Pediatric bilateral cataract imposes a substantial global ophthalmic burden, with repeated general anesthesia for staged surgery raising unique developmental and systemic risks in young children. Multiple clinical studies have confirmed that recurrent anesthesia exposure in pediatric populations is associated with an increased risk of developmental delay, highlighting the urgent need to optimize surgical strategies to minimize anesthetic episodes. Although ISBCS can consolidate two separate operations into a single anesthesia session, widespread adoption in pediatric cataract care has long been limited by theoretical concerns of bilateral endophthalmitis, toxic anterior segment syndrome, and other catastrophic complications, despite emerging evidence supporting its clinical benefits.

Based on PRISMA 2020 guidelines and registered with PROSPERO, the present meta-analysis included four eligible studies covering 224 pediatric bilateral cataract patients across multiple geographic regions. Quantitative results revealed that ISBCS reduced operating room time by an average of 34.69 min per case, while the actual surgical procedure time remained comparable between the two approaches. No significant differences were observed in intraoperative iris injury or anesthesia-related complications, no statistically significant difference was detected. Notably, children undergoing ISBCS presented a significantly lower incidence of postoperative glaucoma, with 66% reduced odds compared with the DSBCS group, representing a signal of lower postoperative glaucoma odds that requires confirmation.

This study provides preliminary pooled evidence that ISBCS is a potentially efficient option for appropriately selected children to conventional DSBCS for pediatric bilateral congenital cataracts. By eliminating a second anesthesia induction and reducing hospital resource occupancy and follow-up burden, ISBCS benefits both pediatric patients and healthcare systems, particularly in high-volume or resource-limited centers. Given existing study heterogeneity and limited prospective long-term data, further large-scale, multicenter trials with standardized protocols are warranted to establish unified clinical guidelines for pediatric ISBCS patient selection, surgical procedures, and postoperative management.

The work titled “Safety and Perioperative Outcomes of Immediate Versus Delayed Sequential Bilateral Cataract Surgery in the Pediatric Population: A Systematic Review and Meta-Analysis”, was published on Eye & ENT Research (published on April 27, 2026).
DOI：10.1002/eer3.70038