OBJECTIVE Simultaneous bilateral extracapsular cataract extraction (SBCE) is not routinely performed in the developed world. This study investigated the safety and efficacy of this procedure as performed in the UK. METHODS A review of 319 consecutive patients (638 eyes) who underwent SBCE with posterior chamber intraocular lens implantation is presented. RESULTS The incidence of intraoperative complications was 7.7%. These included posterior capsule rupture (0.8%) and vitreous loss (0.3%). Postoperative complications were seen in 8.7% of operated eyes and included iris prolapse (0.3%) and raised intraocular pressure (3.0%). Endophthalmitis occurred in one eye (0.15%). There were no major bilateral complications, and, in particular, no cases of bilateral endophthalmitis. Final visual acuities compared favourably with reports for unilateral surgery. Eighty two per cent achieved a final visual acuity of 6/12 or better, and 41% tested 6/6 or better. CONCLUSIONS This study illustrates that SBCE is not associated with an increased incidence of complications and that the visual results are good. Where indicated, and under strict surgical protocol, this procedure is safe.