I introduced bilateral simultaneous LASIK in Belgium in 1996, and I started performing ISBCS in 2002, followed by bilateral simultaneous LACS in 2012. These procedures are not the same: LACS is intraocular surgery, and LASIK is extraocular. However, once the surgeon becomes confident using a bilateral technique, the transition to bilateral LACS is easier. I now perform immediate sequential bilateral LACS in most of my cataract surgery cases.

The biggest concern with immediate sequential bilateral LACS is, of course, bilateral endophthalmitis. When we implemented the procedure, I was already using vancomycin injections in the anterior chamber to prevent endophthalmitis in cataract surgery. Having encountered no issues with endophthalmitis in more than 10,000 cases, I felt confident pursuing the same-day bilateral approach with a LACS technique.

At our center, when we perform immediate bilateral sequential LACS, we change gowns, gloves, and instrument tables between eyes as if operating on two separate patients. We also use different batch numbers of drops, intraocular fluids, and OVDs for the right and left eyes.

I have been using intracameral antibiotics for 15 years, together with povidone-iodine, and I have a rate of 1 in 12,750 cases of endophthalmitis with this regimen. Based on this experience, the risk of bilateral simultaneous endophthalmitis is extremely low.

We ensure that all patients considering immediate bilateral sequential LACS are properly educated about potential complications. Thus, all patients fully understand the risk of endophthalmitis, but only rarely do they elect not to undergo the procedure.

Erik L. Mertens, MD, FEBOphth
• Medical Director of Medipolis, Antwerp, Belgium
• Chief Medical Editor of CRST Europe
• e.mertens@medipolis.be
• Financial disclosure: None