Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2014 Nov 18;2014(11):CD008811.
doi: 10.1002/14651858.CD008811.pub3.

Manual small incision cataract surgery (MSICS) with posterior chamber intraocular lens versus extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens for age-related cataract

Marcus Ang  1 , Jennifer R Evans, Jod S Mehta
Affiliations
Meta-Analysis

Manual small incision cataract surgery (MSICS) with posterior chamber intraocular lens versus extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens for age-related cataract

Marcus Ang et al. Cochrane Database Syst Rev. .

Abstract

Background: Age-related cataract is the opacification of the lens, which occurs as a result of denaturation of lens proteins. Age-related cataract remains the leading cause of blindness globally, except in the most developed countries. A key question is what is the best way of removing the lens, especially in lower income settings.

Objectives: To compare two different techniques of lens removal in cataract surgery: manual small incision surgery (MSICS) and extracapsular cataract extraction (ECCE).

Search methods: We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2014, Issue 8), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to September 2014), EMBASE (January 1980 to September 2014), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to September 2014), Web of Science Conference Proceedings Citation Index- Science (CPCI-S), (January 1990 to September 2014), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 23 September 2014.

Selection criteria: We included randomised controlled trials (RCTs) only. Participants in the trials were people with age-related cataract. We included trials where MSICS with a posterior chamber intraocular lens (IOL) implant was compared to ECCE with a posterior chamber IOL implant.

Data collection and analysis: Data were collected independently by two authors. We aimed to collect data on presenting visual acuity 6/12 or better and best-corrected visual acuity of less than 6/60 at three months and one year after surgery. Other outcomes included intraoperative complications, long-term complications (one year or more after surgery), quality of life, and cost-effectiveness. There were not enough data available from the included trials to perform a meta-analysis.

Main results: Three trials randomly allocating people with age-related cataract to MSICS or ECCE were included in this review (n = 953 participants). Two trials were conducted in India and one in Nepal. Trial methods, such as random allocation and allocation concealment, were not clearly described; in only one trial was an effort made to mask outcome assessors. The three studies reported follow-up six to eight weeks after surgery. In two studies, more participants in the MSICS groups achieved unaided visual acuity of 6/12 or 6/18 or better compared to the ECCE group, but overall not more than 50% of people achieved good functional vision in the two studies. 10/806 (1.2%) of people enrolled in two trials had a poor outcome after surgery (best-corrected vision less than 6/60) with no evidence of difference in risk between the two techniques (risk ratio (RR) 1.58, 95% confidence interval (CI) 0.45 to 5.55). Surgically induced astigmatism was more common with the ECCE procedure than MSICS in the two trials that reported this outcome. In one study there were more intra- and postoperative complications in the MSICS group. One study reported that the costs of the two procedures were similar.

Authors' conclusions: There are no other studies from other countries other than India and Nepal and there are insufficient data on cost-effectiveness of each procedure. Better evidence is needed before any change may be implemented. Future studies need to have longer-term follow-up and be conducted to minimize biases revealed in this review with a larger sample size to allow examination of adverse events.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

1
1
Types of cataract surgery
2
2
Results from searching for studies for inclusion in the review.
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
4
4
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

George 2005 {published data only}
    1. George R, Rupauliha P, Sripriya AV, Rajesh PS, Vahan PV, Praveen S. Comparison of endothelial cell loss and surgically induced astigmatism following conventional extracapsular cataract surgery, manual small‐incision surgery and phacoemulsification. Ophthalmic Epidemiology 2005;12(5):293‐7. - PubMed
Gogate 2003 {published data only}
    1. Gogate PM, Deshpande M, Wormald RP, Deshpande R, Kulkarni SR. Extracapsular cataract surgery compared with manual small incision cataract surgery in community eye care setting in western India: a randomised controlled trial. British Journal of Ophthalmology 2003;87(6):667‐72. - PMC - PubMed
Gurung 2009 {published data only}
    1. Gurung A, Karki DB, Shrestha S, Rijal AP. Visual outcome of conventional extracapsular cataract extraction with posterior chamber intraocular lens implantation versus manual small‐incision cataract surgery. Nepalese Journal of Ophthalmology 2009;1(1):13‐9. - PubMed

Additional references

Apple 1989
    1. Apple DH, Mamalis N, Olson RJ, Kincaid MC. Intraocular Lenses: Evolution, Designs, Complications and Pathology. Baltimore: Williams & Wilkins, 1989:225‐361.
Apple 1992
    1. Apple DJ, Solomon KD, Tetz MR, Assia EI, Holland EY, Legler UF, et al. Posterior capsule opacification. Survey of Ophthalmology 1992;37(2):73‐116. - PubMed
Blumenthal 1992
    1. Blumenthal M, Ashkenazi I, Assia E, Cahane M. Small‐incision manual extracapsular cataract extraction using selective hydrodissection. Ophthalmic Surgery 1992;23(10):699‐701. - PubMed
de Silva 2014
    1. Silva SR, Riaz Y, Evans JR. Phacoemulsification with posterior chamber intraocular lens versus extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens for age‐related cataract. Cochrane Database of Systematic Reviews 2014, Issue 1. [DOI: 10.1002/14651858.CD008812.pub2] - DOI - PMC - PubMed
Duane 1986
    1. Duane T. Textbook of Ophthalmology. Lippincott‐Raven, 1986:25.
Foster 2001
    1. Foster A. Cataract and "Vision 2020‐the right to sight" initiative. British Journal of Ophthalmology 2001;85(6):635‐7. - PMC - PubMed
Glanville 2006
    1. Glanville JM, Lefebvre C, Miles JN, Camosso‐Stefinovic J. How to identify randomized controlled trials in MEDLINE: ten years on. Journal of the Medical Library Association 2006;94(2):130‐6. - PMC - PubMed
Gogate 2005
    1. Gogate PM, Kulkarni SR, Krishnaiah S, Deshpande RD, Joshi SA, Palimkar A, et al. Safety and efficacy of phacoemulsification compared with manual small‐incision cataract surgery by a randomized controlled clinical trial: six‐week results. Ophthalmology 2005;112(5):869‐74. - PubMed
Hennig 1999
    1. Hennig A. Tunnel sutureless high volume cataract surgery. IAPB 6th General Assembly. Beijing, September 6 1999.
Higgins 2011
    1. Higgins JPT, Altman DG, Sterne JAC (editors). Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Javitt 1992
    1. Javitt JC, Tielch JM, Canner JK, Kolb MM, Sommer A, Steinberg EP. National outcomes of cataract extraction. Increased risk of retinal complications associated with Nd:YAG laser capsulotomy. The Cataract Patient Outcomes Research Team. Ophthalmology 1992;99(10):1487‐98. - PubMed
Kirkham 2010
    1. Kirkham JJ, Dwan KM, Altman DG, Gamble C, Dodd S, Smyth R, et al. The impact of outcome reporting bias in randomised controlled trials on a cohort of systematic reviews. BMJ 2010;340:c365. - PubMed
Kupfer 1994
    1. Kupfer C. The International Agency for the Prevention of Blindness. American Journal of Ophthalmology 1994;117(2):253‐7. - PubMed
Limburg 1996
    1. Limburg H, Kumar R, Bachani D. Monitoring and evaluating cataract intervention in India. British Journal of Ophthalmology 1996;80(11):951‐5. - PMC - PubMed
Mehta 1999
    1. Mehta KR, Mehta CK. Teaching standards in phacoemulsification. How realistic are they?. Symposium on Phacoemulsification. VI Ophthalmological Congress of SAARC Countries. Kathmandu, November 20 1999.
Minassian 1990
    1. Minassian DC, Mehra V. 3.8 Million blinded by cataract each year: projections from the first epidemiological study of the incidence of cataract blindness in India. British Journal of Ophthalmology 1990;74(6):341‐3. - PMC - PubMed
Muralikrishnan 2004
    1. Muralikrishnan R, Venkatesh R, Prajna NV, Frick KD. Economic cost of cataract surgery procedures in an established eye care centre in Southern India. Ophthalmic Epidemiology 2004;11(5):369‐80. - PubMed
Norregaard 1999
    1. Norregaard JC, Bernth‐Pettersen P, Bellan L, Alonso J, Black C, Dunn E, et al. Intraoperative clinical practice and risk of early complications after cataract extraction in the Unites States, Canada, Denmark and Spain. Ophthalmology 1999;106(1):42‐8. - PubMed
OCTET 1986
    1. Anonymous. Use of a grading system in the evaluation of complications in a randomised controlled trial on cataract surgery. Oxford Cataract Treatment and Evaluation Team (OCTET). British Journal of Ophthalmology 1986;70(6):411‐4. - PMC - PubMed
Passolini 2004
    1. Passolini D, Mariotti SP, Pokharel GP, Pararajasegarm R, Etyalale D, Negrel AD, et al. 2002 global update of available data on visual impairment:a compilation of population‐based prevalence studies. Ophthalmic Epidemiology 2004;11(2):67‐115. - PubMed
Perera 2007
    1. Perera R, Glasziou P. A simple method to correct for the design effect in systematic reviews of trials using paired dichotomous data. Journal of Clinical Epidemiology 2007;60(9):975‐8. - PubMed
Resnikoff 2004
    1. Resnikoff S, Passolini D, Etyalale D, Kocur I, Pararajasegarm R, Pokharel GP, et al. Global data on visual impairment in the year 2002. Bulletin of The World Health Organisation 2004;82(11):844‐51. - PMC - PubMed
Review Manager 2011 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.1. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2011.
Riaz 2006
    1. Riaz Y, Mehta JS, Wormald R, Evans JR, Foster A, Ravilla T, et al. Surgical interventions for age‐related cataract. Cochrane Database of Systematic Reviews 2006, Issue 4. [DOI: 10.1002/14651858.CD001323.pub2] - DOI - PMC - PubMed
Riaz 2013
    1. Riaz Y, Malik A, Evans JR. Manual small incision cataract surgery (MSICS) with posterior chamber intraocular lens versus phacoemulsification with posterior chamber intraocular lens for age‐related cataract. Cochrane Database of Systematic Reviews 2013, Issue 10. [DOI: 10.1002/14651858.CD008813.pub2] - DOI - PMC - PubMed
Ruit 2000
    1. Ruit S, Paudyal G, Gurung R, Tabin G, Moran D, Brian G. An innovation in developing world cataract surgery: sutureless extracapsular cataract extraction with intraocular lens implantation. Clinial and Experimental Ophthalmology 2000;28(4):274‐9. - PubMed
Singh 2000
    1. Singh AJ, Garner P, Floyd K. Cost‐effectiveness of public‐funded options for cataract surgery in Mysore, India. Lancet 2000;355(9199):180‐4. - PubMed
Snellingen 2002
    1. Snellingen T, Evans JR, Ravilla T, Foster A. Surgical interventions for age‐related cataract. Cochrane Database of Systematic Reviews 2002, Issue 2. [DOI: 10.1002/14651858.CD001323] - DOI - PubMed
Thylefors 1998
    1. Thylefors B. A global initiative for the elimination of avoidable blindness. American Journal of Ophthalmology 1998;125(1):90‐3. - PubMed
Venkatesh 2005
    1. Venkatesh R, Muralikrishnan, Balent LC, Prakash SK, Prajna NV. Outcomes of high volume cataract surgeries in a developing country. British Journal of Ophthalmology 2005;89(9):1079‐83. - PMC - PubMed
White 2008
    1. White IR, Higgins JP, Wood AM. Allowing for uncertainty due to missing data in meta‐analysis‐Part 1: two‐stage methods. Statistics in Medicine 2008;27(5):711‐27. - PubMed
Yorston 2005
    1. Yorston D. High‐volume surgery in developing countries. Eye 2005;19(10):1083‐9. - PubMed

References to other published versions of this review

Ang 2010
    1. Ang M, Mehta JS, Evans JR. Extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens versus manual small incision cataract surgery (MSICS) with posterior chamber intraocular lens for age‐related cataract. Cochrane Database of Systematic Reviews 2010, Issue 11. [DOI: 10.1002/14651858.CD008811] - DOI - PubMed
Ang 2012
    1. Ang M, Mehta JS, Evans JR. Manual small incision cataract surgery (MSICS) with posterior chamber intraocular lens versus extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens for age‐related cataract. Cochrane Database of Systematic Reviews 2012, Issue 4. [DOI: 10.1002/14651858.CD008811.pub2] - DOI - PubMed

Publication types

LinkOut - more resources