Simultaneous bilateral intraocular surgery in children Sudha Nallasamy, MD, a,b Stefanie L. Davidson, MD, b Ivy Kuhn, MSN, CRNP, b Monte D. Mills, MD, b Brian J. Forbes, MD, PhD, b William V. Anninger, MD, b and Paul A. Stricker, MD c BACKGROUND Simultaneous bilateral intraocular surgery (SBIS), defined as sequential bilateral intraocu- lar surgery completed in one visit to the operating room, is a controversial topic. The re- luctance of ophthalmologists to perform SBIS has been mainly attributable to concerns about bilateral catastrophic complications (endophthalmitis, expulsive hemorrhage, or ret- inal detachment). Herein we report our experience with SBIS in children and review the literature. METHODS The medical records of 44 patients who underwent 48 cases of SBIS between 1994 and 2009 were reviewed. Of the 48 cases, 27 were bilateral cataract extractions, 1 including in- traocular lens placement; 21 were cases of bilateral glaucoma surgeries, including goniot- omy, trabeculotomy, and filtering tube placement. Bilateral surgeries were performed in one session under general anesthesia with strict aseptic separation of the 2 surgeries. RESULTS All but one of the cataract cases were performed in patients \1 year of age, and the majorit (15/27) were performed in patients #1 month of age. Postoperative complications included aphakic glaucoma (5 patients) and reproliferation of lens material (3 patients). The majority of patients who underwent glaucoma procedures were \1 year of age (19/21), with 4 of 21 \1 month of age. One eye developed hyphema that required anterior chamber wash out. There were no catastrophic complications from the surgery or anesthesia (death, asphyxia, cardiac or respiratory arrest, or seizures) in either group. CONCLUSIONS Simultaneous bilateralintraocularsurgery wasperformed safely in 48 cases during a 15-year period. In selected pediatric cases requiring bilateral intraocular surgery for glau- coma or cataract, SBIS may reduce risks related to anesthesia and delayed surgery. ( J AAPOS 2010;14:15-19) S imultaneous bilateral intraocular surgery (SBIS), de- fined as sequential bilateral intraocular surgery com- pleted in one visit to the operating room, although controversial, has been growing in popularity for adult pa- tients. 1 This growth is reflected in the American Academy of Ophthalmology Preferred Practice Pattern statements over the years. The 1996 statement did not mention simulta- neous bilateral cataract surgery in adults; the 2001 statement mostly cautioned against it. The 2006 statement discussed its advantages and disadvantages, suggesting that indications for SBIS included the need for general anesthesia, difficulty with travel and follow-up, and poor patient health; it also stressed the need for careful informed consent. 2 In children, the advantages to performing SBIS may in clude reducing the risk to the patient incurred from 2 se arate episodes of generalanesthesia and hospital stays, minimizing the risk of monocular stimulus deprivation a blyopia, reducing the cost of hospital expenses to the p tient, the hospital, and society, as well as time and risk the patientand family associated with traveling to and from the hospital. The reluctance of ophthalmologists to perform SBIS has been mainly attributable to concerns about bilateral catastrophic complications, such as endo thalmitis, expulsive hemorrhage, or retinal detachment. 3-16 SBIS has been performed in tens of thousands of adult p tients, 2,17 with rare reports of bilateral complications. 4,18-25 There are few reports of SBIS in children in the literatu with a total of 163 cases of bilateral cataract surgeries i dren up to 19 years of age and a similar number of case bilateral congenital glaucoma surgery (either goniotomy primarycombined trabeculotomy/trabeculectomy). 9-16,26 Only one paper 12 reports pediatric bilateral simultaneous cataract surgery performed in North America—a study o 16 patients, most of whom had systemic abnormalities may have increased their anesthetic risk. Although no bilateral catastrophic complications have been reported in the pediatric population to date, 9-16,26 it would be virtually impossible to obtain the number of pe diatric SBIS cases necessary to accurately assess the ris Author affiliations: a Scheie Eye Institute, Philadelphia, Pennsylvania; and b Division of Ophthalmology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; c Department of Anesthesiology, Children’s Hospital of Philadelphia Presented in part as a scientific poster at the 34th Annual Meeting of the American Association of Pediatric Ophthalmology and Strabismus, Washington, D.C., April 3, 2008. Submitted June 30, 2009. Revision accepted October 30, 2009. Reprint requests: William Anninger, MD, Department of Ophthalmology, Children’s Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA 19104 (email: anninger@email.chop.edu). Copyright Ó 2010 by the American Association for Pediatric Ophthalmology and Strabismus. 1091-8531/2010/$36.00 1 0 doi:10.1016/j.jaapos.2009.10.014 Journal of AAPOS 15