Eight years of immediately sequential bilateral cataract surgery: temporal trends, visual outcomes, and safety in a tertiary teaching hospital.

BACKGROUND/OBJECTIVES: Immediately sequential bilateral cataract surgery (ISBCS) is increasingly adopted as an alternative to delayed sequential bilateral cataract surgery, offering potential benefits in patient convenience, healthcare efficiency, and avoidance of postoperative anisometropia. Despite growing evidence supporting its safety, concerns regarding bilateral complications and patient selection remain. METHODS: A retrospective observational study was performed of consecutive patients undergoing ISBCS at a tertiary ophthalmic centre in Ireland between January 2018 and June 2025. Demographic characteristics, perioperative data, visual and refractive outcomes, and intra- and postoperative complications were collected from electronic medical records. RESULTS: A total of 116 patients underwent ISBCS. The mean age was 72.0 ± 15.2 years, and 56.0% were female. Neurocognitive disorders were present in 31/110 patients (28.2%), while ocular comorbidity was identified in 83/131 eyes (63.4%) with available data. The proportion of cataract procedures performed as ISBCS increased significantly over the study period (p < 0.001), while the proportion of ISBCS patients with neurocognitive disorders declined significantly (odds ratio per calendar year 0.81, 95% CI 0.68-0.98; p = 0.030), reflecting expansion of the programme from a predominantly neurocognitive/general anaesthesia cohort to a broader patient population. Mean visual acuity improved significantly from 0.64 to 0.24 logMAR (p < 0.001), with 55% of eyes gaining more than 2 lines of vision. Posterior capsule rupture occurred in 2.7% of eyes and cystoid macular oedema in 4.1% of eyes undergoing postoperative OCT assessment. No cases of postoperative endophthalmitis were observed. Among eyes with postoperative refraction available, 51% were within ± 0.50 D and 81% within ± 1.00 D of target refraction. CONCLUSIONS: ISBCS demonstrated favourable visual and refractive outcomes with low complication rates, despite a cohort with a high proportion of patients with neurocognitive disorders, significant ocular comorbidities, and complex biometric characteristics. These findings support the selective use of ISBCS in appropriately counselled patients, while recognising that larger studies are required to evaluate the risk of extremely rare bilateral complications.