Extracapsular Cataract Extraction Group Research Articles

An economic evaluation of phacoemulsification and extracapsular cataract extraction in cataract surgery

Background/Aim. Cataract surgery is one of the most often performed surgical interventions. The predominant method in Western countries is phacoemulsification, while in developing countries, the extracapsular cataract extraction (ECCE) method remains popular. The aim of the study was to evaluate the cost-effectiveness of these two cataract surgery techniques from the provider?s perspective if operation complications were the outcome of the interest. Methods. The data were obtained from the Department of Ophthalmology of the General Hospital Krusevac during a one-year period. A total of 1,179 surgeries by five surgeons were performed. The cost-effectiveness was evaluated using the decision tree. All probabilities were calculated based on the likelihood of the occurrence during the study period. Only direct costs were considered, and values were taken from the documentation at the hospital and the official price list of health services. One- and two-way sensitivity analyses were performed. Results. The total cost per patient in the phacoemulsification group was 71,008.70 Serbian dinars (RSD), while the total cost in the ECCE group was 74,340.36 RSD. At the same time, phacoemulsification shows higher effectiveness than the ECCE method, with 87% and 57% of patients without complications, respectively. With these results, phacoemulsification was the dominant strategy compared to ECCE. The sensitivity analysis revealed that the results are sensitive to the number of performed operations per year. Conclusion. The phacoemulsification technique seems to be the preferred technique for cataract surgery. All the investment in phacoemulsification equipment and consumables is justified if the number of surgeries per year exceeds 350.

Cataract surgery outcomes: comparison of the extracapsular cataract extraction and manual small incision cataract surgery techniques.

Blindness and visual impairment are public health problems and constitute an important socio-economic burden in sub-Saharan Africa. Understanding the outcomes of cataract surgery will improve our knowledge of risk factors for poor outcomes. Previous studies have focused exclusively on the phacoemulsification technique with limited attention to the extracapsular cataract extraction (ECCE) and manual small incision cataract surgery (MSICS) techniques. To compare the cataract surgery outcomes between the ECCE and MSICS techniques. The study was an observational research design that used the LogMAR visual acuity (VA) chart, subjective refraction, slit lamp and ophthalmoscope to collect data. The participants were followed for a period of six-weeks post-surgery and outcomes were recorded. Data were presented using frequencies, percentages and means ± standard deviation. The sample included 101 participants, with a mean age of 66.32 ± 15.99 years. Fifty and 51 participants had undergone the ECCE and MSICS techniques respectively. Overall, one-hundred participants had poor pre-surgery VA and subjective refractions were generally not possible due to the severity of cataracts present. The mean aided post-surgery VA was 0.31 LogMAR and 0.13 LogMAR in the ECCE and MSICS groups respectively (p < 0.001). The mean post-surgery refractive astigmatism was similar in the ECCE (-2.06 D) and MSICS (-1.80 D) groups (p = 0.110). The spherical equivalence was approximately -0.50 D higher in the MSICS group, but not statistically significant (p = 0.330). Approximately one out of every five participants (n = 21) had post-surgery ocular complications such as corneal opacity and haziness as well as posterior capsular absence. The MSICS technique showed better post-surgery outcomes than the ECCE technique.

Comparative Study between Dryness Post Phacoemulsification and Post Extra Capsular Cataract Extraction

Abstract Purpose This study aims to detect and compare the severity and pattern of dry eye occurrence after phacoemulsification and extra capsular cataract extraction surgeries. Methods Twenty eyes of twenty patients in two groups, ten eyes planned for Phacoemulsification(phaco) and ten eyes planned for Extra Capsular Cataract Extraction (ECCE) enrolled in a prospective comparative study. All patients underwent full history taking and full ophthalmological clinical evaluation including (tear film meniscus height, Schirmer 1 test, tear break up time). Evaluations will be done one week before cataract surgery then three and six weeks after the surgery.Also, goblet cell count is measured twice, before and 6 weeks after the operation. Results After both Phaco, andECCE, the changes between means of pre-operative, 3 weeks and 6 weeks visits were significant in tear film meniscus height (p = 0.01) and were insignificant in both Schirmer 1 and tear break up time (p &amp;gt; 0.05). There was a significant deterioration after 3 weeks of surgery in tear film meniscus height followed by significant increase between 3rd and 6th weeks post-operative measurements (p = 0.01). There was a significant difference between the 2 groups in the total change of Schirmer 1 and tear break up time between the6th weeks and the pre-operative measure with more deterioration in group 2. There was no significant difference between the 2 groups in tear film meniscus height 6 weeks post operation.The deterioration in goblet cell count was significantly worse in the ECCE group (mean difference of -22.1±8.5 and was -7.5±5.1 in the phaco group), (p = 0.0005). Conclusions Phacoemulsification surgery may aggravate the signs and symptoms of dry eye and affect dry eye test values in patients in short-term but less than ECCE.

Efficacy of double-incision extracapsular cataract extraction in the treatment of hard-nucleus cataract with low corneal endothelial cell density

Objective: To discuss the efficacy and security of double-incision extracapsular cataract extraction (ECCE) in the treatment of hard-nucleus cataract with low corneal endothelial cell density. Methods: This was a retrospective case series study. Forty-six patients (47 eyes) with hard-nucleus cataract and low corneal endothelial cell density were enrolled at Shandong Eye Hospital from June 2009 to December 2018, including 22 males and 24 females, aged 50 to 74 (63.8±6.3) years. Preoperative corneal endothelial cell density was less than 1 000 cells/mm(2), and the cataract nuclear hardness was equal to or greater than grade IV. According to the surgical methods, the patients were divided into the single-incision ECCE group (24 eyes) and the double-incision ECCE group (23 eyes). The surgical procedures for the double-incision group were as follows. First, a superior scleral pre-incision was made. Then the conventional capsulorhexis was conducted through a 2.6 mm transparent corneal tunnel incision at the temporal or the nasal side, after which the hydro-dissection was performed. Next, the surgeon cut the pre-incision at the sclera, delivered the lens nucleus, sutured the scleral incision and removed the residual cortical materials from the corneal incision. Finally, a foldable intraocular lens was implanted, and the viscoelastic substance was removed. The intraoperative anterior chamber condition and the postoperative corneal edema condition were monitored. During the 6 month follow-up after surgeries, the endothelium cell density, visual acuity and astigmatism in the two groups were compared. The χ(2) test was used to compare the counting data, and the t test was used to compare the measurement data. Results: There was no statistically significant difference (t=1.12, P=0.28) in the preoperative corneal endothelial cell density between the double-incision and single-incision ECCE groups, which was (827±164) cells/mm(2) and (802±121) cells/mm(2), respectively. At 6 months after operation, in the double-incision and single-incision groups, the endothelial cell density was (793±147) cells/mm(2) and (706±101) cells/mm(2), respectively, and the difference was statistically significant (t=4.37, P<0.01). The percentage of corneal endothelial cell loss was 4.16%±3.12% and 11.69%±2.96%, respectively, and the difference was also statistically significant (t=9.52, P<0.01). The hexagon loss rate of corneal endothelial cells was 9.67%±6.11% and 28.33%±8.39%, respectively, and the difference was statistically significant (t=5.52, P<0.05). In the follow-up of 6 months, none of the eyes in the double-incision ECCE group suffered corneal endothelial decompensation compared with 3 eyes in the single-incision ECCE group. There were no statistically significant differences in postoperative astigmatism and surgically induced astigmatism between the two groups (t=-0.71, 0.15; P>0.05). Conclusions: The double-incision ECCE, in which the lens nucleus is delivered through a scleral incision and other procedures are conducted through a corneal tunnel incision, is safe and effective for cataract patients with hard nucleus and low corneal endothelial cell density. (Chin J Ophthalmol, 2020, 56: 126-130).

COMPARISON OF POST OPERATIVE CORNEAL ASTIGMATISM BETWEEN SMALL INCISION CATARACT SURGERY (SICS) AND EXTRA CAPSULAR CATARACT EXTRACTION (ECCE)

Background&#x0D; Cataract surgery is the most common type of surgery done by ophthalmologists. There are many methods of performing cataract surgery. Each of them has its own advantages and complications. Here we want to find the outcome of both the manual small incision cataract surgery and the conventional extracapsular cataract extraction surgery. &#x0D; Objectives &#x0D; To find the degree of postoperative corneal astigmatism in both manual small incision cataract surgery and the extracapsular cataract extraction surgery and compare these outcomes in both techniques.&#x0D; Patients and Methods&#x0D; We performed an experimental study conducted from January 2016 to June 2016 in Shahid Dr.Aso hospital ophthalmology department and Best Vision private hospital, Sulemani Province/Kurdistan Region of Iraq. One hundred cases were enrolled in the study, 50 cases underwent manual small incision cataract surgery and the other 50 underwent extracapsular cataract extraction surgery. All patients had their history taken, preoperative evaluation by (Slit-lamp examination, intraocular pressure measurement, indirect ophthalmoscopy for fundus examination, intraocular lens measurement, B-scan). Postoperatively; after 2 months, all cases in both groups were re-evaluated by the same measures of the preoperative examination.&#x0D; Results&#x0D; The mean postoperative uncorrected visual acuity in the manual small incision cataract surgery and extracapsular cataract extraction group was 6/9 and 6/12, respectively. The mean postoperative corneal astigmatism was 1.27+0.94 in manual small incision cataract surgery compared to 2.59+1.65 in the extracapsular cataract extraction surgery.&#x0D; Conclusion&#x0D; Both manual small incision and extracapsular cataract extraction techniques are safe and effective for visual rehabilitation of cataract patients. However, manual small incision cataract surgery gives better uncorrected visual acuity and less induced corneal astigmatism at 8 weeks postoperatively.

Effects of Cataract Surgery on Endothelium in Transplanted Corneal Grafts: Comparison of Extracapsular Cataract Extraction and Phacoemulsification for Complicated Cataract after Penetrating Keratoplasty.

Background:The endothelium should be carefully evaluated when choosing a surgical technique for cataract removal. Therefore, we aimed to study the effects of different cataract surgery techniques on endothelial cell loss in transplanted corneal grafts.Methods:A total of 54 patients who received complicated cataract surgery in post-penetrating keratoplasty (PKP) eyes at the Shandong Eye Institute between February 2001 and June 2014 were included, and clinical records were reviewed. Baseline demographic details, clinical characteristics, endothelial cell density (ECD), and best-corrected visual acuity (BCVA) were recorded. Wilcoxon rank-sum test and Wilcoxon signed-rank test were used to test the equality of medians. A regression model was constructed to compare the reduced rate of ECD.Results:Of the 54 eyes included in this study, extracapsular cataract extraction (ECCE) was performed in 34 eyes of 33 patients (ECCE group) whereas phacoemulsification was performed in 20 eyes of 20 patients (phacoemulsification group). There was no significant difference in the median age (P = 0.081) or preoperative ECD (P = 0.585) between the two groups. At 6 months after cataract surgery, ECD in ECCE group was significantly higher than that in phacoemulsification group (P = 0.043). In addition, the endothelial cell loss rate in ECCE group was significantly lower than that in phacoemulsification group at 2 months (P = 0.018), 4 months (P < 0.001), and 6 months (P < 0.001) after cataract surgery. Endothelial cell loss rate after cataract surgery increased over the 6-month study duration in both ECCE group (P < 0.001) and phacoemulsification group (P < 0.001), but phacoemulsification resulted in a greater reduction in ECD than that of ECCE in transplanted corneal grafts (P < 0.001). There was no significant difference in postoperative BCVA between the two groups (P = 0.065).Conclusion:ECCE is more suitable than phacoemulsification in cataract surgery in complicated cataract after PKP.

Morphological assessment of lens capsule after different techniques of cataract extraction

to evaluate morphological changes in the posterior lens capsule (LC) after different techniques of cataract extraction. Eight pseudophakic human autopsy eyes were divided into two groups by the technique used for cataract extraction. Group 1 included 4 eyes following extracapsular cataract extraction (ECCE) and rigid IOL implantation. Group 2 included 4 eyes after minimally invasive cataract surgery (MICS) that involves the use of ultrasound energy. Semithin LC sections were polychromatically stained, visually examined, and imaged for further analysis. There were certain common features in clinical and morphological appearances of lens capsules from either group, including fibrous metaplasia of epithelial cells and/or pseudoregenerative Elschnig-Adamuk pearls on their inner surfaces, more significant in the ECCE group. MICS group, however, demonstrated many distinct and previously undescribed changes. In particular, post-MICS LCs looked swollen, flabby, and even amorphous, their architectonics were disturbed and fibers separated forming micro slit-like spaces, which could be a result of acoustic cavitation caused by ultrasound exposure. We have named this morphological type of secondary cataract «hyaloid-like». Clinical and morphological type of postoperative LC opacification as well as its severity depends, to a certain extent, on the technique used for cataract extraction. Hyaloid-like opacifications are typical of minimally invasive surgery involving the use of ultrasound and often show no 'classic' changes (fibroproliferative and pseudoregenerative). The latter is explained by the fact that the posterior LC, which has lost its biomechanical properties, can no longer be a substrate for proliferating cells.

Use of ultrasonic pachymetry to compare the changes in postoperative corneal thickness in extracapsular cataract extraction and in phacoemulsification

Objective The aim of the present study was to evaluate and compare the changes in corneal thickness after extracapsular cataract extraction (ECCE) and phacoemulsification using ultrasonic pachymetry. Background During cataract surgery, several mechanisms may lead to corneal endothelial injury and consequent edema. Ultrasonic pachymetry is the gold standard technique to evaluate corneal thickness changes following different types of cataract surgeries. Patients and methods Of the 50 patients included, 25 patients underwent phacoemulsification (group 1) and 25 patients underwent ECCE (group 2). The inclusion criteria were corneal clarity, absence of lens subluxation, axial lengths of 21-24 mm, and fully dilatable pupils. The exclusion criteria were pre-existing corneal disease, lens subluxation, pseudo-exfoliation syndrome, coexisting eye disease, or a complicated cataract surgery. Corneal pachymetry was carried out preoperatively and on postoperative days 1, 7, 14, and 21. Results The mean preoperative central corneal thickness (CCT) was 546.64 ± 49.95 in group 1 and 537.12 ± 41.01 in group 2 ( P > 0.05). The postoperative day 1 CCT was 627.52 ± 66.93 in group 1 and 682.88 ± 68.85 in group 2 ( P P P P > 0.05). Conclusion Ultrasonic pachymeter is a reliable instrument that can be used to obtain rapid, accurate, and reproducible measurements of corneal thickness. In short-term follow up, the postoperative corneal edema after phacoemulsification cataract surgery offers faster recovery compared with that after ECCE.

A comparative study of astigmatism following manual small incision cataract surgery and conventional extracapsular cataract extraction at a tertiary centre in northern india

Objective: To compare the surgically induced astigmatism following two different techniques of cataract surgery-manual SICS (Small Incision Cataract Surgery) and standard ECCE (Extra-Capsular Cataract Extraction). Materials and Methods: Subjects consisted of patients, aged 10-80 years, from both sexes and divided into two groups of 100 each (one eye per patient). One group was operated with manual SICS and the other with standard ECCE technique. Results: The mean surgically induced astigmatism (SIA) in the SICS group during the sixth week postoperative follow up was found to be 0.66D ± 0.60 SD (Standard Deviation) compared to 2.25D ± 1.23 SD in the ECCE group. At 6th week follow up, no patient in the SICS group had SIA more than 3D whereas in the ECCE group 30% of the patients had astigmatism >3 D. The induced astigmatism between the two groups had a p-value of <0.001 which is highly significant. Conclusions: It is concluded that SICS induces less surgically induced astigmatism, less inflammation, less complications influencing the overall visual prognosis and quick stabilization of refraction, hence providing better and rapid visual rehabilitation in the postoperative period as compared to the patients in the ECCE group.

Comparison of visual outcome between conventional extracapsular cataract extraction and phacoemulsification cataract surgery

Objectives: To compare visual outcomes in patients who had conventional extracapsular cataract extraction (ECCE) and phacoemulsification for age-related cataract.Materials and Methods: Prospective study comparing the visual outcomes in 360 eyes of 352 patients, 180 of whom were randomized to conventional ECCE and the remaining 180 to phacoemulsification cataract surgery. Visual acuity was assessed on day 1, 1 week, 4 weeks, and 12 weeks postoperatively.Results: In the EECE group, good presenting visual acuity of 6/18 or even better was found in 6%, 31%, 46%, and 69% patients at 1-day, 1-week, 4-week, and 12-week postoperative intervals, respectively. In the phacoemulsification group, visual acuity of 6/18 or even better was achieved in 48%, 78%, 82%, and 89% patients, respectively, at the same postoperative interval as the ECCE group. This difference was statistically significant at all the postoperative intervals.Conclusion: Phacoemulsification achieves better postoperative visual acuity at the early and intermediate postoperative periods. Availability of this technique of cataract extraction will enhance eye care in our various institutions.

Manual small incision cataract surgery (MSICS) with posterior chamber intraocular lens versus extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens for age-related cataract.

Age-related cataract is the opacification of the lens, which occurs as a result of denaturation of lens proteins. Age-related cataract remains the leading cause of blindness globally, except in the most developed countries. A key question is what is the best way of removing the lens, especially in lower income settings. To compare two different techniques of lens removal in cataract surgery: manual small incision surgery (MSICS) and extracapsular cataract extraction (ECCE). We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2014, Issue 8), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to September 2014), EMBASE (January 1980 to September 2014), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to September 2014), Web of Science Conference Proceedings Citation Index- Science (CPCI-S), (January 1990 to September 2014), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 23 September 2014. We included randomised controlled trials (RCTs) only. Participants in the trials were people with age-related cataract. We included trials where MSICS with a posterior chamber intraocular lens (IOL) implant was compared to ECCE with a posterior chamber IOL implant. Data were collected independently by two authors. We aimed to collect data on presenting visual acuity 6/12 or better and best-corrected visual acuity of less than 6/60 at three months and one year after surgery. Other outcomes included intraoperative complications, long-term complications (one year or more after surgery), quality of life, and cost-effectiveness. There were not enough data available from the included trials to perform a meta-analysis. Three trials randomly allocating people with age-related cataract to MSICS or ECCE were included in this review (n = 953 participants). Two trials were conducted in India and one in Nepal.Trial methods, such as random allocation and allocation concealment, were not clearly described; in only one trial was an effort made to mask outcome assessors. The three studies reported follow-up six to eight weeks after surgery. In two studies, more participants in the MSICS groups achieved unaided visual acuity of 6/12 or 6/18 or better compared to the ECCE group, but overall not more than 50% of people achieved good functional vision in the two studies. 10/806 (1.2%) of people enrolled in two trials had a poor outcome after surgery (best-corrected vision less than 6/60) with no evidence of difference in risk between the two techniques (risk ratio (RR) 1.58, 95% confidence interval (CI) 0.45 to 5.55). Surgically induced astigmatism was more common with the ECCE procedure than MSICS in the two trials that reported this outcome. In one study there were more intra- and postoperative complications in the MSICS group. One study reported that the costs of the two procedures were similar. There are no other studies from other countries other than India and Nepal and there are insufficient data on cost-effectiveness of each procedure.Better evidence is needed before any change may be implemented. Future studies need to have longer-term follow-up and be conducted to minimize biases revealed in this review with a larger sample size to allow examination of adverse events.

Causes of subnormal vision in patients following cataract surgery at a tertiary hospital in Kashmir

Cataract surgery is aimed at restoring sight to near normal vision. This study, conducted at the Department of Ophthalmology, Government Medical College, Srinagar, is an attempt to determine the causes of subnormal vision in patients following cataract surgery at a tertiary hospital in Kashmir. One hundred patients who underwent cataract surgery with an unaided visual acuity of <6/9 at 16 weeks postoperatively were included in the study. Postoperative follow-up examinations were conducted until the 16th week. Intraoperative and postoperative complications were recorded to determine the cause of subnormal vision. Of 100 patients, 40 underwent extracapsular cataract extraction (ECCE), 30 underwent small incision cataract surgery (SICS) and 30 underwent phacoemulsification. Seventy-five percent of the patients who underwent ECCE had postoperative astigmatism with a mean astigmatism of 2.2 ± 0.81 diopters at 16 weeks, with the majority having with-the-rule astigmatism. In the SICS group, 17 (56.6 %) patients had a mean postoperative astigmatism of 0.75 ± 0.40 diopters, with the majority (82.3 %) having against-the-rule (ATR) astigmatism. In the phacoemulsification group, 13 (43.3 %) of the patients had a mean postoperative astigmatism of 0.48 ± 0.23 diopters with the majority having ATR astigmatism. Other causes of subnormal vision were pseudophakic ametropia, posterior capsular opacity and intraoperative complications like posterior capsular rent and vitreous loss. Postoperative astigmatism was the major cause of subnormal vision with greater astigmatism seen in the ECCE group. Therefore, procedures like smaller incision sutureless surgery and careful biometry are advocated to improve visual outcome and patient satisfaction.

Phacoemulsification with posterior chamber intraocular lens versus extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens for age-related cataract

Age-related cataract is one of the leading causes of blindness worldwide. Therefore, it is important to establish the most effective surgical technique for cataract surgery. The aim of this review is to examine the effects of two types of cataract surgery for age-related cataract: phacoemulsification and extracapsular cataract extraction (ECCE). We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2013, Issue 4), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to May 2013), EMBASE (January 1980 to May 2013), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to May 2013), Web of Science Conference Proceedings Citation Index - Science (CPCI-S) (January 1970 to May 2013), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 13 May 2013. We included randomised controlled trials of phacoemulsification compared to ECCE for age-related cataract. Two authors independently selected and assessed all studies. We defined two primary outcomes: 'good functional vision' (presenting visual acuity of 6/12 or better) and 'poor visual outcome' (best corrected visual acuity of less than 6/60) at three and 12 months after surgery. We also collected data on intra and postoperative complications, and the cost of the procedures. We included 11 trials in this review with a total of 1228 participants, ranging from age 45 to 94. The studies were generally at unclear risk of bias due to poorly reported trial methods. No study reported presenting visual acuity, so we report both uncorrected (UCVA) and best corrected visual acuity (BCVA). Studies varied in visual acuity assessment methods and time frames at which outcomes were reported. Participants in the phacoemulsification group were more likely to achieve UCVA of 6/12 or more at three months (risk ratio (RR) 1.81, 95% confidence interval (CI) 1.36 to 2.41, two studies, 492 participants) and one year (RR 1.99, 95% CI 1.45 to 2.73, one study, 439 participants). People in the phacoemulsification group were also more likely to achieve BCVA of 6/12 or more at three months (RR 1.12, 95% CI 1.03 to 1.22, four studies, 645 participants) and one year (RR 1.06, 95% CI 0.99 to 1.14, one study, 439 participants), but the difference between the two groups was smaller. No trials reported BCVA less than 6/60 but three trials reported BCVA worse than 6/9 and 6/18: there were fewer events of this outcome in the phacoemulsification group than the ECCE group at both the three-month (RR 0.33, 95% CI 0.20 to 0.55, three studies, 604 participants) and 12-month time points (RR 0.62, 95% CI 0.36 to 1.05, one study, 439 participants). Three trials reported posterior capsule rupture: this occurred more commonly in the ECCE group than the phacoemulsification group but small numbers of events mean the true effect is uncertain (Peto odds ratio (OR) 0.56, 95% CI 0.26 to 1.22, three studies, 688 participants). Iris prolapse, cystoid macular oedema and posterior capsular opacification were also higher in the ECCE group than the phacoemulsification group. Phacoemulsification surgical costs were higher than ECCE in two studies. A third study reported similar costs for phacoemulsification and ECCE up to six weeks postoperatively, but following this time point ECCE incurred additional costs due to additional visits, spectacles and laser treatment to achieve a similar outcome. Removing cataract by phacoemulsification may result in a better visual acuity compared to ECCE, with a lower complication rate. The review is currently underpowered to detect differences for rarer outcomes, including poor visual outcome. The lower cost of ECCE may justify its use in a patient population where high-volume surgery is a priority, however, there are a lack of data comparing phacoemulsification and ECCE in lower-income settings.

Outcomes of manual extracapsular versus phacoemulsification cataract extraction by beginner resident surgeons

To evaluate the safety and efficacy of phacoemulsification cataract extraction and manual extracapsular cataract extraction (ECCE) performed by beginning resident surgeons. Dallas Veterans Affairs Medical Center, Dallas, Texas, USA. Retrospective cohort study. A review was performed of each resident's series of initial cataract surgery procedures as a late first-year or second-year resident. Data were collected for cases performed over almost a 6-year period during which initially the first primary surgeon cases were ECCE and later, the first primary surgeon cases were phacoemulsification. For each case, the following data were gathered: technique of cataract extraction, laterality, resident, vitreous loss or dropped nucleus, placement of posterior chamber intraocular lens (IOL), and need for reoperation within 90 days of surgery. Complications occurred in 6 (2.5%) of 244 cases in which phacoemulsification was performed by a beginner resident primary surgeon and in 7 (4.1%) of 172 cases in which ECCE was used (P=.40). Posterior chamber IOLs were placed in all but 2 phacoemulsification cases and 4 ECCE cases (P=.24). Moreover, 3 cases in the phacoemulsification group and 1 case in the ECCE group required a reoperation within 90 days (P=.65). Phacoemulsification cataract extraction can be taught safely and effectively to residents with no cataract surgery experience as a primary surgeon.

Long-term change in intraocular pressure after extracapsular cataract extraction with posterior chamber intraocular lens implantation versus phacoemulsification with posterior chamber intraocular lens implantation in Indians

Purpose:The purpose of the study is to evaluate the long-term changes in intraocular pressure (IOP) after extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens (PCIOL) implantation versus phacoemulsification with PCIOL implantation in otherwise normal cataract patients in India.Materials and Methods:The study was conducted in the Department of Ophthalmology, King George's Medical College, Lucknow between August 2000 and August 2001. One hundred and seventeen eyes of 115 patients were included in the study. 84 patients were randomly selected for ECCE with PCIOL implantation (ECCE group) and 31 patients were selected for phacoemulsification with PCIOL implantation (Phaco group). IOP was measured pre-operatively and post-operatively, from the 1st month to the 12th month. Statistical significance was indicated by P > 0.05.Results:There was a mean fall in IOP of 2.70 mm Hg (19.74%) in the ECCE group and 2.74 mm Hg (20.57%) in the phaco group. The decrease in the mean post-operative IOP from baseline was statistically significant (P > 0.01) at the end of 2 months in both groups. There was no statistically significant difference in post-operative IOP at any visit between groups (P < 0.05, all post-operative visits). After 4th monthpost-operatively, the IOP was mostly stable, but it was significantly lower than the pre-operative IOP.Conclusion:Significant IOP reduction may be expected after cataract surgery with either ECCE or phacoemulsification with IOL implantation. The lowering of IOP became statistically significant at about 2 months post-operatively, but became almost stable after the 4th month.

Corneal endothelial cell loss in post-penetrating keratoplasty patients after cataract surgery: Phacoemulsification versus planned extracapsular cataract extraction

To compare the changes in endothelial cell density (ECD) in post-penetrating keratoplasty (PKP) patients after cataract extraction with phacoemulsification or planned extracapsular cataract extraction (ECCE). Haydarpasa Numune Education and Research Hospital, Ophthalmology Clinic, Istanbul, Turkey. Clinical trial. Eyes with hard nuclear cataract that had previous PKP were randomly assigned to have phacoemulsification or ECCE. Noncontact specular microscopy was performed preoperatively and 1, 3, and 6 months postoperatively. Twenty-six eyes of 26 patients were enrolled (14 phacoemulsification; 12 ECCE). Six months postoperatively, the mean corneal ECD was statistically significantly lower in the phacoemulsification group (1869.50 cells/mm(2) ± 158.05 [SD]) than in the ECCE group (1996.00 ± 127.96 cells/mm(2)) (P=.024). The mean percentage of endothelial cell loss at 6 months was 20.3% and 12.7%, respectively (P<.05). In both groups, there was no significant difference in the percentage hexagonality between preoperatively and postoperatively (P>.05). Extracapsular cataract extraction seemed to cause less endothelial cell damage than phacoemulsification in post-PKP patients with hard nuclear cataract.

A comparative evaluation of outcome of cataract surgery at Ago-Iwoye, Ogun State

Objective : To compare the outcome of cataract surgery using intracapsular/ extracapsular extraction alone to surgery with lens implantation. Methods : A retrospective review of all patients who had cataract surgery by all methods between February 1998 and October 1999 at St Mary’s Catholic eye hospital Ago-Iwoye, Ogun state, for post operative visual acuity and surgery related complications. Results : Two hundred and forty nine eyes of 211 patients were reviewed. 128 (60.7 %) were males and 83(39.3) were females. The age range was from 9years to 90years. Post op vision of 6/18 or better was present in 71% of the posterior chamber intra ocular lens (PC-IOL) group; 50% of anterior chamber lens (AC-IOL) group, 62% of intracapsular cataract extraction (ICCE) group and 31.2% of the extracapsular cataract extraction group. Preventable causes of poor visual outcome were present in 14.9% 0f the cases reviewed especially the ECCE and ICCE groups and included: posterior capsule opacity, uveitis, cystoid macular oedema and endophthalmitis. Poor outcome was associated with pre-existing ocular disease in 10.8% of the eyes operated and were due to pre-existing glaucoma, macular degeneration, optic atrophy and diabetic retinopathy. Conclusion : Best functional visual results are obtained by modern techniques of ECCE with IOL, which ensures that the patient has adequate post op vision for his needs. Adequate case selection to exclude pre-existing ocular morbidity as well as prevention or proper management of surgery related complications when they occur are also essential for satisfactory results. Older techniques of ICCE or ECCE with out IOL are associated with less satisfactory functional visual acuity and should therefore be discouraged.

Phacoemulsification versus extracapsular extraction: governmental costs

PURPOSETo evaluate the governmental costs of patients undergoing phacoemulsification and extracapsular cataract extraction at a public hospital in a developing country.METHODSA prospective study was conduced with 205 patients. The subjects were randomized for cataract surgery using either phacoemulsification or extracapsular cataract extraction techniques.RESULTSOf the 205 patients, 101 patients were submitted to phacoemulsificationand 104 patients were submitted to extracapsular cataract extraction. Brazilian Health Care System expenditures for the surgery and the postoperative period were US$ 95.49 more in the phacoemulsification group than in the extracapsular cataract extractiongroup. If we take into account Social Security expenditures, then we estimate that the average difference for the total direct cost for the government for the surgery and the postoperative period for both procedures was US$ 50.91 or approximately half of the initial difference in cost for the phacoemulsification surgery. The total cost of cataract surgery for the government (excluding social security) was estimated at US$ 258.79 for extracapsular cataract extraction and US$ 309.70 for phacoemulsification per patient. Focusing only on working patients, the total cost was US$ 342.21 for phacoemulsification and US$ 587.71 for extracapsular cataract extraction, a difference of US$ 245.50. This difference can be considered monetarily and socially justifiable when the benefits of the surgical technique are evaluated.CONCLUSIONUnder the conditions of this study, we observed that phacoemulsification was an efficient procedure with regard to the impact on public health care system, when all costs are assessed comprehensively, mainly for subjects with regular jobs.

Surgical and visual outcomes for posterior polar cataract

Aims:The aims of this study were to report the surgical and visual outcomes of posterior polar cataract and to assess the risk factors for posterior capsule rupture.Method:Medical records of 81...

Laser-assisted corneal welding in cataract surgery: Retrospective study

To evaluate the efficacy of laser welding to close corneal wounds in cataract surgery. Department of Ophthalmology, Hospital of Misericordia e Dolce, Prato, Italy. This retrospective nonrandomized interventional case series included 20 eyes of 20 patients. All eyes had cataract with visual acuity worse than 20/200. Ten patients had phacoemulsification surgery, and 10 had extracapsular cataract extraction (ECCE). Surgeries were followed by laser-assisted closure of the corneal wounds by diode laser welding of the stroma using a technique established in animal models. Preoperative and postoperative (1, 3, 7, 30, and 90 days) astigmatism, level of inflammation, Seidel testing, and endothelial cell counts were obtained. There were minor differences in preoperative and postoperative astigmatism except in 1 eye in the ECCE group. The Seidel test showed no wound leakage during the follow-up examinations, and endothelial cell loss was similar to that published for standard surgical cataract procedures. No collateral effects of the laser welding were detected, nor was postoperative inflammation. Astigmatism was slightly affected by the use of laser welding for corneal wound closure after phacoemulsification and ECCE. The laser-assisted corneal sealing procedure was rapid and safe and could serve as an alternative to corneal suturing, with significant potential applications for the closure of longer incisions, such as those used in penetrating keratoplasty.