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

Background To compare outcomes of phacoemulsification (PE) with manual small-incision cataract surgery (MSICS) for age-related cataract. Design Meta-analysis. Participants Patients from previously reported randomized controlled trials (RCTs) of PE and MSICS with clinical outcomes. Methods A comprehensive literature search of Cochrane Library, PubMed and EMBASE to identify relevant RCTs comparing PE and MSICS. A meta-analysis was performed on the results and a RevMan 5.0 software (version 5.0; Cochrane Collaboration, Oxford, UK) was used for data analysis. Main Outcome Measures Primary outcome measures included best corrected vision acuity (BCVA), uncorrected visual acuity (UCVA). Secondary outcome measures included surgically induced astigmatism (SIA), percentage of endothelial cell count (ECC) loss and complications. Results Six RCTs describing a total of 1315 eyes were identified. There were no significant differences between the techniques regarding the BCVA 6/9 or better (P=0.69) and less than 6/18 (P=0.68), percent of ECC loss (P=0.45), intraoperative or postoperative complications (P=0.44 and P=0.87, respectively). However, a greater proportion of patients in the PE group had final UCVA6/9 (P=0.03), whereas a greater proportion of patients in the MSICS group had final UCVA<6/18 (P=0.03). Moreover, PE group induced less SIA (P<0.00001). Conclusions PE is superior to MSICS in UCVA and causes less SIA, but there were no significant differences in visual rehabilitation, ECC loss and complication rates between the two techniques.