Safety and Perioperative Outcomes of Immediate Versus Delayed Sequential Bilateral Cataract Surgery in the Pediatric Population: A Systematic Review and Meta‐Analysis

ABSTRACT Background Bilateral congenital cataracts are a major cause of preventable childhood blindness. Although delayed sequential bilateral cataract surgery (DSBCS) has traditionally been the preferred approach, immediate sequential bilateral cataract surgery (ISBCS) is increasingly being considered to reduce anesthesia exposure and healthcare burden. Method We performed a systematic review and meta‐analysis on four studies involving 224 patients. A comprehensive literature search was conducted on PubMed, Embase, Cochrane Library, and ScienceDirect. Analysis was conducted on RevMan 5.4. Moreover, the risk of bias was assessed via RoB 2.0. The primary outcomes were operating room (OR) time, procedure time, anesthesia‐related complications, number of follow‐up visits, and incidence of postoperative glaucoma. Results ISBCS was associated with significantly shorter OR time compared with DSBCS (mean difference, −34.69 min; p < 0.001). There were no significant differences in procedure time or anesthesia‐related complications between groups. Postoperative glaucoma incidence was significantly lower in the ISBCS group (odds ratio, 0.34; p = 0.02). Follow‐up visit burden was comparable between the two approaches. Conclusion In pediatric patients with bilateral congenital cataracts, ISBCS was associated with reduced OR time and a lower risk of postoperative glaucoma without increasing intraoperative risks. These findings support the consideration of ISBCS as a safe and effective surgical option in appropriately selected pediatric cases. However, these results should be considered with caution due to heterogeneity and lack of prospective cohort studies and further research in this field is warranted.