Outcome of patients undergoing immediate sequential bilateral vitreoretinal surgery
Reviewed by Sofia Rokerya

This was a multicentre retrospective review of a case series from patients undergoing immediate sequential bilateral vitreoretinal surgery (ISBVS). A proforma was circulated to ophthalmic surgeons across the UK for cases of this rarely performed approach to collate indications, operative approach and postoperative results. The cohort comprised of 17 patients (34 eyes) that underwent ISBVS at 8 centres. Ten of the cases had rhegmatogenous retinal detachments, 5 cases had proliferative diabetic retinopathy, 1 case had vitreous haemorrhage/tractional detachment, and 1 case had full-thickness macular hole. Principal pathology was the same bilaterally in each patient. Age of the patients ranged from 18–72 years, and 8 patients were females. Preoperative vision was 6/60 or worse bilaterally in 9 patients. Indications for bilateral surgery included bilateral disease requiring immediate surgical intervention, high-risk general anaesthetic, anticipated difficulty with follow-up, convenience in postoperative care and patient preference. The most frequently cited reason for ISBVS was to avoid delay to treatment. Concerns regarding risk from geographic atrophy ranked second. One case combined sclera buckle in 1 eye with vitrectomy in the fellow eye. Three cases had bilateral scleral buckling, and 1 case had bilateral phaco-vitrectomies. Air was used for tamponade in 11 eyes. In 1 case, silicone oil was used in 1 eye with no tamponade required in the fellow eye. Long-acting gas in both eyes was only used in 1 case. Vision improved in 22 eyes, remained the same in 2, and eyes had deterioration of vision of 2 lines or more. Postoperative complications included 4 eyes with elevated intraocular pressure, 3 with vitreous haemorrhages, 1 had cystoid macular oedema, and 1 developed a macular fold. One eye required re-operation for non-clearing vitreous haemorrhage. No incident of endophthalmitis was recorded. The study concluded that ISBVS is a useful approach which is currently underutilised. It does offer significant potential advantages in terms of reducing the risks from repeated anaesthesia, progression of disease due to delay and overall benefits to patients for recovery and follow-up. Although this case series illustrates the feasibility of ISBVS as a treatment option, clinical wisdom dictates that each case be tailored according to the situation at hand. Limitations: the small cohort makes risk assessment difficult. This study lacks comparison to global data.

Indications and outcomes of patients undergoing immediate sequential bilateral vitreoretinal surgery: a case series.
Simpson AI, Gigona A, Whitlow S, et al.
OPHTHALMOLOGICA 
2025;248:326–31