n South African Ophthalmology Journal - Immediately sequential bilateral cataract surgery: a possible solution for public sector cataract backlogs - research

Volume 14 Number 4
  • ISSN : 2218-8304


Introduction: Sebokeng Hospital is the only ophthalmic service provider for a population of 1 million people. One hundred cataract surgeries are performed per month and 80–100 new cataracts are booked per month, resulting in no reduction of the patient backlog. The study aimed to investigate whether simultaneous bilateral cataract surgery could decrease this backlog in the Sebokeng setting. Potential reasons include patients not being returned to the cataract booking pool for a second eye; and that bilateral surgery decreases turnover time in theatre resulting in more eyes operated on over a given period.
Method: A retrospective analysis was done on patients receiving bilateral cataract surgery versus single eye surgery. Hospital endophthalmitis rates had previously been ascertained as 0/990 for two years; theatre sterility and communications were also analysed. Theatre turnover time, number of cases performed per theatre list, number of patient visits, number of pharmacy visits, and complications were recorded.
Results: A total of 159 cataract surgery patients were analysed, of which 47 had immediately sequential bilateral surgery. The average waiting time from first consultation to first surgery was 8 months. The average total time of theatre from patient entry to exit was 7 min 51 sec faster per eye for simultaneous bilateral surgeries. For bilateral cases, there was a 30% increase in productivity per theatre day. Patients having each eye surgery performed separately waited an average of 16 months from the date booked for the first surgery to the second eye surgery being performed. No significant complications, including endophthalmitis, were noted in either the unilateral or bilateral cases.
Conclusions: The age-old belief that it is more beneficial to perform single eye surgery per patient as this provides a greater service to more patients does not reduce cataract backlogs or long-term patient benefit. Immediately sequential bilateral cataract surgery certainly has a place in controlled settings to assist and alleviate cataract backlogs. The service benefits include reduced patient waiting times, reduced costs to patient as a result of fewer hospital visits, and a reduced burden of sick leave for patients and their escorts bringing them to hospital. Reducing cataract backlogs is also essential to provide better overall service to patients and creates more theatre time for other surgeries, including glaucoma surgery.

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