VIsual outcomes in manual small incision cataract surgery versus phacoemulsification: A prospective comparative data analysis

Abstract

Purpose: The aim of the study was to compare the visual outcomes, namely surgically induced astigmatism and visual acuity, of phacoemulsification cataract surgery with manual small incision cataract surgery (MSICS). Method and Design: The study design was a prospective comparative interventional cohort study. Patients were collected over a 13-month period - September 2016 to October 2017. Participants were patients routinely booked for elective cataract surgery at the Helen Joseph Hospital. Patients were assigned to either receiving phacoemulsification or manual small incision cataract surgery depending on the maturity of their cataract – as is routinely done. Keratometry was measured preoperatively and 6 weeks post-operatively, and visual acuity was assessed at 6 weeks post-operatively. Results: 100 eyes from 92 patients were enrolled in the study, 48 patients in the MSICS group and 44 patients in the phacoemulsification group. Surgically induced astigmatism was comparable between the two groups with a median value of 0.95 dioptres in the phacoemulsification group and 1.13 dioptres in the MSICS group (p= 0.25) when assessed with a univariate median regression. The p-values became even less significant when a multivariate median regression was performed using surgically induced astigmatism as the outcome and type of surgery, age and gender as the predictors. Uncorrected visual acuity 6 weeks post-operatively was comparable between the two groups (p =0.24). Best corrected visual acuity at 6 weeks was also comparable, (p =0.07). Conclusion: There was no statistical difference in the visual outcomes between phacoemulsification and manual small incision cataract surgery. The teaching of manual small incision cataract surgery should be promoted in the public health system to replace large limbal extracapsular cataract extraction as its outcomes are comparable to phacoemulsification- the gold standard. In doing so, this could increase our cataract surgery rate and reduce patient follow up time.