Visual outcome and patient satisfaction after cataract surgery: A pragmatic study

Introduction: Cataract is a leading cause of blindness globally. This study compared the best corrected visual acuity (BCVA), surgically induced astigmatism (SIA), endothelial cell loss, and patient satisfaction between corneal section phacoemulsification (CSP) and Blumenthal manual small incision cataract surgery (MSICS). Methods: In this pragmatic study, following pre-operative assessment, patients made a choice to undergo either CSP or MSICS after the options were explained by the ophthalmologist. Pre- and post-operative (Day 1, 1-week, 6-weeks) refraction, keratometry and specular microscopy were performed. Subjective improvement in visual function was assessed before surgery and at 6-weeks post-surgery using the 7-item VF-7 scale that assesses functional status and quality-of-life changes. Results: Of the 178 eyes, 99 had CSP and 79 MSICS. At 6-weeks, BCVA of < 6/18 was achieved in 100% in CSP and 96.2% in MSICS (p = 0.27). The mean (SD) SIA was significantly lower (p = 0.003) with CSP (1.29 +/- 0.71 D) than MSICS (1.01 +/- 0.49 D). Endothelial loss was lower (p = 0.008) with MSICS (271 +/- 280 vs. 527 +/- 475 cells/mm(2)). Subjective improvement in visual function was better after MSICS than with CSP. Conclusion: Despite similar visual acuity with CSP and MSICS, subjective improvement was better with MSICS. SIA was lower with CSP while endothelial loss was lower with MSICS.