title: Predictability of refraction following immediate sequential bilateral cataract surgery (ISBCS) performed under general anaesthesia.
abstract: BACKGROUND
  To evaluate the predictability of refraction following immediate sequential bilateral cataract surgery (ISBCS) performed under general anaesthesia.
  
  
  METHODS
  This is a retrospective review of all ISBCS performed at Kantonsspital Winterthur, Switzerland, between April 2000 and September 2013. The case notes of 250 patients were reviewed. Patients having full refraction reported (110 patients/220 eyes) were included. 210 (95 %) eyes had a straight forward phacoemulsification with posterior chamber intraocular lens implantation, seven eyes had a planned extracapsular cataract extraction (ECCE); three eyes had an intracapsular cataract extraction.
  
  
  RESULTS
  Both eyes of 110 patients (64 women, 46 men) with a mean age of 79.0 years, standard deviation (SD) ±11.4 (range 26 to 97 years) were included. Median preoperative best corrected visual acuity (BCVA) was 0.5 LogMAR in the first eye, the interquartile range (IQR) was [0.4, 1.2]; 0.7 LogMAR in the second eye with IQR [0.4, 1.8]. At one month, the median BCVA was 0.2 LogMAR, IQR [0.1, 0.3] in the first eye, median BCVA was 0.1 LogMAR and IQR [0.0, 0.5] in the second eye. There were 3 eyes (3 %) that lost 3 lines or more in BCVA at one month (control vs. pre-operatively). In all three cases, poor visual acuity had been recorded pre-operatively (>1 LogMAR). Achieved refraction was within ±1.0 D of the target in 83 % of eyes. There were only 5 % (n = 6) of cases where if delayed sequential bilateral extraction had been performed could potentially intraocular lens (IOL) choice have been adjusted, in four of these cases, target refraction was within ±1.0 D in the second eye.
  
  
  CONCLUSIONS
  ISBCS performed under general anaesthesia achieves target refraction in 83 % of eyes after consideration of complications, ocular co-morbidities and systemic restrictions. In the majority of cases where IOL power calculation could be considered, the achieved refraction of the second surgical eye was within ±1.0 D of intended refraction. This undermines the utility of IOL power adjustments in the second surgical eye.
authors.affiliation: Jules Gonin Eye Hospital, Foundation Asile des Aveugles, University of Lausanne, Avenue de France 15, 1000 Lausanne 7, Vaud Switzerland ; Department of Ophthalmology, Kantonsspital Winterthur, Zürich, Switzerland.
authors.forename: Ivo
authors.initials: I
authors.lastname: Guber
authors.affiliation: Department of Ophthalmology, CHU of Liège, University of Liège, Liège, Belgium.
authors.forename: Laurent
authors.initials: L
authors.lastname: Rémont
authors.affiliation: Jules Gonin Eye Hospital, Foundation Asile des Aveugles, University of Lausanne, Avenue de France 15, 1000 Lausanne 7, Vaud Switzerland.
authors.forename: Ciara
authors.initials: C
authors.lastname: Bergin
keywords: Cataract; Cataract surgery; Immediate sequential bilateral cataract surgery