OBJECTIVE To assess the visual outcome and safety of simultaneous bilateral cataract extraction. METHODS Department of Ophthalmology, Queen's Hospital, Burton on Trent, Staffordshire, United Kingdom. METHODS Simultaneous bilateral cataract extraction was performed in 288 eyes of 144 patients over 10 years in a single department in selected cases. Case notes were retrospectively analyzed for final best corrected visual acuity (BCVA) and intraoperative and postoperative complication rates. RESULTS The final BCVA was 6/9 or better in 87.0% of eyes. The incidence of intraoperative complications was 2.42%. These included posterior capsule rupture without vitreous loss (0.69%) and with vitreous loss (1.04%). Postoperative complications occurred in 10.05% of eyes and included raised intraocular pressure (IOP) (3.82%), iris prolapse (0.69%), uveitis (0.69%), and suture abscess (0.35%). There were no major bilateral complications such as endophthalmitis or corneal decompensation. CONCLUSIONS The outcome of simultaneous bilateral cataract extraction was comparable to that of single-eye cataract surgery, indicating that the procedure is safe under strict surgical protocol and beneficial in selected cases.