No abstract

Background Cataract accounts for 50% of blindness globally and remains the leading cause of visual impairment in all regions of the world, despite improvements in surgical outcomes (WHO 2005). This number is expected to rise due to an aging population and increase in life expectancy. Although cataracts are not preventable, their surgical treatment is one of the most cost-e ective interventions in healthcare. Objectives To compare the e ects of di erent surgical interventions for age-related cataract. Search methods We searched CENTRAL, MEDLINE, EMBASE up to July 2006, NRR Issue 3 2005, the reference lists of identified trials and we contacted investigators and experts in the field for details of published and unpublished trials. Selection criteria We included randomised controlled trials (RCTS). Data collection and analysis Two review authors independently extracted data and discrepancies were resolved by discussion. Where appropriate, risk ratios, odds ratios and weighted mean di erences were summarised a er assessing heterogeneity between the studies. Main results We identified 17 trials that randomised a total of 9627 people. Phacoemulsification gave a better visual outcome than extracapsular surgery but similar average cost per procedure in Europe but not in poorer countries. Extracapsular surgery with posterior chamber lens implant and ICCE with or without an anterior chamber intraocular lens (IOL) implant gave acceptable visual outcomes but extracapsular surgery had less complications. Manual small incision surgery provides better visual outcome than ECCE but slightly inferior unaided visual acuity compared to phacoemulsification.

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

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

Analysis 03.01. Comparison 03 INTRACAPSULAR EXTRACTION WITH AC-IOL VS INTRACAPSULAR EXTRACTION WITH GLASSES, Outcome 01 Best-corrected vision less than 6/60 one year after surgery. Analysis 03.02. Comparison 03 INTRACAPSULAR EXTRACTION WITH AC-IOL VS INTRACAPSULAR EXTRACTION WITH GLASSES, Outcome 02 Functional vision less than 6/18 one year after surgery. . Analysis 03.03. Comparison 03 INTRACAPSULAR EXTRACTION WITH AC-IOL VS INTRACAPSULAR EXTRACTION WITH GLASSES, Outcome 03 Clinical complications. .. .. .. .. .. .. Analysis 03.04. Comparison 03 INTRACAPSULAR EXTRACTION WITH AC-IOL VS INTRACAPSULAR EXTRACTION WITH GLASSES, Outcome 04 Corneal endothelial cell loss 12-24 months after surgery .