Cost-effectiveness of ISBCS vs. DSBCS
Cost-effectiveness of ISBCS vs. DSBCS
The purpose of this study is to evaluate the effectiveness and costs of immediately
 sequential bilateral cataract surgery (ISBCS) compared to delayed sequential bilateral
 cataract surgery (DSBCS) in order to determine whether ISBCS is an effective and
 cost-effective alternative to DSBCS.
With an estimated number of 180,000 cataract extractions per year in the Netherlands,
 cataract surgery is one of the most frequently performed types of surgery. The majority of
 patients suffer from bilateral cataract and while cataract surgery of one eye is effective in
 restoring functional vision, second-eye surgery leads to further improvement in
 health-related quality of life.

 Currently, most patients undergo cataract surgery in both eyes on separate days as
 recommended in national guidelines, referred to as delayed sequential bilateral cataract
 surgery (DSBCS). An alternative procedure involves cataract surgery of both eyes on the same
 day, but as separate procedures, known as immediately sequential bilateral cataract surgery
 (ISBCS).

 Potential benefits of ISBCS include less time between surgeries, a faster total recovery
 period and lower costs. Potential risks, however, are complications of cataract surgery in
 general, most importantly the risk of endophthalmitis and refractive surprise. In ISBCS, both
 eyes are at risk at the same time, while in DSBCS both eyes are exposed to these risks
 consecutively.

 Since there is no consensus yet about the role of ISBCS in current regular practice, further
 investigation of functional and surgical outcomes and cost-effectiveness of ISBCS compared to
 DSBCS is required. Therefore, the purpose of this study is to evaluate the effectiveness and
 costs of ISBCS compared to DSBCS, in order to determine whether ISBCS is an effective and
 cost-effective alternative to DSBCS.
Inclusion Criteria:

 -  Bilateral cataract

 -  Indication for bilateral cataract surgery

 -  Expected uncomplicated surgery

 Exclusion Criteria:

 -  Inability to comply with study procedures or to complete follow-up / Dutch
 questionnaires.

 -  Non-routine cataract surgery

 -  Cognitive or behavioural conditions that might interfere with surgery

 -  Cataract surgery with premium IOL implantation

 -  Conditions that increase the risk of endophthalmitis (e.g. current
 ocular/adnexal/periocular infections, immune-compromised, iodine allergy)

 -  Factors that increase the risk of refractive surprise (e.g. axial lengths <21mm or
 >27mm, difference between eyes of >1.5mm, abnormal keratometry readings, previous
 refractive surgery)

 -  Conditions that increase the risk of corneal edema

 -  Factors that increase the risk of complicated surgery (e.g. previous surgery, trauma,
 anatomical abnormalities)

 -  Sight-threatening comorbidity, Glaucoma or IOP > 24mmHg, Uveitis, Diabetes with
 diabetic retinopathy and macular edema