Manual small incision cataract surgery for mature cataracts

Abstract

To the Editor,We congratulate DeCroos et al. [1] for their interesting article describing the outcomes of resident-performed manual small incision cataract surgery (MSICS) and would like to discuss in greater detail the usefulness of MSICS for cataract surgeons of all levels of experience. While phacoemulsification is commonly performed in developed countries, MSICS has been reported to be cost-effective in developing countries as the technique is less dependent on technology, and faster and cheaper than phacoemulsification [2]. Speed and cost-efficiency is vital in developing countries as cataract surgery capacity is limited by the severe shortage of ophthalmic surgeons and MSICS avoids the costs, maintenance and disposal costs associated with phacoemulsification [2]. MSICS has proven to be an efficacious method for mature cataract extraction [3]. In the study by DeCroos et al. [1] although the surgeries were performed by residents, 87.5 % of patients achieved a best-corrected visual acuity (BCVA) of [20/40 at final follow-up. This is comparable to other studies where the surgery was performed by senior surgeons (range 83.8–97.1 %) [3]. The benefits of MSICS are most clearly seen among patients with advanced cataracts. Studies have reported that for mature cataracts, phacoemulsification may be associated with a greater risk of posterior capsule rupture, endothelial cell loss and incision complications such as wound burns [4]. In contrast, MSICS has been shown to be efficacious and safe even in complicated mature cataracts such as phacolytic glaucoma [5], and brunescent and white cataracts [2, 6]. In a study of 33 patients with phacolytic glaucoma, Venkatesh et al. [5] showed no sightthreatening complications such as expulsive haemorrhage and posterior capsule rupture with 60.6 % of patients achieving a BCVA of C20/40. In other studies on patients with brunescent and white cataracts, the authors reported low complication rates and a large number of patients achieved good visual acuity (97.1 and 87.9 %, respectively) [3, 6]. In summary, we congratulate the authors for investigating the safety and efficacy of residentperformed MSICS and agree with their comments on the utility and practicality of MSICS for mature cataracts in developing countries. The authors have no financial or proprietary interests in the subject of this correspondence.