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.

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.

BACKGROUND
Age -related cataract is a clouding of the lens, which occurs as a result of lens protein denaturation. Age -related cataract remains the leading cause of blindness globally, except in the most advanced countries. A key question is what is the best way of eliminating the lens, especially in low-income settings.


OBJECTIVE
To compare two different techniques of elimination of the lens in cataract surgery: the user is operating a small incision (MSICS) and extracapsular cataract extraction (ECCE).


METHOD
We searched CENTRAL (which contains the Cochrane Eyes and Trials Vision Group Register) (2014, Issue 8), Ovid MEDLINE, Ovid MEDLINE in process and Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946-September 2014), EMBASE ( January 1980 until September 2014), Latin America and the 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), which metaRegister of Controlled Trials (mRCT) ), and the World Health Organization (WHO) International Clinical Trials Registry platform (ICTRP) . We do not use date or language restrictions in the electronic searches for trials. Last we are looking for an electronic database on 23 September 2014.


METHOD
We included randomized controlled trials (RCTs) only. Participants in the trials were people with age-related cataract. We included trials in which MSICS with posterior chamber intraocular lens (IOL) implant compared to ECCE with posterior chamber IOL implant.


METHOD
Data were collected independently by two authors. We aim to collect data on presenting visual acuity of 6/12 or better and best corrected visual acuity less than 6/60 in three months and one year after surgery. Other results included intraoperative complications, complications of long-term (one year or more after surgery), quality of life, and cost effectiveness. There is not enough data available from the trial and to conduct a 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.
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.


RESULTS
Three randomized trial allocate people with age-related cataract to MSICS or ECCE included in this review (n = 953 participants). Two trials conducted in India and one in Nepal. experimental methods, such as random allocation and allocation concealment, not clearly explained; only in one experiment was an attempt to conceal the outcome assessors. Three studies reported follow-up six to eight weeks after surgery. In two studies, a participant in the group MSICS achieved without the aid of visual acuity 6/12 or 6/18 or better than the ECCE group, but overall no more than 50% of people achieve a good functional vision in two studies.

10/806 (1.2%) of those enrolled in the two trials had poor outcomes after surgery (best corrected vision of less than 6/60) with no evidence of a difference in risk between the two techniques (risk ratio (RR) 1.58 , 95% confidence interval (CI) 0.45 to 5.55). Surgically induced astigmatism more common with ECCE procedure of MSICS in two trials that reported this outcome. In one study there more complications intra and post-surgery in MSICS group. One study reported that the cost of two similar procedures.

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CONCLUSION
No other studies from other countries besides India and Nepal and there are insufficient data cost-effectiveness of each procedure. Better evidence is needed before any changes can be implemented. Future studies should have a long-term follow-up and conducted to minimize bias revealed in this review with a larger sample size to allow inspection of its side effects.

Benoit

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