Immediate Sequential Bilateral Cataract Surgery: A Systematic Review and Meta-Analysis

Table 4

Quality assessment and summary of findings.

Outcomes	Number of participants (studies); Follow-up	Quality of the evidence; (GRADE)	Relative effect; (95% CI)	Anticipated absolute effects
				Risk with bilateral surgery on different days	Risk difference with immediate sequential bilateral cataract surgery (95% CI)
Any postoperative complications	2613; (2 studies)	⊕⊕⊝⊝; Low^1,2; Due to risk of bias and inconsistency	RR 0.76; (0.55 to 1.07)	142 per 1000	34 fewer per 1000 (from 64 fewer to 10 more) patients were diagnosed with any postoperative complication in the ISBCS group
Serious postoperative complications	2613; (2 studies)	⊕⊝⊝⊝; Verylow^1,2,3; Due to risk of bias, inconsistency, and imprecision	RR 1.63; (0.55 to 4.78)	9 per 1000	6 more per 1000 (from 4 fewer to 35 more) were diagnosed with a serious postoperative complication in the ISBCS group
Subjective visual function test; (VF-7 or VF-14 questionnaire)	2096; (2 studies)	⊕⊕⊕⊝; Moderate^1; Due to risk of bias			The mean subjective visual function (VF-7 or VF-14 questionnaire) was 0.01 standard deviations higher (0.47 lower to 0.48 higher) in the group randomized to ISBCS

The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; RR: risk ratio; ISBCS: immediate sequential bilateral cataract surgery; VF: visual function.
GRADE working group grades of evidence are as follows.
High quality: further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: we are very uncertain about the estimate.
¹Studies were not blinded to outcome assessment.
²Very large differences between studies in the reported rates of complications.
³Studies do not have the sufficient size to reliably assess the number of serious but rare complications (e.g., endophthalmitis).