Same-day cataract surgery should be the standard of care for patients with bilateral visually significant cataract.

Same-day, or immediately sequential, bilateral cataract surgery (ISBCS) is being practiced with increasing frequency worldwide. It provides many advantages including convenience for the patient and the patient's family. ISBCS repairs the visual system, not merely one eye, restoring normal binocularity as well as unilateral clarity, creates a much more relaxed surgical atmosphere in harried operating rooms, and saves money for society. It is often preferred by busy professionals. The purported risks of ISBCS have been unsupported by the literature, including bilateral retinal detachment, bilateral corneal decompensation, bilateral diabetic macular edema, bilateral severe cystoid macular edema, significant IOL power errors in the first eye that could be refined and thereby prevented in the second eye, and toxic anterior segment syndrome. The greatest fear of ISBCS has been possible simultaneous bilateral endophthalmitis, which did not occur in a series of nearly 100,000 ISBCS cases and has only occurred elsewhere when complete separation of the two eyes and strict sterile protocol were not followed. The International Society of Bilateral Cataract Surgeons (www.isbcs.org) has prepared the "iSBCS General Principles for Excellence in ISBCS," which should be followed for safe ISBCS.