Effectiveness and safety of manual small incision cataract surgery compared to phacoemulsification with intraocular lens implantation for dense brown or black cataracts – UK experience
Rajesh Deshmukh, Mana Rahimzadeh, Owais Majid, Neil Shah, Alasdair Warwick, Kamran Saha, Lucy BarkerAbstract:
BACKGROUND:
To evaluate the effectiveness and safety of manual small incision cataract surgery (MSICS) compared to phacoemulsification in managing dense brown or black cataracts at a large tertiary teaching eye hospital in the United Kingdom.
METHODS:
We included eyes operated by MSICS (Gr1) and phacoemulsification (Gr2) in this cohort study. Before and 6 weeks after surgery, uncorrected visual acuity and best-corrected visual acuity (BCVA) were noted. Refractive status was compared after 6 weeks. The Effectiveness index-1 was defined as BCVA >6/18. The Effectiveness index-2 was also described as postoperative spherical equivalent refraction ±1D of the target. Safety was defined as the intraoperative and postoperative complication rates in the two groups.
RESULTS:
Gr1 and Gr2 had 17 and 56 eyes, respectively. Effectiveness 1 of Gr1 (59%) was significantly lower than that of Gr2 (84%) (
CONCLUSIONS:
MSICS is safer than phacoemulsification for managing dense brown or black cataracts but less effective at achieving an excellent visual prognosis and minimal residual astigmatism. Both could achieve similar refractive outcomes. MSICS was associated with fewer intraoperative complications than phacoemulsification in managing dense brown or black cataracts, although excellent visual outcomes were achieved less frequently, and residual astigmatism was greater. Refractive predictability was comparable, suggesting that MSICS remains a valuable alternative for appropriately selected dense cataracts.