Curative effects of small incision cataract surgery versus phacoemulsification: a meta-analysis

Methodological quality of the review: Low confidence

Author: Yang CJ, Zeng LT, Jiang M.

Region: China

Sector: Cataract surgery

Sub-sector: None specified

Type of cataract: Age-related cataract

Equity focus: None specified

Review type: Other review

Quantitative synthesis method: Meta-analysis

Qualitative synthesis methods: Not applicable

Background

Different surgical methods might have different surgical outcome (visual acuity), and postoperative surgical complication (astigmatism, corneal oedema, post-capsular rupture and pupil reaction) rate. Recently, small incision cataract surgery (SCIS) and phacoemulsification (Phaco) were the most popular surgical method.

Research objectives

To evaluate the curative effectiveness of small incision cataract surgery (SICS) versus phacoemulsification (Phaco), with the focus on the postoperative visual acuity and complications rates.

Main findings

In total, authors included eight studies in the meta-analysis. One of the eight was a randomized controlled trial study, others were controlled clinical trials. Geographical location was not mentioned in the article, but all were conducted in China.

Results suggest that there were no significant differences of surgical results found from SICS and Phaco for cataract.

Authors reported that, as SICS requires less investment on equipment, it is also an easy skill to obtain with reliable surgical outcomes and could be adaptable in many circumstances, SICS should be more widely recommended.

Methodology

Included studies were restricted to clinical controlled trials analysing cataract operations using Phaco or SICS in walk-in cataract patients from eight hospitals. Outcome measures included visual acuity and complications rates measured 90 days after surgery.

This review was based on a search of the literature on the Chinese Biomedical Database, Wanfang Data, WIP and Chinese National Knowledge Infrastructure. Although no date restriction was applied, articles were restricted to articles written in Chinese and to published articles only. As part of the search strategy, authors also reviewed reference lists of relevant papers. Although study selection was not conducted by two reviewers independently, methods used to extract data were appropriately conducted by two reviewers independently. Authors did not report assessing the quality of included studies.

Authors conducted a meta-analysis of the data from the eight included studies. Further details regarding the studies were necessary to ensure the appropriateness of the meta-analysis.

Applicability/external validity

The authors mentioned the visual acuity 90 days post-operated, astigmatism 30 days post-operated, corneal oedema, post capsular rupture, etc. However, they did not introduce the location of the conducted operations, who conducted them, whether all cases covered senile cataract patients, and what were the surgical conditions of the hospital.

Geographic focus

This review only focused on one country only: China. Therefore, findings may not be applicable to low- and middle- income countries.

Quality assessment

Overall, this review was attributed low confidence in the conclusions about the effects of this study. As the search for literature was restricted to studies written in Chinese, only Chinese databases were searched. Therefore, we cannot be confident that relevant studies were not omitted in the review. Selection bias within the review was not avoided as two reviewers did not conduct study selection independently, and further information in regards to the studies included, such as study design, is required to understand the appropriateness of the meta-analysis. The reviewers partially described which evidence was subject to low risk of bias in assessing causality and which was likely to be biased; and further details of the methods used to analyse the findings were required to determine the robustness of the review.