Phacoemulsification versus small incision cataract surgery (SICS): which one is a better surgical option for immature cataract in developing countries?

Abstract

Background: Several studies have shown comparable visual outcomes of SICS and phacoemulsification (Gogate et al 2007, Ruit et al 2007.Objective: To compare the safety and efficacy of different types of surgical procedures (phacoemulsification versus SICS) for cataract surgery in immature cataract. Material and methods:A prospective randomized controlled trial was carried out involving 93 and 89 patients with immature senile cataract selected for phacoemulsification and SICS respectively. Statistics:Mean values with standard deviations were calculated. P value of less than 0.05 was considered significant.Results: There was no difference between the groups in terms of gender, age and pre-operative visual acuity (p = 0.09). In phacoemulsification group (n=93) more than two thirds and in SICS group (n=89) more than three quarters of the patients had good visual outcome (6/6-6/18) on first postoperative day (p=0.065). Poor outcome (<6/60) was recorded in 6% (phacoemulsification group) and 1% (small incision cataract surgery group). Mean visual acuity was 0.43 ± 0.27 in phacoemulsification group and 0.47 ± 0.24 in SICS group. Mean surgery time was significantly shorter in SICS group (p=0.0003).Statistics: Data were computed and analyzed using the SPSS software program vs 10. The p value of < 0.05 was considered significant. Conclusion:There was no significant difference in visual outcome on first post operative day in between phacoemulsification and SICS technique. However, performing SICS was significantly faster. Small incision cataract surgery with implantation of rigid PMMA lens is a suitable surgical technique to treat immature cataract in developing countries.

Outcomes of manual small incision cataract surgery (mSICS) compared with phacoemulsification from population based outreach eye camp, in Yogyakarta and Southern Central Java Region, Indonesia

“…Gogate et al 15 revealed that mSICS was almost half the cost of phacoemulsification with easier learning curves. Moreover, Singh et al 8 showed that sterilization procedures for mSICS is more available and inexpensive than phacoemulsification.…”

“…7 However, several comparable previous studies in Nepal have shown similar visual outcomes from both mSICS and phacoemulsification but there are no studies yet in Indonesia that report the significance of each visual outcome after the surgery. 8 Similar studies in Egypt also stated that there were insignificant results of uncorrected visual acuity (UVCA) and best corrected visual acuity (BCVA) of patients who underwent phacoemulsification versus mSICS. 7,9 In the Department of Ophthalmology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia, outreach cataract programs have been conducted frequently with approximately 15-20 programs annually.…”

Phacoemulsification versus manual small‐incision cataract surgery for age‐related cataract: meta‐analysis of randomized controlled trials

“…A total of 14 potential controlled clinical trials relevant to a comparison of the PE and MSICS were identified through the search. [15][16][17][18][19][20][21][22][23][24][25][26][27][28] Eight studies were excluded; seven lacking primary outcome data, [16][17][18][19][20][21][22] two reporting on the same subjects 15,23 integrated into one study. 23 Thus, a total of six RCTs were included in the final meta-analysis.…”

A critical review of some of the articles published in the Nep J Oph 2009; 1(2)

“…The attempt of Singh et al (2009) to justify the rationale of the widely used small incision cataract surgery (SICS) in developing countries is impressive. The technique used in the SICS by the principle author in immature cataract seems to be ideal that the external and internal wound size remains the same.…”