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Editorial Spotlight | Jul 2015

Same-Day Bilateral Lens-Based Surgery

I started offering same-day bilateral lens-based surgery 5 years ago. In doing so, I feel my practice is able to provide patients with superior outcomes by accelerating neural adaption, minimizing the risk for injury that can develop when there is an interval between surgical encounters,1 increasing the efficiency of recovery, and reducing the financial burden.2 Any patient concerns related to possible surgical complications are discussed thoroughly with the patient as part of the unique consent form. I am comfortable with the relative risk reduction achieved with the use of intracameral antibiotics3 and adequate postoperative antiinflammatory therapy.

To take yesterday as a typical surgery day, my schedule started with a bilateral phakic IOL implantation in a high myope. Avoiding the imbalance that comes with anisometropia is a huge benefit to patients with high myopia. A few cases later, I performed bilateral laser-assisted cataract surgery (LACS) in a patient who was nightmarishly afraid of surgery. This patient had been actually tremulous during the slit-lamp examination at his initial consultation. Multiple teleconferences with the patient, his wife, and the anesthesiologist were required. We finally collectively agreed that bilateral same-day surgery would make the most sense to avoid the need for a second surgical encounter. It all went fine.

I finished the day with bilateral lens exchange surgery in a 53-year-old truck driver with 6.50 D of refractive with-the-rule cylinder. This patient was not a candidate for keratorefractive surgery. He flew into town for his consultation and planned to do the same for the surgery. After a lengthy discussion regarding all options, we decided to proceed with bilateral refractive laser-assisted lens exchange with arcuate incisions and toric IOL placement, with the understanding that his need for reading glasses would persist. Postoperatively, at his 90-minute visit, his UCVA was 20/25 in the right and left eyes. He left the office ecstatic and looked forward to driving his big rig back into town the following week for his postoperative visit, without the need for his glasses and with his father (who is also interested in surgery) along for the ride.

My decision to offer same-day sequential refractive lens-based surgery has been well received by patients. By paying careful attention to the principles that are intended to reduce complications in same-day bilateral cataract surgery, I remain comfortable that I am putting my patients on the path toward an easier recovery without compromising quality or safety.

1. Meuleners LB, Fraser ML, Ng J, Morlet N. The impact of first- and second-eye cataract surgery on injurious falls that require hospitalization: a whole-population study. Age and Ageing. 2014;43:341-346.

2. Brown GC, Brown MM, Menezes A, Busbee BG, Lieske HB, Lieske PA. Cataract surgery cost utility revisited in 2012: a new economic paradigm. Ophthalmology. 2013;120:2367-2376.

3. Arshinoff S, Bastianelli P. Incidence of postoperative endophthalmitis after immediate sequential bilateral cataract surgery. J Cataract Refract Surg. 2011;37:2105-2114.

Jonathan D. Solomon, MD
• Surgical/Refractive Director of Solomon Eye Associates, Bowie, Maryland
• Financial disclosure: None