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Immediately Sequential Bilateral Cataract Surgery (ISBCS) Adapted Protocol During COVID-19

Article Title:

Immediately Sequential Bilateral Cataract Surgery (ISBCS) Adapted Protocol During COVID-19: Quality Improvement Initiative

Background information:

The COVID-19 pandemic has led to increased waitlists for cataract surgery due to a reduced number of elective surgeries being performed. This study evaluated immediately sequential bilateral cataract surgery (ISBCS) as a possible way to provide timely and safe care by increasing surgical volumes and reducing the number of patient hospital visits. The current standard of care in North America is delayed sequential bilateral cataract surgery (DSBCS), however, with increasing evidence from multiple RCTs, many countries are considering ISBCS to be equally safe and effective. Possible concerns of ISBCS include the risk of postoperative infection (endophthalmitis) and bilateral toxic anterior segment syndrome (TASS).

What are the takeaway points from this article?

The Department of Ophthalmology at the University of Alberta assembled a multidisciplinary team to establish a new standard of practice for cataract surgery. Considering stakeholder concerns, perspectives, and a growing body of literature, they outlined the potential contraindications to ISBCS, the ideal candidates for ISBCS, and the consent process for ISBCS.

Of the 406 patients that underwent ISBCS during this study in 2020, there were no reported cases of endophthalmitis or TASS. As well, surgical volumes increased by 25%, hospital, clinic, and pharmacy visits decreased by 50%, and waitlists decreased. Other benefits include less time off work for patients and caregivers, faster restoration of binocular vision and return to driving, and less confusion in eye drop regimen.

ISBCS appears to be beneficial to both patients and the healthcare system. The authors propose ISBCS as an effective solution to reduce surgical wait times in a safe, low risk, and cost-effective manner.


Simrenjeet Sandhu MD, Daisy Liu MD, Pamela Mathura MBA, Mathew Palakkamanil, MD, Khaliq Kurji, MD, FRCSC, Christopher J. Rudnisky, MD, FRCSC, Kam Kassiri, MD FRCSC. Immediately Sequential Bilateral Cataract Surgery (ISBCS) Adapted Protocol during Covid 19: quality improvement initiative, Canadian Journal of Ophthalmology/Journal canadien d’ophtalmologie (2021), doi:

Article Published: November 8, 2021

Summary by: Desiree Naude


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