Immediate Versus Delayed Sequential Bilateral Cataract Surgery: A Systematic Review

Objective: To compare the visual outcomes, safety, and patient-reported outcomes of ISBCS versus DSBCS in adults undergoing cataract surgery. Evidence Review: A systematic search of PubMed, Embase, CENTRAL, Web of Science, and gray literature (conference abstracts, registries) was conducted for studies published up to March 2023. Eligible studies directly compared ISBCS and DSBCS in adults, reporting best corrected visual acuity (BCVA), complications, or patient-reported outcomes. Two reviewers independently screened studies, extracted data, and resolved discrepancies by consensus. Findings: Nine studies were included (3 randomized controlled trials, 5 retrospective cohorts, 1 review), encompassing sample sizes ranging from 298 patients to over 496,000 eyes. Both ISBCS and DSBCS resulted in significant improvements in BCVA, with comparable refractive accuracy. No significant differences were observed in serious complications such as endophthalmitis, cystoid macular edema, or posterior capsular rupture. Some studies reported a trend toward slightly higher patient satisfaction and faster rehabilitation in the ISBCS group. Conclusions and Relevance: ISBCS appears to be a safe and effective alternative to DSBCS in carefully selected patients, offering potential benefits in efficiency, recovery time, and patient satisfaction. Rigorous randomized controlled trials with standardized outcome measures and long-term follow-up are needed to further validate these findings.