|
The primary indication for surgery is when vision impaired by cataract
no longer meets the patient's needs and surgery provides a reasonable
likelihood of improved visual function. Cataract removal is also indicated
when there is evidence of lens-induced disease (e.g., phakomorphic
glaucoma, phakolytic glaucoma, etc.) or when it is necessary to visualize
the fundus in an eye that has the potential for sight (the latter includes
a diabetic patient who is at risk of visual loss from retinopathy or other
special investigations that demonstrate intraocular pathology, both of
which require clear media for optimal management).
Benefits of Second-Eye Surgery
Cataract surgery in both eyes is an appropriate treatment for patients
with bilateral cataract-induced visual impairment in order to restore
binocular vision. Three studies comparing the outcomes of first- and
second-eye surgeries after extracapsular cataract extraction concluded
that patients who underwent surgery in both eyes had greater improvement
in functional status than did those who underwent surgery in one eye,1-3
and another study demonstrated improved binocular function and ability to
meet a driving standard.4 Patients who had surgery in both eyes also have
been shown to have statistically significant improvement in satisfaction
with vision than patients who had surgery in only one eye.2 Another study
demonstrated that the cataractous eye interfered with the function of the
pseudophakic eye, and after surgery on the second eye, multiple complaints
of visual disability were eliminated.5
Timing
Consideration of the appropriate interval between the first-eye surgery
and second-eye surgery is influenced by several factors: the patient's
visual needs, the patient's preferences, visual acuity or function in the
second eye, the medical and refractive stability of the first eye, the
need to develop binocular vision and the presence of symptomatic
anisometropia as well as logistical concerns of the patient in traveling
back and forth to the physician's office. The patient and ophthalmologist
should discuss the benefit, risk and timing of second-eye surgery when
they have had the opportunity to evaluate the results of surgery on the
first eye.
Conclusion
Patients receiving second-eye surgery experience significant
improvement in visual function. The indication for second-eye surgery is
the same as for the first eye. Prior to performing surgery on the second
eye, the patient's first eye should have a stable postoperative refraction
and the patient should perceive improved function, and sufficient time
should have elapsed to evaluate and treat early postoperative
complications, such as endophthalmitis. In addition, the patient needs
sufficient time to assess the results of his or her first-eye surgery to
determine the need and appropriate timing for surgery in the second eye.
References
- Javitt JC, Brenner MH, Curbow B, et al: Outcomes of cataract
surgery-improvement in visual acuity and subjective visual function
after surgery in the first, second, and both eyes. Arch Ophthalmol
1993; 111:686-91.
- Javitt JC, Steinberg EP, Sharkey P, et al: Cataract surgery in one
eye or both: a billion dollar per year issue. Ophthalmology
1995; 102:1583-93.
- Cassells X, Alonso J, Ribo C, et al: Comparison of the results of
first and second cataract eye surgery. Ophthalmology 1999; 106:676-82.
- Talbot EM, Perkins A: The benefit of second eye cataract surgery. Eye
1998; 983-9.
- Laidlaw A, Harrad R: Can second eye cataract extraction be
justified? Eye 1993; 7:680-6.
|
