Safety and efficacy of manual small incision cataract surgery and phacoemulsification: a retrospective, comparative study in a low-to-middle-income country
Mario Renato Papa-Vettorazzi1, José Benjamin Cruz-Rodríguez2, Gladys Lucia Silva-Linares3, Nuno Moura-Coelho4, Nicolás Yee-Melgar3
1 Department of Ophthalmology, Visualiza Clinic, Guatemala, Guatemala; Department of Cornea and Anterior Segment, Instituto de Microcirugía Ocular, Barcelona, Spain
2 Department of Research, University of California San Diego, San Diego, CA, USA
3 Department of Ophthalmology, Visualiza Clinic, Guatemala, Guatemala
4 Department of Cornea and Anterior Segment, Instituto de Microcirugía Ocular, Barcelona, Spain; Department of Ophthalmology, Hospital CUF Cascais, Cascais; Department of Research,NOVA Medical School,Faculdade de Ciências Médicas – Universidade Nova de Lisboa, Lisbon, Portugal
Dr. Mario Renato Papa-Vettorazzi
5TA AV. 11-44 Zona 9, 01009, Guatemala
Source of Support: None, Conflict of Interest: None
Purpose: To compare the efficacy and safety of manual small incision cataract surgery (mSICS) versus phacoemulsification in a referral center from a low-to-middle-income country.
Subjects and Methods: A retrospective cohort of 177 eyes with visually significant cataract and ≤1.0 diopter (D) of keratometric astigmatism was intervened during 2017 by four surgeons either by mSICS or by phacoemulsification. Last follow-up was at 4–6 weeks. Outcome measures included postoperative uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refractive cylinder, spherical equivalent (SE), complications, and re-interventions.
Results: The mSICS group included 107 eyes; the phacoemulsification group included 70 eyes. UDVA was comparable between both groups; 89.6% in the mSICS group and 95.7% in the phacoemulsification group achieved a UDVA ≥6/18 (20/60) (P = 0.06). CDVA was comparable between both groups; 100% in the mSICS cohort and 98.6% in the phacoemulsification cohort had a CDVA ≥6/18 (20/60) (P = 0.26). Although the absolute difference in postoperative refractive astigmatism between both groups was small, it was statistically significant in favor of the phacoemulsification group (P = 0.02). Postoperative refractive SE was also comparable between both cohorts (P = 0.64). One intraoperative complication was found in the phacoemulsification group (1.4%), with no complications in the mSICS group. However, there were six reoperations in the mSICS cohort (5.6%) and no reoperations in the phacoemulsification one.
Conclusions: Both mSICS and phacoemulsification achieved excellent visual outcomes with low complication rates. Phacoemulsification gives better UDVA and lower postoperative refractive astigmatism in a larger proportion of patients at 4–6 weeks.