Abstract
Purpose: :
To compare patient–rated outcomes between same day (study group) and separate day (control group) bilateral cataract surgery.
Methods: :
Helsinki Simultaneous Bilateral Cataract Surgery Study (HSBCSS) enrolled 507 patients with bilateral cataract, 250 of whom were randomized to study group (SG) and 257 to control group (CG). Consecutive patients were eligible if best corrected visual acuity of the better eye was 20/40 or worse (485 patients) or, if vision was better, Visual Functioning Index VF–7 was lower than 70 (16 patients) or anisometropia over 2 D would have resulted from 1st eye surgery (6 patients). SG underwent bilateral phacoemulsification under topical anesthesia on the same day as two separate procedures, and CG underwent bilateral surgery separated by 4–6 weeks. VF–7 was taken before surgery, 1 month after 1st and 2nd eye surgery, and 3–4 months after 2nd eye surgery. Cataract Symptom Score (CSS), Self–Rated Satisfaction with Vision (SRSV) and Self–Rated Trouble with Vision (SRTV) were taken before and after each surgery. The patient rated overall satisfaction, pain and comfort in the operating room (OR) immediately after each surgery.
Results: :
Initial median VF–7 score was 66.7 (range, 12.5–100) vs. 68.3 (range, 0–100) in the SG vs. CG, respectively (P=0.95, Kruskal–Wallis). The median score rose to 86.6 (range, 31–100) after 1st eye surgery in the CG, and to 93.3 (range, 46–100) vs. 95 (range, 50–100) after 2nd eye surgery in the SG vs. CG (P=0.39), respectively. At last follow–up, the median score was 100 in both groups (range, 69–100 vs. 35–100, respectively; P=0.25). The difference in VF–7 score 1 month after 1st surgery was significantly better in the SG (93.3 vs. 86.6; P<0.001). No difference was observed in initial CSS (median, 4 vs. 4, P=0.78). After 1st surgery, CG had a worse CSS (1 vs. 2; P<0.001), and 1 month after 2nd eye surgery the CG tended to have a worse CSS (median, 1 vs. 1, mean 1.5 vs. 1.8; P=0.050). SRSV and SRTV were similar after 2nd eye surgery. No difference was found in overall satisfaction in OR with 1st (P=0.82) and 2nd eye surgery (P=0.51), pain during 1st (P=0.18) and 2nd eye surgery (P=0.98), and patient comfort during 1st (P=0.65) and 2nd eye surgery (P=0.97).
Conclusions: :
Patient–rated visual functioning was significantly better after same day bilateral cataract surgery than after 1st eye surgery on separate days. No difference remained after 2nd surgery. Other patient–rated outcomes did not differ between same and separate day bilateral cataract surgery.
Keywords: cataract • clinical (human) or epidemiologic studies: outcomes/complications • clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials