Effect of phacoemulsification versus extracapsular extraction on visual acuity: a Meta-analysis

Methodological quality of the review: Low confidence

Author: Cheng JW, Wei RL, Li Y.

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


Recently, phacoemulsification (Phaco) became to be a popular surgical method. This article aimed to examine the effects of Phaco versus extracapsular extraction (ECCE) on visual acuity. Different surgical method might have different surgical outcome (visual acuity) and complication rates.

Research objectives

To evaluate the curative effectiveness of ECCE versus Phaco.

Main findings

Authors included nine studies in the meta-analysis. All the studies were clinical randomized controlled trials with the focus on cataract surgery. Based on findings of the meta-analysis, authors found that Phaco is a safer and reliable surgery for restoration of visual acuity in patients with cataract, and is superior to ECCE.


Selected studies were restricted to clinical randomized controlled trials which compared Phaco against ECCE in patients with cataracts. Outcomes measures included visual acuity measured within one week and more than three months after surgery; Complication rate including corneal oedema, posterior capsule rupture, pupil synechia, hyphaema, iris injury, cystoid macular oedema.

The review was based on a search of the literature on the Chinese Biomedical Database and Medline (1990 – 2013) with no language restriction imposed. Reference lists of relevant trials were also searched as part of the search strategy. Selection of articles as well as data extraction of included studies was conducted independently by two reviewers. It was not reported if authors conducted quality and risk of bias assessment of included studies.

Authors conducted a meta-analysis of the data from the nine included studies which seems appropriate as all included studies in the review were clinical randomized controlled trials with comparable results; and also a heterogeneity test was conducted using both, fixed effect and random effects model.

Applicability/external validity

Authors did not discuss the applicability/external validity of the results.

Geographic focus

The authors did not provide geographical location of included studies.

Quality assessment

Overall, this study was attributed low confidence in the conclusions about the effects as major limitations were identified. Although authors used appropriate methods to select and extract data of studies, the search strategy was partially comprehensive. Authors do not clearly report the criteria used to select studies and characteristics of included studies. Additionally, authors did not discuss or acknowledged limitations of the review.

Publication Details

Cheng JW, Wei RL, Li Y. Effect of phacoemulsification versus extracapsular extraction on visual acuity: a Meta-analysis. Chin J Ophthalmol. 2004;40(7):474-7.