Chapter 12 Identification of suitable patients for immediately sequential bilateral cataract surgery

Immediately sequential bilateral cataract surgery (ISBCS) should be undertaken only when high-quality standards regarding operation theater and sterility assurance routines are met. The ISBCS surgeon must be confident that the risk/benefit balance is to the patients' advantage and provide thorough information to the patient about the plan and risks, giving the patient the choice between ISBCS and DSBCS. The surgeon's all-type complications must be at an acceptably low level. Benchmarking with international peer-reviewed literature data and/or national quality register data is highly recommended. With these fundamental conditions met, the selection process for suitable ISBCS patients may begin. Everything possible is done to minimize the risk for bilateral vision-threatening complications, including, but not limited to, postoperative endophthalmitis (POE), corneal edema, cystoid macular edema (CME), retinal detachment, and IOL malposition. As a general remark, surgeons taking on their first ISBCS cases are advised to select patients with extra caution to avoid potentially complicating circumstances. With increased experience relative contraindications will decrease and be balanced against the evident advantages of ISBCS. This chapter contains some suggestions for selecting ISBCS cases when starting to implement this approach, as well as when more experience has been gathered.