Cited by 106Intraocular Surgery and LensesRetinal and Macular SurgeryCorneal surgery and disorders

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Meta-analysis to compare the safety and efficacy of manual small incision cataract surgery and phacoemulsification

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Gogate, Parikshit, Optom, Jyoti JaggernathB, Deshpande, Swapna, Naidoo, Kovin·2015·Middle East African Journal of Ophthalmology

Abstract

PURPOSE: A systematic review and meta-analysis comparing the safety, efficacy, and expenses related to phacoemulsification versus manual small incision cataract surgery (SICS). METHODS: PubMed, Cochrane, and Scopus databases were searched with key words manual SICS 6/18 and 6/60; astigmatism and endothelial cell loss postoperatively, intra- and post-operative complications, phacoemulsification, and comparison of SICS and phacoemulsification. Non-English language manuscripts and manuscripts not indexed in the three databases were also search for comparison of SICS with phacoemulsification. Data were compared between techniques for postoperative uncorrected and corrected distance visual acuity (UCVA and best corrected visual acuity [BCVA], respectively) better than 6/9, surgical cost and duration of surgery. The Oxford cataract treatment and evaluation team scores were used for grading intraoperative and postoperative complications, uncorrected near vision. RESULT: This review analyzed, 11 comparative studies documenting 76,838 eyes that had undergone cataract surgery considered for analysis. UCVA of 6/18 UCVA and 6/18 BCVA were comparable between techniques (P = 0.373 and P = 0.567, respectively). BCVA of 6/9 was comparable between techniques (P = 0.685). UCVA of 6/60 and 6/60 BCVA aided and unaided vision were comparable (P = 0.126 and P = 0.317, respectively). There was no statistical difference in: Endothelial cell loss during surgery (P = 0.298), intraoperative (P = 0.964) complications, and postoperative complications (P = 0.362). The phacoemulsification group had statistically significantly less astigmatism (P = 0.005) and more eyes with UCVA of 6/9 (P = 0.040). UCVA at near was statistically significantly better with SICS due to astigmatism and safer during the learning phase (P = 0.003). The average time for SICS was lower than phacoemulsification and cost <½ of phacoemulsification. CONCLUSION: The outcome of this meta-analysis indicated there is no difference between phacoemulsification and SICS for BCVA and UCVA of 6/18 and 6/60. Endothelial cell loss and intraoperative and postoperative complications were similar between procedures. SICS resulted in statistically greater astigmatism and UCVA of 6/9 or worse, however, near UCVA was better.

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Crossref · 10.4103/0974-9233.159763

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Figures

Figure 1 (a) Comparison of best corrected visual acuity at 6/18 cutoff using Phaco vs. SICS Meta Analysis based on data from 7 studies; Event is BCVA < 6/18, OR: odds ratio, OR of Phaco over SICS. (b) Comparison of Unaided corrected visual acuity at 6/18 cutoff using Phaco vs. SICS Meta Analysis based on data from 5 studies; Event is UCVA < 6/18, OR: odds ratio, OR of Phaco over SICS
Figure 1 (a) Comparison of best corrected visual acuity at 6/18 cutoff using Phaco vs. SICS Meta Analysis based on data from 7 studies; Event is BCVA < 6/18, OR: odds ratio, OR of Phaco over SICS. (b) Comparison of Unaided corrected visual acuity at 6/18 cutoff using Phaco vs. SICS Meta Analysis based on data from 5 studies; Event is UCVA < 6/18, OR: odds ratio, OR of Phaco over SICSCC BY-NC-SA · PubMed Central
Figure 2 (a) Comparison of best corrected visual acuity at 6/9 cutoff using Phaco vs. SICS. (b) Comparison of unaided corrected visual acuity at 6/9 cutoff using Phaco vs. SICS
Figure 2 (a) Comparison of best corrected visual acuity at 6/9 cutoff using Phaco vs. SICS. (b) Comparison of unaided corrected visual acuity at 6/9 cutoff using Phaco vs. SICSCC BY-NC-SA · PubMed Central
Figure 3 (a) Comparison of best corrected visual acuity at 6/60 cutoff using Phaco vs. SICS. (b) Comparison of unaided corrected visual acuity at 6/60 cutoff using Phaco vs. SICS
Figure 3 (a) Comparison of best corrected visual acuity at 6/60 cutoff using Phaco vs. SICS. (b) Comparison of unaided corrected visual acuity at 6/60 cutoff using Phaco vs. SICSCC BY-NC-SA · PubMed Central
Figure 4 Astigmatism using Phaco vs. SICS technique
Figure 4 Astigmatism using Phaco vs. SICS techniqueCC BY-NC-SA · PubMed Central
Figure 5 (a) Intra-operative complications excluding studies with learning curves and high volume surgery using Phaco vs. SICS technique. (b) Intra-operative complications including high volume setting. (c) Intra-operative complications including studies with learning curves and high volume surgery using Phaco vs. SICS technique
Figure 5 (a) Intra-operative complications excluding studies with learning curves and high volume surgery using Phaco vs. SICS technique. (b) Intra-operative complications including high volume setting. (c) Intra-operative complications including studies with learning curves and high volume surgery using Phaco vs. SICS techniqueCC BY-NC-SA · PubMed Central
Figure 6 (a) Post-operative complications excluding studies with learning curves and high volume surgery using Phaco vs. SICS technique. (b) Post-operative complications including high volume settings but excluding studies with learning curves. (c) Post-operative complications including studies with learning curves and high volume surgery
Figure 6 (a) Post-operative complications excluding studies with learning curves and high volume surgery using Phaco vs. SICS technique. (b) Post-operative complications including high volume settings but excluding studies with learning curves. (c) Post-operative complications including studies with learning curves and high volume surgeryCC BY-NC-SA · PubMed Central
Figure 7 Endothelial cell count loss using Phaco vs. SICS technique
Figure 7 Endothelial cell count loss using Phaco vs. SICS techniqueCC BY-NC-SA · PubMed Central

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Cites

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Research works printed but not linked: 4

  1. Use, 1986, Oxford Cataract Treatment and Evaluation Team (OCTET), Br J Ophthalmol, 411
  2. Kulkarni AN, Bhomaj P, Badhe G. Manual Small Incision Cataract Surgery is Almost as Effective but Less Expensive than Phacoemulsification. Proceedings of the 73 rd Annual Conference of the All India Ophthalmology Society 2010 at Kolkata, Cataract Session IV; 2010. p. 146-8.
  3. Venkatesh, 2012, Manual small incision cataract surgery: A review, Asia Pac J Ophthalmol, 113
  4. Gogate, 2011, Monitoring and modernization improves the outcome of cataract surgery in Maharashtra, India, J Cataract Refract Surg, 328

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Metadata

Authors
Gogate, P., Optom, J. J., Deshpande, S., & Naidoo, K.
Affiliations
Brien Holden Vision Institute (AU)
Corresponding author
Gogate, Parikshit
Venue
Middle East African Journal of Ophthalmology
Published
2015
Volume
22
Issue
3
Pages
362
ISSN
0974-9233 (ISSN-L)
OpenAlex
W2168894369
Cited by
106
References
33
Citations by year
2026: 2 · 2025: 8 · 2024: 8 · 2023: 12 · 2022: 20 · 2021: 12 · 2020: 11 · 2019: 14 · 2018: 9 · 2017: 5 · 2016: 4 · 2015: 1
FWCI
6.08
Type
journal article
Language
en
Open access
Licence
cc-by-nc-sa
Locations
  • Middle East African Journal of Ophthalmology (publishedVersion)
  • PubMed Central (publishedVersion, cc-by-nc-sa)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Ophthalmology › Intraocular Surgery and Lenses
  • Health Sciences › Medicine › Ophthalmology › Retinal and Macular Surgery
  • Health Sciences › Medicine › Ophthalmology › Corneal surgery and disorders
Keywords
cataract surgery, phacoemulsification, manual small incision cataract surgery, visual acuity outcomes, astigmatism, endothelial cell loss, intraoperative complications, postoperative complications, surgical costs, learning curve, operative time
MeSH terms
Astigmatism, Biometry, Cataract Extraction, Humans, Intraoperative Complications, Male, Microsurgery, Postoperative Complications, Visual Acuity, Phacoemulsification, Corneal Endothelial Cell Loss

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