Dear Editor,We read with interest the article ″Bilateral Pseudomonas
aeruginosa endophthalmitis following bilateral simultaneous
cataract surgery″ by Kashkouli et al.1 It is without doubt that
in today′s modern fast-paced world, the relevance of bilateral
simultaneous cataract surgery (BSCS) will inevitably become
more prominent, with some centers conducting BSCS in 40% of
their cataractpatients.2 We would like to add a few comments
to the above article.Although there has been much debate on BSCS, as alluded
to by the authors in their report, we would like to highlight
the proven viability of BSCS. Arshinoff et al., reported the
largest BSCS series with 2040 eyes operated on from 1996
to 2002.3 The results of their series were promising with few
complications, none of which could have been attributed to
the procedure being done bilaterally as opposed to one eye
operated on in one session. In the United Kingdom, one of
the earlier studies by Beatty et al. supporting the viability of
BSCS also showed promising results with no cases of bilateral
endophthalmitis.4 This study included 638 eyes with a final
best corrected visual acuity of 20/40 or better seen in 82.1%
of the patients, the remainder having preexisting ophthalmic
conditions attributing to the poor visual acuity outcome.We strongly affirm the authors′ comment that ″the surgeon
needs to consider the other eye cataract surgery as a
separate surgery.″ In the above studies which highlighted
the viability of BSCS,2-4 each operation was considered
as two separate procedures. The surgeons used different
instruments and fluids (ophthalmic viscosurgical devices
and balanced salt solutions) for each eye.Should bilateral blindness result in a patient, the effect
on the patient′s quality of life (QoL) is clearly magnified,
compared to a patient with unilateral blindness. Although
in the Beatty et al. study there were no cases of bilateral
endophthalmitis, one case of unilateral endophthalmitis
was reported which necessitated enucleation of that eye.4
It is very fortunate that they did not encounter bilateral
endophthalmitis, with the frightening possible outcome
of bilateral enucleation. Obviously, the greatest risk in
BSCS is the risk of bilateral blindness that has tremendous
detrimental effects on the patient′s QoL. Vu et al., showed
that those with non-correctable bilateral vision loss were
associated with an odds ratio of 5.81 in the perception
of health and emotional problems arising from extreme
interference with normal social activities (compared
to those with normal vision), whilst those with non-
correctable unilateral vision loss were associated with an
odds ratio of 2.33.5 They also showed that the odds ratio
of a bilaterally blind patient (compared to a patient of
normal vision) being placed in a nursing home was 14.8;
in contrast, those with unilateral blindness were found to
have an odds ratio of 2.92. The drastic effects of bilateral
blindness on a patient′s QoL must therefore prompt a
surgeon considering BSCS to be very cautious in his
decision to perform the operation, as well as ensuring that
the patient considering BSCS should be fully informed of
the real (although small) risk of bilateral blindness and its
significantly deleterious effects on their QoL.