Orient Journal of Surgical Sciences
Vol 2[1] Jan - Dec, 2021

original article





Ndulue OI (MBBS)2, Uba-Obiano CU (MBBS, FMCOph)1


1Guinness Eye Centre Onitsha,

PMB 1534 Onitsha, Anambra State, Nigeria.


2Ebony Eye Specialist Clinic Onitsha.

Author for Correspondence: sabenwosu@gmail.com


Nwosu SNN, Ndulue OI, Uba-Obiano CU.


Unilateral Versus Simultaneous Bilateral

Cataract  Surgery  In  A  Nigerian  Eye

Hospital.  Orient  Journal  of  Surgical

Sciences. Vol. 2. January - December 2021: Page 14 - 19


Objective: To compare the outcome of unilateral versus bilateral simultaneous cataract surgery at the Guinness Eye Center Onitsha, Nigeria.
Materials and Methods: The visual outcome and complications rates in patients who had bilateral simultaneous cataract surgery (BSCS) intraocular lens implant between 01 January, 2014 and 31 December, 2016 and had been followed up for 6 months were compared with those who had unilateral cataract surgery (UCS) within the same period. Information on socio-demographic characteristics, domicile, pre-operative visual acuity, visual acuity on last follow up, intra-operative complications, post-operative complications and causes of poor vision were analyzed.

Results: Thirty nine patients with bilateral simultaneous surgery and 142 with uniocular surgery were studied. The age range was 6 – 93 years, median – 66years. There were 104 males (57.5%). Pre-operatively 62 (79.5%) and 134 (94.4%) eyes had visual acuity <3/60 in bilateral and uniocular surgery patients respectively. Post-operatively, 36 (46.1%) and 60 (42.3%) eyes of bilateral and uniocular surgery patients respectively had unaided acuity ≥6/18. Post-operative acuity significantly improved in both unilateral (X2 = 9.626; p<0.05) and bilateral (X2 = 9.556; p<0.05) surgeries. However, there was no statistically significant difference in the improvement in visual acuity between unilateral and bilateral surgeries (X2 = 0.562; p>0.05)
Intra-operatively, vitreous loss occurred in one (1.3%) BSCS and 2 (1.4%) UCS patients. Post-operatively posterior capsule opacification occurred in 10(12.8%) and 22 (15.5%) eyes of bilateral and uniocular surgery patients respectively. Recurrent uveitis occurred in 8 (10.3%) and 13 (9.2%)eyes of bilateral and uniocular surgery patients respectively. Post-operative endophthalmitis occurred in one (0.7%) eye of a uniocular surgery patient.


Conclusion: Simultaneous bilateral cataract extraction with intraocular lens implant has visual outcome and complication rate similar to those of uniocular surgery. It should be recommended for patients who do not want staged surgery and those who cannot afford long hospital admission.



Cataract is the commonest cause of blindness in Nigeria.1 Cataract accounts for 50% of blindness in Nigeria - about 500,000 persons in immediate sight restoration surgery1. Cataract affects all ages although age-related cataract is more prevalent in the elderly. This disease occurs equally in both males and females without any sex predilection. Many cataract blind patients reside in underserved communities.


Surgery is, for now, the confident method of restoring vision in the cataract blind. Cataract surgery with intraocular lens implant ensures better post-operative visual rehabilitation. For fear of severe complications such as endophthalmitis, it is often advised that cataract surgery be performed on a uniocular basis.2,3 The 2011 American Academy of Ophthalmology preferred practice pattern of cataract in an adult eye further cautioned that where it is intended to perform bilateral simultaneous cataract surgery, the pros and cons of the procedure should be carefully discussed with the patient.2


Indeed bilateral simultaneous cataract surgery (BSCS) has been the subject of extensive debates in developed countries where phacoemulsification via small clear corneal incision is the standard surgical technique4-6 

Nevertheless, there may be many compelling reasons for performing BSCS especially in developing countries. These include late presentation of many patients with bilateral hypermature cataract, the inability of many patients to afford both the direct and indirect costs of prolonged hospital stay. In developing countries including Nigeria, health facilities with capability of intraocular surgery are often located in the urban areas far from the rural abode of many patients.


The Guinness Eye Center Onitsha is the only publicly-owned eye hospital in Anambra State (population 4.1million by 2006 census). It offers comprehensive eye care services including medical, surgical and optical care as well as 24-hour emergency service. Elective surgeries are performed 4 days every week. Although other private eye clinics exist, it has the highest concentration of ophthalmic manpower and facilities in the State. It attends to patients from all over Nigeria and beyond although its immediate catchment area is Anambra and the adjoining states.


The present study is a retrospective comparison of outcome of unilateral versus bilateral simultaneous cataract surgery at the Guinness Eye Center Onitsha, Nigeria over a 2-year period.

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