Comparison of clinical outcomes, cost, and patient perceptions between delayed and immediate sequential bilateral cataract surgery in Thailand: a retrospective case-control study.

Abstract

Purpose: To compare clinical outcomes, complication rates, costs, and patient perceptions-encompassing satisfaction, anxiety, pain, and visual function-between delayed sequential bilateral cataract surgery (DSBCS) and immediately sequential bilateral cataract surgery (ISBCS) in Thailand.

Setting: King Chulalongkorn Memorial Hospital (KCMH) and Sukhumvit Hospital, Bangkok, Thailand.

Methods: A retrospective comparative study was performed, including 201 adult patients (402 eyes) who underwent DSBCS (n = 99) or ISBCS (n = 102), performed by a single surgeon between January 2016 and December 2023. Patient perceptions were assessed through structured interviews.

Results: No major intraoperative or postoperative complications-including posterior capsule rupture or endophthalmitis-were observed in either group. Postoperative visual acuity (LogMAR) and refraction within ±0.5D of target were comparable between groups (61.6% DSBCS vs 65.5% ISBCS, p = 0.485). ISBCS patients reported significantly higher anxiety scores (median 3 vs 2, p = 0.002) and lower satisfaction scores (median 8 vs 10, p < 0.001) than DSBCS patients. ISBCS patients also reported significantly higher pain during surgery (p < 0.001). DSBCS patients demonstrated greater improvement in near visual function, specifically reading (median improvement 3 vs 2, p = 0.021) and computer use (p < 0.001). The total healthcare cost was significantly higher for DSBCS (USD 1,624 [IQR 1,492-4,029]) compared to ISBCS (USD 1,012 [IQR 910-1,839]) (p < 0.001).

Conclusion: Safety and efficacy outcomes were equivalent for DSBCS and ISBCS. However, ISBCS patients reported higher anxiety, greater pain during surgery, and lower satisfaction compared to DSBCS. DSBCS patients demonstrated greater improvement in near visual function. The overall cost was significantly lower for ISBCS, a finding consistent across both government and private hospital settings. These results highlight the need for interventions to reduce perioperative anxiety and pain in ISBCS patients, and provide Thai-specific evidence to inform healthcare policy decisions regarding the wider implementation of ISBCS.