Immediate sequential vs. delayed sequential bilateral cataract surgery: a systematic review and meta-analysis.

The main aim of this Systematic Review and Meta-analysis was to evaluate the safety and efficacy profile of immediate sequential bilateral cataract surgery (ISBCS) compared to delayed sequential bilateral cataract surgery (DSBCS). MEDLINE Ovid, EMBASE, and CENTRAL databases were searched. Outcome measures were post-operative visual acuity, post-operative spherical equivalent (refractive outcome), endophthalmitis, corneal edema, pseudophakic macular edema and posterior capsule rupture. Thirteen articles met criteria for final inclusion. A total of 11,068,622 participants (18,802,043 eyes) were included. No statistically significant differences between ISBCS or DSBCS was identified in all the postoperative outcomes evaluated. However, a higher risk for posterior capsule rupture was identified in the ISBCS group from the pooled analysis of NRSs (RR: 1.34, 95% CI: 1.08 - 1.67, p = 0.0081). In our view, the ISBCS approach has an acceptable safety-efficacy profile, comparable to DSBCS. Future investigations are warranted, with a focus on the analysis of risk factors for surgical complications, patient-reported outcome-measures, and cost effectiveness.