatre efficiency and fewer hospital visits
- Avoidance of visual imbalance between surgeries
- Quicker improvement in eyesight
- Reduced time off work
- Minimised disruption to caring responsibilities
- Cost savings on interim spectacles or blank lenses
- Reduced carbon footprint due to fewer hospital visits
Safety and Efficacy of ISBCS
Concerns about the safety of ISBCS, particularly regarding the risk of bilateral endophthalmitis, have been a barrier to its widespread adoption. However, extensive research has demonstrated the safety and efficacy of this approach:
- A large case series of 95,606 ISBCS patients reported no incidences of bilateral endophthalmitis.
- Multiple randomised controlled trials have identified no significant safety concerns.
- Refractive and visual function outcomes for ISBCS are similar to those of DSBCS.
A recent Cochrane review concluded that current evidence supports no clinically important differences in outcomes between ISBCS and DSBCS, with ISBCS offering lower overall costs.
Patient Selection for ISBCS
Careful patient selection is crucial for the success of ISBCS. Suitable candidates typically meet the following criteria:
- Visually significant bilateral cataracts
- No absolute contraindications
Absolute Contraindications
While these may vary by unit and surgeon, common absolute contraindications include:
- Concomitant surgery for glaucoma, corneal, or retinal disease
- Previous significant eye surgery or injury
- Increased risk of post-operative corneal failure
- Elevated infection risk (e.g., active blepharitis, conjunctivitis)
- Certain ocular co-morbidities (e.g., recurrent uveitis, uncontrolled glaucoma)
- Iodine allergy
Relative Contraindications
Some factors may require careful consideration before proceeding with ISBCS:
- Extreme axial lengths
- Immune compromise or immunosuppression
- Cooperation issues or increased complication risks
The ISBCS Procedure: Ensuring Safety and Efficacy
To maintain the highest standards of safety and efficacy, Blue Fin Vision® Eye Clinic follows a strict protocol for ISBCS:
- Thorough Pre-operative Assessment: Each eye is evaluated independently to ensure suitability for ISBCS.
- Informed Consent: Patients are fully informed about the potential risks and benefits of ISBCS.
- Surgical Planning: A clear plan is established for which eye to operate on first.
- Independent Procedures: Each cataract surgery is treated as a completely independent procedure.
- Aseptic Separation: Complete aseptic separation of the first and second eye surgeries is mandatory to minimise infection risk.
- Equipment and Supplies: All instruments, consumables, and medications used for each eye are from separate batches and sterilisation cycles.
- Surgical Technique: The surgical technique remains consistent with standard cataract procedures.
- Intracameral Antibiotics: All patients receive intracameral cefuroxime at the end of each procedure.
- Between-Eye Protocol: The operating theatre is fully reset between eye surgeries, with the surgeon rescrubbing and ideally a different scrub nurse for the second eye.
- Complication Management: If any significant intraoperative complication occurs in the first eye, surgery on the second eye is postponed.
ISBCS Principles Applied to Bilateral Lens Replacement Surgery
It’s important to emphasise that all the principles of ISBCS also apply to bilateral lens replacement surgery. At Blue Fin Vision® Eye Clinic, we adhere to the same rigorous standards and protocols for all bilateral surgeries, ensuring the highest level of safety and efficacy for our patients, whether they are undergoing cataract removal or lens replacement.
Patient-Centred Approach
At Blue Fin Vision® Eye Clinic, we believe in a patient-centred approach to care. We thoroughly discuss the potential risks and benefits of ISBCS with each patient, including:
- The potential for immediate visual improvement in both eyes
- The inability to adjust the intraocular lens choice based on first eye outcome
- The rare possibility of complications affecting both eyes
- The likely need for additional support after the operation
Conclusion: Embracing Advanced Eye Care
ISBCS represents a significant advancement in cataract surgery, offering numerous benefits to suitable patients. At Blue Fin Vision® Eye Clinic, we’re proud to offer this innovative approach, backed by robust evidence and strict safety protocols. These same high standards are applied to all our bilateral procedures, including lens replacement surgery.
If you’re considering cataract surgery or lens replacement, we encourage you to discuss ISBCS with our expert team. We’re here to provide you with the most advanced, safe, and effective eye care solutions tailored to your individual needs.
References
- Malcolm, J., Leak, C., Day, A.C., Baker, H. and Buchan, J.C., 2023. Immediate sequential bilateral cataract surgery: patient perceptions and preferences. Eye, 37(7), pp.1509-1514.
- Sarikkola A-U, Uusitalo RJ, Hellstedt T, Ess S-L, Leivo T, Kivelä T. Simultaneous bilateral versus sequential bilateral cataract surgery: Helsinki Simultaneous Bilateral Cataract Surgery Study Report 1. J Cataract Refract Surg. 2011;37:992–1002.
- Serrano-Aguilar P, Ramallo-Fariña Y, Cabrera-Hernández JM, Perez-Silguero D, Perez-Silguero MA, Henríquez-De La FeF, et al. Immediately sequential versus delayed sequential bilateral cataract surgery: Safety and effectiveness. J Cataract Refract Surg. 2012;38:1734–42.
- Arshinoff SA, Bastianelli PA. Incidence of postoperative endophthalmitis after immediate sequential bilateral cataract surgery. J Cataract Refract Surg. 2011;37:2105–14.
- Lundström M, Albrecht S, Nilsson M, Åström B. Benefit to patients of bilateral same-day cataract extraction: randomized clinical study. J Cataract Refract Surg. 2006;32:826–30
- Spekreijse, L., Simons, R., Winkens, B., van den Biggelaar, F., Dirksen, C., Bartels, M., de Crom, R., Goslings, O., Joosse, M., Kasanardjo, J. and Lansink, P., 2023. Safety, effectiveness, and cost-effectiveness of immediate versus delayed sequential bilateral cataract surgery in the Netherlands (BICAT-NL study): a multicentre, non-inferiority, randomised controlled trial. The Lancet, 401(10392), pp.1951-1962.
- Herrinton LJ, Liu L, Alexeeff S, Carolan J, Shorstein NH. Immediate sequential vs. delayed sequential bilateral cataract surgery: retrospective comparison of postoperative visual outcomes. Ophthalmology 2017;124:1126–35.
- Dickman MM, Spekreijse LS, Winkens B, et al.. Immediate sequential bilateral surgery versus delayed sequential bilateral surgery for cataracts. Cochrane Database Syst Rev 2022; 4:Cd013270.
