Extracapsular cataract extraction compared with small incision surgery by phacoemulsification: a randomised trial

Abstract

Background-Cataract extraction constitutes the largest surgical workload in ophthalmic units throughout the world. Extracapsular cataract extraction (ECCE), through a large incision, with insertion of an intraocular lens has been the most widely used method from 1982 until recently. Technological advances have led to the increasing use of phacoemulsification (Phako) to emulsify and remove the lens The technique requires a smaller incision, but requires substantial capital investment in theatre equipment. In this randomised trial we assessed the clinical outcomes and carried out an economic evaluation of the two procedures. Methods-In this two centre randomised trial, 232 patients with age related cataract received ECCE, and 244 received small incision surgery by Phako. The main comparative outcomes were visual acuity, refraction, and complication rates. Resource use was monitored in the two trial centres and in an independent comparator centre. Costs calculated included average cost per procedure, at each stage of follow up. Results-Phako was found to be clinically superior. Surgical complications and capsule opacity within 1 year after surgery were significantly less frequent, and a higher proportion achieved an unaided visual acuity of 6/9 or better (<0.2 log-MAR) in the Phako group. Postoperative astigmatism was more stable in Phako. The average cost of a cataract operation and postoperative care within the trial was similar for the two procedures. With the input of additional spectacles for corrected vision at 6 months after surgery, the average cost per procedure was £359.89 for Phako and £367.57 for ECCE. Conclusion-Phako is clinically superior to ECCE and is cost eVective. (Br J Ophthalmol 2001;85:822-829)

Manual Small Incision Cataract Surgery: Experience at a Military Hospital

“…Average astigmatism at the end of 6 weeks was ± 0.75 dioptre which compares well with the results of phacoemulsification in a randomised trial where astigmatism (mean cylinder dioptre) was < 1 dioptre [9]. Our results also compares well with the results of the series reported by Malik et al [10], who reports astigmatism of 0.75 ± 0.35 dioptre at 4 weeks post-op in SICS with 6mm straight incision.…”

“…59 (85.5%) of our patients achieved BCVA of 6/12 or better. In a randomised trial [9] 90% of the patients undergoing phacoemulsification through 3.2mm clear corneal incision (on steep corneal axis) and IOL implantation had 6/9 or better vision with spectacles at the end of 6 weeks, which is better than our results with SICS as far as postoperative visual outcome is concerned. The incision size and the choice of incision site on the steeper site in these cases is the likely cause of better postoperative acuity.…”

High-volume surgery in developing countries

“…22,23 In wealthy countries, manual ECCE has been replaced by phacoemulsification, which has been shown to be superior. 24 The benefits of rapid visual recovery, and low induced astigmatism, are even more important in the developing world. However, a new phaco machine costs d35 000 or more.…”

Aqualase for cataract extraction

“…1 Phacoemulsification, however, still carries a significant risk of posterior capsule rupture with vitreous loss, which engenders an eight-fold increased risk of endophthalmitis, a 10-fold increased risk of retinal detachment in the first three postoperative months and a fourfold risk of a final visual acuity of worse than 6/12. 2 The rate of posterior capsular rupture depends on experience and although the National Cataract Surgery Survey in 1997-1998 showed a rate of 4%, 3 this may be as high as 10% in the most junior trainees and lower than 1% in experienced surgeons.…”