Safety and Efficacy of Phacoemulsification Compared with Manual Small-Incision Cataract Surgery by a Randomized Controlled Clinical TrialSix-Week Results

Gogate, Parikshit; Kulkarni, Sucheta; Krishnaiah, Sannapaneni; Deshpande, Rahul; Joshi, Shilpa Ajit; Palimkar, Anand; Deshpande, Madan

doi:10.1016/j.ophtha.2004.11.055

Cited by 210 publications

(220 citation statements)

References 12 publications

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“…The visual results are similar to randomised control trails comparing phacoemulsification and MSICS performed in India and Nepal. 10,11 BBC cataracts may require a larger scleral tunnel (6.5-7.5 mm) for extraction of nucleus from the eye, which can induce postoperative corneal astigmatism. A temporal incision may help control corneal astigmatism.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of manual small incision cataract surgery for brunescent and black cataracts

Venkatesh

Tan

Singh

et al. 2008

Eye

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Aims To evaluate the safety, visual outcome and complications of manual small incision cataract surgery (MSICS) in the treatment of patients with brunescent and black cataract (BBC). Methods In a non-randomised interventional case series, 102 consecutive patients with BBC underwent cataract extraction by MSICS, with staining of the anterior capsule by trypan blue. Results Of the 102 eyes with BBC, MSICS was performed through superior scleral tunnel (SST) in 31 eyes (30.4%) and through temporal scleral tunnel (TST) in 71 eyes (69.6%). The main intraoperative complication was posterior capsule rupture in two patients (2.0%). Postoperatively, 20 eyes (19.6%) developed corneal oedema. Mild iritis was seen in six eyes (5.9%) and moderate iritis with fibrin membrane formation occurred in three eyes (2.9%). On the 40th postoperative day, 80 patients (78.4%) achieved uncorrected visual acuity of 6/18 or better, and 99 (97.1%) had best-corrected visual acuity of 6/18 or better. Patients in the SST group had significantly higher postoperative astigmatism compared to those in the TST group (À1.08 D vs À0.72 D, P ¼ 0.017). Conclusion MSICS with trypan blue staining of the anterior capsule is a safe and effective method of cataract extraction for patients with BBC.

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Section: Discussionmentioning

confidence: 99%

Safety and efficacy of manual small incision cataract surgery for brunescent and black cataracts

Venkatesh

Tan

Singh

et al. 2008

Eye

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“…A randomised trial of phacoemulsification vs SICS in South Africa produced results that are very similar to trials carried out in South Asia. 7,8,10 Provided surgeons are equally proficient at sclerocorneal tunnel and clear corneal incisions, the visual outcomes with rigid PMMA IOLs following phaco are at least as good as, if not better than, foldable IOLs at a much lower cost. As the greater expense of the foldable IOL accounts for a considerable portion of the additional cost of phacoemulsification in LMICs, this study demonstrates that the benefits of phacoemulsification can be made available to patients who are unable to afford a foldable IOL without any risk of worse short-term outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…We anticipated that 35% of the group receiving foldable lenses would achieve visual acuity of 6/9 or better and 80% would achieve vision of 6/18 or better at 1 year. 7,8 We anticipated that 80% of the participants would be followed up at 1 year. We knew that the occurrence of many of the secondary outcomes would be too infrequent for this study to detect differences.…”

Section: Methodsmentioning

confidence: 99%

“…The smaller incision leads to less astigmatism and better visual outcomes after surgery. 6 In low-and middle-income countries (LMICs), trials of phacoemulsification vs small incision manual extracapsular cataract surgery (SICS) have had variable results, with two trials showing the superiority of phaco 7,8 and two showing little difference between the two methods. 9,10 However, a recent meta-analysis showed that phacoemulsification was more likely than SICS to give an uncorrected visual acuity of 6/18 or better soon after surgery.…”

Section: Introductionmentioning

confidence: 99%

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Foldable vs rigid lenses after phacoemulsification for cataract surgery: a randomised controlled trial

Hennig¹,

Puri²,

Sharma³

et al. 2014

Eye

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Purpose To compare the outcomes of phacoemulsification with either a 2.5-mm clear corneal incision and a foldable intraocular lens (IOL) or a 5-mm sclerocorneal tunnel incision and a rigid polymethyl methacrylate (PMMA) IOL. Methods In a prospective, randomised clinical trial of phacoemulsification cataract surgery, 1200 patients received either a foldable hydrophilic acrylic IOL through a 2.5-mm corneal incision or an inexpensive rigid PMMA IOL via a 5-mm sclerocorneal tunnel. Intra-and post-operative data and visual acuity at discharge, 6 weeks, and 1 year follow-up were analysed.Results At 1 year after surgery, 996 (83.0%) patients were followed up with an uncorrected visual acuity of 6/18 or better in 90.3% of the foldable and 94.3% in the rigid IOL group (risk ratio (RR) 0.96, 95% confidence intervals (CI) 0.92-0.99). Poor outcome (best-corrected acuity 6/60 or worse) occurred in 1.0% and 0.4%, respectively (RR 4.28,). The surgical cost of consumables and overall surgical time were similar in both groups; however, the cost of the foldable IOL was eight times higher than the PMMA IOL. Posterior capsule opacification was more common in the rigid IOL group at 12 months (36.1% vs 23.3%); however, this did not affect postoperative vision. Conclusion In the hands of experienced cataract surgeons, phacoemulsification with implantation of a foldable or a rigid IOL gives excellent results. Using an inexpensive rigid PMMA IOL will make phacoemulsification more affordable for poor patients in low-and middle-income countries.

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“…In the largest clinical trial of phaco vs manual small-incision cataract surgery (MSICS), patients who had undergone phacoemulsification with a foldable IOL were significantly more likely to have a presenting visual acuity of 6/18 or better at 8 weeks after surgery than those having MSICS with a rigid IOL. 3 There is increasing demand for phacoemulsification in poor and middle-income countries, both from patients and from ophthalmologists. This will lead to increased costs, and possibly to reduced numbers of surgeries because of this.…”

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confidence: 99%

Response to Dr Colin Tan

Hennig¹,

Singh

Winter

et al. 2010

Eye

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Safety and Efficacy of Phacoemulsification Compared with Manual Small-Incision Cataract Surgery by a Randomized Controlled Clinical TrialSix-Week Results

Cited by 210 publications

References 12 publications

Safety and efficacy of manual small incision cataract surgery for brunescent and black cataracts

Safety and efficacy of manual small incision cataract surgery for brunescent and black cataracts

Foldable vs rigid lenses after phacoemulsification for cataract surgery: a randomised controlled trial

Response to Dr Colin Tan

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