Prospective randomized comparative study of macular thickness following phacoemulsification and manual small incision cataract surgery

Abstract

. Purpose: To compare macular thickness following uncomplicated phacoemulsification with foldable acrylic lens and manual small incision cataract surgery (MSICS) with non‐foldable polymethyl methacrylate (PMMA) lens implantation. Methods: Prospective study was carried out with one eye each of 224 patients with senile cataract randomized into two groups, phacoemulsification and MSICS, by simple 1:1 randomization. Following surgery by either of the two methods, macular thickness was measured by optical coherence tomography (OCT) on the 1st, 7th, 42nd and 180th postoperative day. Main outcome measure was postoperative macular thickness. Results: On the first postoperative day, central subfield mean thickness (CSMT) in MSICS group was 192.8 ± 17.9 μm and that in phacoemulsification group was 192.1 ± 27.4 μm, with no significant difference (p = 0.12). On the 7th day, CSMT in MSICS group (198.9 ± 21.4 μm) was significantly (p = 0.04) more than that in phacoemulsification group (193.1 ± 19.3 μm). On the 42nd day, CSMT in MSICS group was 207.8 ± 26.3 μm and that in phacoemulsification group was 198.3 ± 23 μm, the difference being significant (p = 0.007). Clinically macular oedema was not diagnosed in any of the patients at any visit. The increase in macular thickness was sub‐clinical and did not affect final visual outcome in any patient. Conclusion: In spite of the greater theoretical risk of increased postoperative inflammation following MSICS, there was no evidence of cystoid macular oedema, either clinically or on OCT. However, chance of sub‐clinical increase in CSMT was more following MSICS compared to phacoemulsification.

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

“…The literature search identified 223 articles. A total of 14 potential controlled clinical trials relevant to a comparison of the PE and MSICS were identified through the search . Eight studies were excluded; seven lacking primary outcome data, two reporting on the same subjects integrated into one study .…”

“…Eight studies were excluded; seven lacking primary outcome data, two reporting on the same subjects integrated into one study . Thus, a total of six RCTs were included in the final meta‐analysis …”

“…The data of this outcome was collected from all trials . There was no statistically significant difference in the proportion of eyes with BCVA<6/9 between the two groups (OR, 0.77; 95% CI, 0.23 to 2.61; P = 0.68; Fig.…”

Cataract surgery in developing countries

“…However, in a recent prospective randomized trial, Ghosh et al [24 ] compared the macular thickness following MSICS and phacoemulsification in 224 patients by optical coherence tomography and found no evidence of cystoid macular edema, either clinically or on optical coherence tomography. There was increased central subfield mean thickness in MSICS group at seventh day and 42nd day 42.…”

Changes of the Macular Ganglion Cell-Inner Plexiform Layer Thickness after Cataract Surgery in Glaucoma Patients

“…Several studies have investigated the effect of cataract surgery on macula and RNFL using different OCT platforms [5–11]. Recent studies have shown that the GCC and peripapillary RNFL thickness significantly increased after routine cataract surgery in nonglaucomatous eyes [12, 13].…”