Manual Small Incision Cataract Surgery Group Research Articles

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.

To compare postoperative astigmatism and visual outcome following phacoemulsification versus Manual Small Incision Cataract Surgery (MSICS) seen at tertiary care center

Purpose: To compare postoperative astigmatism and visual outcome following phacoemulsification versus Manual Small Incision Cataract Surgery (MSICS) seen at a tertiary care center. Method: A total of 100 patients were enrolled in this retrospective study. Group A included 50 patients undergoing phacoemulsification surgery and group B included 50 patients undergoing MSICS. The outcome was evaluated in both techniques in terms of astigmatic profile and visual outcome at post-operative day 1 and 3 months. Results: The mean age was 60 ± 1.84 years in the phacoemulsification group and 61 ± 1.25 years in the MSICS group. In the phacoemulsification group, 60% were male patients as compared with 40% female patients while MSICS group included 62% female patients and 38 % male patients. The initial visual recovery on the first postoperative day was better in the patients who underwent phacoemulsification, with the uncorrected visual acuity better than or equal to 6/18 in 94% of the patients, whereas the percentage was 72% in the MSICS group. At three months, 80% of the patients in the MSICS group had uncorrected visual acuity better than or equal to 6/18 versus 88% of the patients in the phacoemulsification group. The mean astigmatism was 0.808 ± 0.39D in the phaco group and 1.565 ± 0.51D in the MSICS group, p-value significant (0.0001). Conclusion: Both phacoemulsification and MSICS achieved comparable and excellent visual outcomes. However, MSICS appears to be more advantageous than phacoemulsification in terms of speed, cost and independence from technology and appears to be more suitable for mass surgery especially in developing countries.

Comparative study of anatomical and functional recovery of eye along with patient satisfaction score after small-incision cataract surgery and phacoemulsification cataract surgery.

Functional recovery after cataract surgery depends on the anatomical recovery of the eye. This study compared the improvement in visual function parameters after uniocular manual small-incision cataract surgery (MSICS) and phacoemulsification cataract surgery. This study included 310 patients divided randomly into two groups: 155 who received MSICS (MSICS group) and 155 who underwent phacoemulsification (phaco group) for cataract treatment. Outcome measures assessed included vertical and horizontal keratometry reading. The mean corneal astigmatism tear function measured using Schirmer 1 test results were recorded preoperatively, and on postoperative day 1, day 7, and day 30. Optical coherence tomography (OCT) was done to record the average central macular thickness (μm) on day 7 and day 30. The mean corneal astigmatism and anterior chamber inflammation were more in the MSICS group than in the phaco group immediately postoperatively. However, no statistically significant difference was found between the groups with respect to corneal sensation, mean corneal astigmatism, tear film function, and visual outcomes on postoperative day 30. Uncorrected visual acuity was better in the phacoemulsification group than in the manual SICS group on postoperative day 1, day 7, and day 30 (P &lt; 0.001). Both phacoemulsification cataract surgery and manual small-incision sutureless cataract surgery (MSICS) are safe and effective for visual rehabilitation. Phacoemulsification is the preferred technique where resources are available with the advantages of less mean corneal astigmatism, less anterior chamber inflammation, and better uncorrected visual acuity (UCVA) in the immediate postoperative period.

Comparison of the outcomes of phacoemulsification and manual small-incision cataract surgery in posterior polar cataract - A retrospective study.

To compare the visual outcomes and intraoperative complications between phacoemulsification and manual small-incision cataract surgery (MSICS) in cases of posterior polar cataract (PPC). A retrospective study was carried out involving 142 patients (164 eyes) with PPC who underwent cataract surgery between January and December 2017. Data collected include the demographic details, preoperative uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), type of cataract, intraocular pressure, anterior and posterior segment findings, type of surgery performed, intraoperative complications, postoperative UCVA on the first day, UCVA and BCVA at 1 month after surgery, complications, and resurgery details. In total, 90 patients (107 eyes) underwent phacoemulsification, and 52 patients (57 eyes) underwent MSICS. There was no significant difference in the mean age, sex, and type of PPC between the two groups (P = 0.326, 0.852, and 0.220, respectively). Patients who underwent phacoemulsification had significantly better preoperative BCVA (P = 0.002). The BCVA on first postoperative day and 1 month after surgery was better in the phacoemulsification group than in the MSICS group (P &lt; 0.001 and 0.002, respectively). The overall incidence of posterior capsular rupture (PCR) was 11.6%, which included the 10.3% in phacoemulsification and 14.0% in MSICS. There was, however, no significant difference in the rates of PCR between the two groups (P = 0.506). Phacoemulsification delivered better postoperative visual outcomes than MSICS in PPC patients, whereas the complication rates were similar between the two groups.

Comparison of the Outcomes of Manual Small Incision Cataract Surgery (MSICS) and Phacoemulsification (PHACO) in Ghana

Background: The growing middle-class population of Ghana has seen more people being employed in visually demanding occupations and hence there is an increased desire for quality post-cataract surgical visual outcomes. This study aimed at comparing the outcomes of manual small incision cataract surgery (MSICS) and phacoemulsification (PHACO) among Ghanaians.&#x0D; Methods: This was a retrospective cross-sectional study in which records of patients who underwent MSCIS or phacoemulsification by the same surgeon were reviewed.&#x0D; Results: Medical records of 248 eyes were reviewed, out of which 132 underwent PHACO and 116 had MSICS. A significant number of the PHACO group had good (6/6–6/18) uncorrected visual acuity (UCVA) compared to the MSICS group at 1–2 weeks follow-up (p = 0.003) and 4–6 weeks follow-up (p = 0.002). MSICS resulted in a higher total astigmatic change compared to PHACO (p &lt; 0.001). The PHACO grouphad a higher number of postoperative complications compared with the MSICS group (p &lt;0.001). Postoperative borderline and poor uncorrected visual acuity were associated with age, total astigmatic change, and postoperative complications.&#x0D; Conclusion: The postoperative UCVA outcomes at 4–6 weeks’ follow-up indicates that PHACO resulted in noticeably less spectacle dependency when compared to MSICS.

Comparative Study between Corneal Topographic Changes Following Phacoemulsification and Small Incision Cataract Surgery

Background: Phacoemulsification has become the routine procedure for cataract extraction for most of the surgeons because of its smaller incision and rapid visual rehabilitation. Also, manual small incision cataract surgery (MSICS) with its sutureless relatively smaller incision, compared to conventional extracapsular cataract extraction, has similar advantages to phacoemulsification in addition to its lower risk to corneal endothelium especially in hard cataracts and elder patients. Objective: To compare the effect of phacoemulsification and small incision cataract surgery on corneal topography in a prospective randomized study. Patients and methods: 80 eyes were included in this study. Patients were divided into two groups: Group A (40 eyes) underwent phacoemulsification and Group B (40 eyes) underwent MSICS. Both groups were studied preoperatively and postoperatively regarding uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), keratometry, and corneal topography. Results: There was a significant difference between preoperative and postoperative uncorrected visual acuity (UCVA) during the follow up period (p value < 0.001) among both study groups. There was no significant difference in preoperative as well as postoperative intraocular pressure (IOP) or between preoperative and postoperative IOP values in both study groups. There was significant increase in the mean central corneal thickness during first postoperative week in both studied groups (p value <0.001). In MSICS group there was minimal significant increase in astigmatism within the first weak and first month of follow up (p value 0.041). Conclusion: Cataract surgery using phacoemulsification or small incision cataract surgery was found to yield excellent visual results with no significant difference as regards to central corneal thickness, keratometric readings, and postoperative astigmatism or perioperative complications.

Comparative study of anatomic and functional changes of the corneal endothelium in cataract patients undergoing phacoemulsification and MSICS

The purpose of this study was to compare the effect of Phacoemulsification and Manual small incision cataract surgery (MSICS) on the corneal endothelium and to assess its impact on visual acuity and induced astigmatism. In this prospective randomized study, 100 cases were randomly selected with the help of lottery system. 50 cases underwent phacoemulsification (group 1) and 50 underwent MSICS (group 2) by a single surgeon. The endothelial cell count, central corneal thickness, best corrected visual acuity and induced astigmatism was measured preoperatively and postoperatively on day 1, 7, 28 and on day 42. Mean endothelial cell loss (cells/mm2) in group 1 at the end of six weeks was 538.64 (20.59%) and in group 2 was 485.66 (19.20%) which was statistically insignificant (p &amp;#62;0.05). The mean central corneal thickness was reduced in both the groups with a mean of 0.51±0.04 mm in group 1 and 0.50±0.03 mm in group 2 which was statistically insignificant. Postoperative best corrected visual acuity of more than 6/18 was found in 49 (98%) cases in each group at six weeks, and was statistically insignificant (p value &amp;#62; 0.05). Phacoemulsification group had statistically significant less mean postoperative astigmatism than MSICS group (p value &amp;#60; 0.05). Both groups gave similar statistically insignificant results in relation to endothelial cell loss, central corneal thickness and best corrected visual acuity at the end of six weeks, although the mean astigmatism was more in group 2 in comparison to group 1 with a statistically significant difference.

Comparison of surgical technique and outcomes of phacoemulsification and manual small incision cataract surgery in management of phacomorphic glaucoma and analysis of the risk factors for developing phacomorphic glaucoma

Background: Phacomorphic glaucoma is highly prevalent in developing countries. In India, the prevalence of phacomorphic glaucoma is 3.91%. The definitive treatment of phacomorphic glaucoma is surgery. The purpose of our study was to compare the surgical technique and outcomes of phacoemulsification and manual small incision cataract surgery (MSICS), in management of phacomorphic glaucoma and analysis of the risk factors for developing phacomorphic glaucoma. Methods: This was a hospital based retrospective study done at a tertiary eye care center, over a period of nineteen months. A rigorous protocol to diagnose phacomorphic glaucoma was followed. All patients were given IV mannitol 20%, before surgery. The study patients were divided in to phaco group and MSICS group. The data analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0. Results: Out of 99 phacomorphic glaucoma cases, 37 underwent phacoemulsification and 62 underwent MSICS. The total number of female patients was 66 (66.67%) and that of male was 33 (33.33%) with female to male ratio of 2:1. The mean age of presentation was 63.64±8.27 years. The overall mean IOP was 42.9±9.68 mmHg in both the groups. The mean axial length was 22.47±1.03 mm in study patients and 22.82±0.8 mm in control group, (p=0.0082). The mean AC depth was 2.54±0.53 mm for phacomorphic eyes and 2.69±0.5 mm for control groups, (p=0.04). Conclusions: MSICS is effective, safe and inexpensive in controlling IOP and achieving good visual acuity with minimal complications in the management of phacomorphic glaucoma as compared to phacoemulsification.

Cataract surgery in eyes with associated coloboma: Predictors of outcome and safety of different surgical techniques.

Purpose:The aim of this study was to report the outcome of cataract surgery with different surgical techniques in eyes with coexisting coloboma and to define factors of prognostic importance.Methods:Retrospective case sheet review of patients presenting between January 2016 and December 2018, who underwent cataract surgery in eyes with coexisting coloboma.Results:Of the 3,30,231 cases operated during the study period, 280 eyes of 276 patients had associated colobomatous malformation. The prevalence of coloboma in eyes undergoing cataract surgery was 0.085%. The mean age of the patients was 46.4 years (range 19 - 88 years). Phacoemulsification (PE) was performed in 130 eyes (46.4%), manual small incision cataract surgery (M-SICS) was done in 115 eyes (41.1%), and 35 eyes (12.5%) underwent intra capsular cataract extraction. Intra-operative complications were noted in 26 (9%) eyes. Incidence of intra-operative and post-operative complications was comparable between PE and M-SICS groups (p = 0.94). The mean corrected distance visual acuity (CDVA) improved from logMAR 1.71 ± 0.62 to 0.87 ± 0.61 (p = 0.00009). On multivariate analysis, microcornea (p = 0.002), type 1 and 2 coloboma (p < 0.001), and intraoperative complications (p = 0.001) were associated with poor visual outcome.Conclusion:Favorable functional outcomes can be achieved with phacoemulsification in eyes with softer cataract and corneal diameter >8 mm and with M-SICS in eyes with hard cataracts and corneal diameter of 6–8 mm. PE should be considered as the primary choice whenever permissible by the corneal diameter and severity of nuclear sclerosis. Poor functional outcomes were seen in eyes with smaller corneal diameter, extensive chorioretinal coloboma, and intraoperative complications.

Randomized Controlled Trial of varied incision sites in Manual Small Incision Cataract Surgery done in a Medical College Hospital in Kancheepuram District, Tamil Nadu, India

Aim: To compare visual outcome, postoperative surgically induced astigmatism (SIA), andpostoperative complications of superior and temporal scleral incision in manual small incisioncataract surgery (MSICS). Materials and Methods: A Prospective Randomized, parallel-group,active-controlled Trial Study of 80 cases of senile/pre-senile cataract. 40 cases were randomlyassigned (computer-generated randomization) to superior incision and 40 cases to the temporalincision. Results: The majority of patients (38 patients- 47.5%) were in the age group of 56-65years. The next common age group was 66-75 years(31 patients-38.75%). In the superior MSICSgroup, the majority of patients (28 patients-70%) had a moderate post-operative unaided visualacuity of 6/18-6/12. In the temporal MSICS group, majority of patients(33patients-82.5%) had agood post-operative unaided visual acuity of 6/9-6/6. The mean surgically induced astigmatism(SIA)in the superior MSICS group was 1.12 and in the temporal MSICS group was 0.45 with a differenceof 0.67. The SIA values were analyzed using the unpaired T-test which showed a value of 9.967which was statistically significant(P value of 0.0001). Conclusion: This study has shown that thetemporal approach for Manual small incision cataract surgery(MSICS) has less postoperativeastigmatism and better postoperative unaided visual acuity compared to the superior approach.

Phacoemulsification versus manual small incision cataract surgery in hard nuclear cataracts

Purpose The aim of this study was to compare the clinical outcomes of phacoemulsification with that of manual small incision cataract surgery (MSICS) in cases of hard nuclear cataract. Patients and methods Eighty eyes of 80 patients with gradual painless diminution of vision, diagnosed as senile nuclear cataract grade 4 or higher according to Lens Opacities Classification System III (brown cataract), were studied. These eyes were divided randomly into two groups: group A included 40 eyes treated by phacoemulsification by the vertical chopping technique and group B included 40 eyes treated by MSICS by the viscoexpression technique. Results One day postoperatively, the corrected distance visual acuity was at least 6/18 in 21 (52.5%) patients in the MSICS group and in nine (22.5%) patients in the phacoemulsification group. The difference was statistically significant (P=0.01). A postoperative increase in intraocular pressure was recorded in one (2.5%) case in the phacoemulsification group. On the first postoperative day, 11 (27.5%) cases in the MSICS group and 13 (32.5%) cases in the phacoemulsification group developed postoperative iritis, with no statistically significant difference between both the groups. Conclusion Both phacoemulsification and MSICS achieved comparable and excellent visual outcomes for treatment of hard brown cataract, with lower complications rates and earlier postoperative visual rehabilitation in small incision cataract surgery.

COMPARATIVE SPECULAR MICROSCOPIC STUDY OF CORNEAL ENDOTHELIAL CELLS IN PHACOEMULSIFICATION VERSUS SUTURELESS MANUAL SMALL INCISION CATARACT SURGERY

Background: Low socio-economic group patients from rural areas often opt for free cataract surgeries offered by public hospital. Cataract surgery can be performed by or phacoemulsification or sutureless manual small Incision cataract surgery. Manual small incision cataract surgery is more cost effective Objective: Comparing the morphological (cell density, coefficient of variation and standard deviation) endothelial changes after phacoemulsification versus manual small-incision cataract surgery (MSICS). Patients and Methods: Patients were randomly allocated to undergo phacoemulsification (Group A, n = 40) or MSICS (Group B, n = 40). The patients underwent complete ophthalmic evaluation and specular microscopy preoperatively, and after 1 and 6 months postoperatively. Morphological endothelial evaluation was done using Topcon SP- 2000 specular microscope. Phacoemulsification was performed by stop and chop technique. MSICS was performed by the irrigating vectis technique. Results: On comparing between the phacoemulsification and MSICS groups regarding the endothelial cell density, the P value after 1 month and 6 months postoperatively were not statistically significant. The difference in mean endothelial cell density between groups at 1 week and 6 weeks was statistically significant. The mean coefficient of variation and mean standard deviation between groups were not statistically significant. Conclusion: Both groups showed comparable endothelial cell loss in the post-operative period. As SICS was economical and less dependent on technology than phacoemulsification, it may be the appropriate surgical procedure for treatment of cataract in the developing world.

Phacoemulsification Versus Manual Small Incision Cataract Surgery in Patients With Fuchs Heterochromic Iridocyclitis.

To compare the safety and efficacy of phacoemulsification and manual small incision cataract surgery (SICS) to treat cataract in patients with Fuchs heterochromic iridocyclitis (FHI). A randomized, double-masked, prospective, multicenter study. Consecutive patients with cataract after FHI were randomly assigned to have phacoemulsification or manual SICS by 1 of 2 surgeons experienced in both techniques. Complications (intraoperatively and postoperatively), operative time, visual acuities, endothelial cell counts, and surgically induced astigmatism were compared. At 6 months, 65 (92.8%) patients in the phacoemulsification group and 70 (92.1%) in the manual SICS group had a corrected distance visual acuity of 20/63 or better (P = 0.974). Surgical time was significantly shorter in the SICS group (11.2 ± 2.4 minutes) than in the phacoemulsification group (14.2 ± 3.1 minutes) (P < 0.001). The mean surgically induced astigmatism was 0.8 ± 0.2 diopters (D) in the phacoemulsification group and 1.16 ± 0.2 D in the SICS group (P < 0.001). Endothelial cell counts at 1 week and at 6 months did not differ significantly in the phacoemulsification and SICS groups (t test; P = 0.133 and P = 0.032, respectively). Intraoperatively, 2 (3%) eyes randomized to receive phacoemulsification and 4 (5.3%) eyes randomized to receive SICS had posterior capsular rent (P = 0.465). Both techniques achieved good visual outcomes with low rates of complications. Manual SICS may be a viable alternative for cataract management in patients with FHI in settings with limited access to phacoemulsification.

Efficacy of manual small incision cataract surgery in preventing the endothelial cell loss

Background: Every year 5 million cataract surgeries are performed in India. Two major procedures are used to conduct cataract operations either MSICS/Phecoemulisfication. In both the procedures the loss of endothelial cells are observed. The present study is based on comparison of endothelial cell loss in both the procedures. Objectives: The aim of the study is to compare endothelial cell loss after manual small incision cataract surgery (MSICS) and Phacoemulsification by specular microscopy. Methods: Present study was conducted at Sarojini Devi Eye Hospital, Hyderabad from 2013-14. Total number of eyes studied was 100 in 100 study subjects who were age and sex matched and divided into two groups of 50 eyes of 50 study population. Group I patients underwent Phaecoemulsification & Group II with MSICS by the same operating surgeon from 2013-14. The patients were evaluated on first post operative day, first week, 6 weeks and 6 months for endothelial density. Endothelial density was evaluated through Specular Microscopy EM 3000, Tomey. Best image of 15 shots was taken to evaluate endothelial density. Results: Mean age in both the groups was 58 and 59 years. Equal number was taken sex wise in both the groups. The mean endothelial loss was 200 cells/mm2 & 250 cells/mm2 in Group I & II respectively. Conclusions: In phacoemulsification group, the maneuvering was performed in the capsular bag and newer advanced phacoemulsification units with better fluidics reduced the chances of endothelial damage. In MSICS group, Visco-expression of the nucleus significantly reduced the endothelial cell loss.

Phacoemulsification versus small incision cataract surgery in patients with uveitis.

To compare the safety and efficacy of phacoemulsification and small incision cataract surgery (SICS) in patients with uveitic cataract. In a prospective, randomized multi-centric study, consecutive patients with uveitic cataract were randomized to receive phacoemulsification or manual SICS by either of two surgeons well versed with both the techniques. A minimum inflammation free period of 3mo (defined as less than 5 cells per high power field in anterior chamber) was a pre-requisite for eligibility for surgery. Superior scleral tunnel incisions were used for both techniques. Improvement in visual acuity post-operatively was the primary outcome measure and the rate of post-operative complications and surgical time were secondary outcome measures, respectively. Means of groups were compared using t-tests. One way analysis of variance (ANOVA) was used when there were more than two groups. Chi-square tests were used for proportions. Kaplan Meyer survival analysis was done and means for survival time was estimated at 95% confidence interval (CI). A P value of <0.05 was considered statistically significant. One hundred and twenty-six of 139 patients (90.6%) completed the 6-month follow-up. Seven patients were lost in follow up and another six excluded due to either follow-up less than six months (n=1) or inability implant an intraocular lens (IOL) because of insufficient capsular support following posterior capsule rupture (n=5). There was significant improvement in vision after both the procedures (paired t-test; P<0.001). On first postoperative day, uncorrected distance visual acuity (UDVA) was 20/63 or better in 31 (47%) patients in Phaco group and 26 (43.3%) patients in SICS group (P=0.384). The mean surgically induced astigmatism (SIA) was 0.86±0.34 dioptres (D) in the phacoemulsification group and 1.16±0.28 D in SICS group. The difference between the groups was significant (t-test, P=0.002). At 6mo, corrected distance visual acuity (CDVA) was 20/60 or better in 60 (90.9%) patients in Phaco group and 53 (88.3%) in the manual SICS group (P=0.478). The mean surgical time was significantly shorter in the manual SICS group (10.8±2.9 versus 13.2±2.6min) (P<0.001). Oral prednisolone, 1 mg/kg body weight was given 7d prior to surgery, continued post-operatively and tapered according to the inflammatory response over 4-6wk in patients with previously documented macular edema, recurrent uveitis, chronic anterior uveitis and intermediate uveitis. Rate of complications like macular edema (Chi-square, P=0.459), persistent uveitis (Chi-square, P=0.289) and posterior capsule opacification (Chi-square, P=0.474) were comparable between both the groups. Manual SICS and phacoemulsification do not differ significantly in complication rates and final CDVA outcomes. However, manual SICS is significantly faster. It may be the preferred technique in settings where surgical volume is high and access to phacoemulsification is limited, such as in eye camps. It may also be the appropriate technique for uveitic cataract under such circumstances.

Cost-effectiveness analysis should continually assess competing health care options especially in high volume environments like cataract surgery.

Context:Cost-effectiveness analysis should continually assess competing health care options especially in high volume environments like cataract surgery.Aims:To compare the cost effectiveness of phacoemulsification (PE) versus manual small-incision cataract surgery (MSICS).Settings and Design:Prospective randomized controlled trial. Tertiary care hospital setting.Subjects and Methods:A total of 52 consenting patients with age-related cataracts, were prospectively recruited, and block randomized to PE or MSICS group. Preoperative and postoperative LogMAR visual acuity (VA), visual function-14 (VF-14) score and their quality-adjusted life years (QALYs) were obtained, and the change in their values calculated. These were divided by the total cost incurred in the surgery to calculate and compare the cost effectiveness and cost utility. Surgery duration was also compared.Statistical Analysis Used:Two group comparison with Student's t-test. Significance set at P < 0.05; 95% confidence interval (CI) quoted where appropriate.Results:Both the MSICS and PE groups achieved comparative outcomes in terms of change (difference in mean [95% CI]) in LogMAR VA (0.03 [−0.05−0.11]), VF-14 score (7.92 [−1.03−16.86]) and QALYs (1.14 [−0.89−3.16]). However, with significantly lower costs (INR 3228 [2700–3756]), MSICS was more cost effective, with superior cost utility value. MSICS was also significantly quicker (10.58 min [6.85–14.30]) than PE.Conclusions:MSICS provides comparable visual and QALY improvement, yet takes less time, and is significantly more cost-effective, compared with PE. Greater push and penetration of MSICS, by the government, is justifiably warranted in our country.

Phacoemulsification versus manual small incision cataract surgery for treatment of cataract

Objectives The aim of the study was to evaluate the effect of sutureless scleral tunnel manual small incision cataract surgery (MSICS) on the postoperative astigmatism in comparison with the effect of phacoemulsification. Background Nonphaco sutureless cataract extraction retains most of the advantages of phacoemulsification with comparable visual outcome and is affordable. Materials and methods Phacoemulsification and MSICS were performed in 20 eyes of 20 patients. Both techniques were performed at the Department of Ophthalmology, Menoufia University Hospital, Menoufia Governorate, Egypt. The study was conducted between 1 September 2011 and 28 February 2013. The outcome was evaluated in both techniques in terms of early visual rehabilitation, surgically induced astigmatism, and final best-corrected visual acuity. Results Of the 20 patients who underwent phacoemulsification, 60% were male patients and 40% were female patients. Of the 20 patients who underwent MSICS, 45% were male patients and 55% were female patients. Both surgical techniques achieved excellent visual outcomes with low complication rates. The initial visual recovery on the first postoperative day was better in the patients who underwent phacoemulsification, with the uncorrected visual acuity better than or equal to 6/18 in 75% of the patients, whereas the percentage was 60% in the MSICS group. The initial difference was nearly equalized within 4 weeks. At the sixth month, 85% of the patients in the MSICS group had uncorrected visual acuity better than or equal to 6/18 versus 90% of the patients in the phacoemulsification group. The surgically induced astigmatism at the sixth month was comparable in both techniques, 1.18 ΁ 0.2 D in the phacoemulsification group versus 1.2 ΁ 0.23 D in the MSICS group. Conclusion Both phacoemulsification and MSICS achieved excellent visual outcomes with low complication rates. MSICS is less technology dependent; hence, it is less expensive and more appropriate for treatment of advanced cataracts prevalent in the developing world.

Comparision of two different surgical procedures for hard nuclear cataract

Objective To compare the clinical efficacy of manual small-incision cataract surgery with phacoemusification in the management of hard nuclear cataract.Methods 404 eyes of 386 senile cataract with hard nuclei grade over Ⅲ were randomly divided into two groups:small-incision cataract surgery group (206 eyes of 194 cases) and phacoemusification group (198 eyes of 192 cases).Primary intraocular lenses implantation were performed in all cases.The postoperaive visual acuities,corneal astigmatism and surgical complications were compared between two groups.Results For cataract patients with grade Ⅲ hard nuclei,there were no significant differences in postoperative visual acuities,corneal astigmatism,posterior capsule rupture and corneal edema beween two groups.For cataract paients with grade Ⅳ or Ⅴ hard nuclei,the incidence of corneal edema was much lower in manual small-incision cataract surgery group than phacoemusification group,and the difference was statistically significant.Conclusion Small-incision cataract surgery is safe,time-saving and easy to operate which is the ideal choice for hard nuclear cataract patients in rural hospital. Key words: Cataract, nuleus, hard; Surgery, cataract, small-incision; Phacoemusification

Phacoemulsification versus manual small‐incision cataract surgery for age‐related cataract: meta‐analysis of randomized controlled trials

To compare outcomes of phacoemulsification (PE) with manual small-incision cataract surgery (MSICS) for age-related cataract. Meta-analysis. Patients from previously reported randomized controlled trials (RCTs) of PE and MSICS with clinical outcomes. A comprehensive literature search of Cochrane Library, PubMed and EMBASE to identify relevant RCTs comparing PE and MSICS. A meta-analysis was performed on the results and a RevMan 5.0 software (version 5.0; Cochrane Collaboration, Oxford, UK) was used for data analysis. Primary outcome measures included best corrected vision acuity (BCVA), uncorrected visual acuity (UCVA). Secondary outcome measures included surgically induced astigmatism (SIA), percentage of endothelial cell count (ECC) loss and complications. Six RCTs describing a total of 1315 eyes were identified. There were no significant differences between the techniques regarding the BCVA 6/9 or better (P = 0.69) and less than 6/18 (P = 0.68), percent of ECC loss (P = 0.45), intraoperative or postoperative complications (P = 0.44 and P = 0.87, respectively). However, a greater proportion of patients in the PE group had final UCVA ≥ 6/9 (P = 0.03), whereas a greater proportion of patients in the MSICS group had final UCVA < 6/18 (P = 0.03). Moreover, PE group induced less SIA (P < 0.00001). PE is superior to MSICS in UCVA and causes less SIA, but there were no significant differences in visual rehabilitation, ECC loss and complication rates between the two techniques.

Comparative outcomes of manual small incision cataract surgery and phacoemulsification performed by ophthalmology trainees in a tertiary eye care hospital in India: a retrospective cohort design

ObjectiveTo compare the outcomes of manual small incision cataract surgery (MSICS) and phacoemulsification performed by ophthalmology trainees.DesignRetrospective cohort design.SettingTertiary eye care centre.ParticipantsA total of 1029 subjects underwent cataract surgeries with...