August 24, 2012
1 min read

Manual small-incision cataract surgery may offer safer starting point for new cataract surgeons

Article originally published August 7, 2012. Video Perspective published August 24, 2012.

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Manual small-incision cataract surgery may be a safer initial procedure for inexperienced cataract surgeons to learn than phacoemulsification, which has a relatively higher complication rate, according to a study.

The retrospective cohort study analyzed consecutive cataract surgeries performed during a 12-month period: 20,438 phacoemulsification procedures, 53,603 manual small-incision cataract surgery (SICS) procedures and 5,736 extracapsular cataract extraction procedures. The procedures were performed by staff surgeons, fellows, residents and visiting trainees at a network of five regional eye hospitals in Southern India.

The overall intraoperative complication rate was 0.79% for staff, 1.19% for fellows, 2.06% for residents and 5% for visiting trainees. 

The complication rates for trainees were 4.8% with phacoemulsification and 1.46% with SICS; the difference was statistically significant (P < .001).

“These findings suggest that compared with phacoemulsification, manual SICS is comparably safe for experienced surgeons but is the safer technique for less experienced cataract surgeons,” the study authors said. “The need to train large numbers of new cataract surgeons in underserved societies to stem the growing backlog of cataract blindness is yet another reason manual SICS may initially be the procedure of choice for less experienced surgeons in the developing world.”

Potential confounding factors included that patients paying fully for a procedure tended to be treated with phaco, while those receiving free or reduced-fee surgery tended to receive the less costly SICS procedure, according to the authors.

Manual SICS was often selected for the most advanced or complicated cataracts by staff surgeons, but because these surgeons tend to be equally proficient in both techniques, the study results support the comparable safety of manual SICS and phacoemulsification when performed by experienced surgeons, the authors said.