Safety and Efficacy of the Transition from Extracapsular Cataract Extraction to Manual Small Incision Cataract Surgery in Prevention of Blindness Campaigns

Abstract

Purpose: To compare the safety and the visual outcomes of two experienced cataract surgeons who converted from extracapsular cataract extraction (ECCE) to manual small incision cataract surgery (MSICS) during a campaign for the prevention of blindness.

Methods: Two surgeons used the ECCE technique (ECCE group) during a campaign in Burkina Faso on 93 consecutive cataract patients with a corrected distance visual acuity (CDVA) <20/80 in the best eye. Both surgeons used MSICS for the first time on 98 consecutive cases in another campaign in Kenya after theoretical instructional courses.

Results: There were no significant differences in CDVA at 3 months postoperatively. There were 69% of eyes with uncorrected distance visual acuity ≥20/60 in the MSICS group and 49% eyes in the ECCE group. Spherical equivalents ranged between -1D and +1D in 55% of the MSICS group versus 43% in the ECCE group. There were significant differences in the changes in the vertical component of astigmatism (J45) but not the horizontal (J0) component. There were no significant differences in the intraoperative complications. The most common postoperative complication was corneal edema on the first day in 40.86% and 19.38% of the ECCE and MSICS groups, respectively.

Conclusion: Transitioning from ECCE to MSICS for experienced cataract surgeons in surgical campaigns is safe. The rate of complications is similar for both techniques. Slightly better visual and refractive outcomes can be achieved due to the decreased induction of corneal astigmatism.

Keywords: Blindness; Cataract Surgery; Extracapsular Cataract Extraction; Manual Small Incision Cataract Surgery; Visual Impairment.

Figure 1

(a) The efficacy (top); (b) safety (middle) and (c) predictability (bottom) over the time of the surgical procedures 3 months after surgeries are shown in standardized graphs for reporting refractive surgery data

Figure 2

Polar representation of the mean corneal astigmatism vectors (being the vector's length the magnitude of corneal astigmatism in diopters as seen in the horizontal and vertical axes of the graph) calculated before and 3 months after procedures for both series