Skip to main content
PMC home page
The British Journal of Ophthalmology logoLink to The British Journal of Ophthalmology
. 2001 Jul;85(7):822–829. doi: 10.1136/bjo.85.7.822

Extracapsular cataract extraction compared with small incision surgery by phacoemulsification: a randomised trial

D Minassian 1, P Rosen 1, J Dart 1, A Reidy 1, P Desai 1, M Sidhu 1
PMCID: PMC1724033  PMID: 11423457

Abstract

BACKGROUND—Cataract extraction constitutes the largest surgical workload in ophthalmic units throughout the world. Extracapsular cataract extraction (ECCE), through a large incision, with insertion of an intraocular lens has been the most widely used method from 1982 until recently. Technological advances have led to the increasing use of phacoemulsification (Phako) to emulsify and remove the lens The technique requires a smaller incision, but requires substantial capital investment in theatre equipment. In this randomised trial we assessed the clinical outcomes and carried out an economic evaluation of the two procedures.
METHODS—In this two centre randomised trial, 232 patients with age related cataract received ECCE, and 244 received small incision surgery by Phako. The main comparative outcomes were visual acuity, refraction, and complication rates. Resource use was monitored in the two trial centres and in an independent comparator centre. Costs calculated included average cost per procedure, at each stage of follow up.
RESULTS—Phako was found to be clinically superior. Surgical complications and capsule opacity within 1 year after surgery were significantly less frequent, and a higher proportion achieved an unaided visual acuity of 6/9 or better (<0.2 logMAR) in the Phako group. Postoperative astigmatism was more stable in Phako. The average cost of a cataract operation and postoperative care within the trial was similar for the two procedures. With the input of additional spectacles for corrected vision at 6 months after surgery, the average cost per procedure was £359.89 for Phako and £367.57 for ECCE.
CONCLUSION—Phako is clinically superior to ECCE and is cost effective.



Full Text

The Full Text of this article is available as a PDF (248.5 KB).

Figure 1  .

Figure 1  

Open in a new tab

Recruitment, randomisation, and flow of patients through the various stages of the trial.

Figure 2  .

Figure 2  

Open in a new tab

Astigmatism in the two treatment groups before surgery and in the follow up period after surgery. The higher figures (in the ECCE group) are undesirable as they result in poorer unaided vision and a greater requirement for spectacles.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Dam-Johansen M., Olsen T. Refractive results after phacoemulsification and ECCE. A comparative study. Acta Ophthalmol (Copenh) 1993 Jun;71(3):382–387. doi: 10.1111/j.1755-3768.1993.tb07152.x. [DOI] [PubMed] [Google Scholar]
  2. Desai P., Minassian D. C., Reidy A. National cataract surgery survey 1997-8: a report of the results of the clinical outcomes. Br J Ophthalmol. 1999 Dec;83(12):1336–1340. doi: 10.1136/bjo.83.12.1336. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Gills J. P., Sanders D. R. Use of small incisions to control induced astigmatism and inflammation following cataract surgery. J Cataract Refract Surg. 1991;17 (Suppl):740–744. doi: 10.1016/s0886-3350(13)80695-5. [DOI] [PubMed] [Google Scholar]
  4. Hollick E. J., Spalton D. J., Ursell P. G., Pande M. V., Barman S. A., Boyce J. F., Tilling K. The effect of polymethylmethacrylate, silicone, and polyacrylic intraocular lenses on posterior capsular opacification 3 years after cataract surgery. Ophthalmology. 1999 Jan;106(1):49–55. doi: 10.1016/S0161-6420(99)90047-7. [DOI] [PubMed] [Google Scholar]
  5. Kaugars G. E., Riley W. T., Grisius T. M., Page D. G., Svirsky J. A. Comparison of articles published in Oral Surgery Oral Medicine Oral Pathology in 1972 and 1992. Oral Surg Oral Med Oral Pathol. 1994 Sep;78(3):351–353. doi: 10.1016/0030-4220(94)90067-1. [DOI] [PubMed] [Google Scholar]
  6. Leaming D. V. Practice styles and preferences of ASCRS members--1998 survey. J Cataract Refract Surg. 1999 Jun;25(6):851–859. [PubMed] [Google Scholar]
  7. Minassian D. C., Reidy A., Desai P., Farrow S., Vafidis G., Minassian A. The deficit in cataract surgery in England and Wales and the escalating problem of visual impairment: epidemiological modelling of the population dynamics of cataract. Br J Ophthalmol. 2000 Jan;84(1):4–8. doi: 10.1136/bjo.84.1.4. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Ober M. D., Lemon L. C., Shin D. H., Nootheti P., Cha S. C., Kim P. H. Posterior capsular opacification in phacotrabeculectomy : a long-term comparative study of silicone versus acrylic intraocular lens. Ophthalmology. 2000 Oct;107(10):1868–1874. doi: 10.1016/s0161-6420(00)00270-0. [DOI] [PubMed] [Google Scholar]
  9. Pfleger T., Scholz U., Skorpik C. Postoperative astigmatism after no-stitch, small incision cataract surgery with 3.5 mm and 4.5 mm incisions. J Cataract Refract Surg. 1994 Jul;20(4):400–405. doi: 10.1016/s0886-3350(13)80174-5. [DOI] [PubMed] [Google Scholar]
  10. Sparrow J. M., Bron A. J., Brown N. A., Ayliffe W., Hill A. R. The Oxford Clinical Cataract Classification and Grading System. Int Ophthalmol. 1986 Dec;9(4):207–225. doi: 10.1007/BF00137534. [DOI] [PubMed] [Google Scholar]
  11. Uusitalo R. J., Ruusuvaara P., Järvinen E., Raivio I., Krootila K. Early rehabilitation after small incision cataract surgery. Refract Corneal Surg. 1993 Jan-Feb;9(1):67–70. [PubMed] [Google Scholar]
  12. Watson A., Sunderraj P. Comparison of small-incision phacoemulsification with standard extracapsular cataract surgery: post-operative astigmatism and visual recovery. Eye (Lond) 1992;6(Pt 6):626–629. doi: 10.1038/eye.1992.135. [DOI] [PubMed] [Google Scholar]
  13. el-Maghraby A., Anwar M., el-Sayyad F., Matheen M., Marzouky A., Gazayerli E., Salah T., Ballew C. Effect of incision size on early postoperative visual rehabilitation after cataract surgery and intraocular lens implantation. J Cataract Refract Surg. 1993 Jul;19(4):494–498. doi: 10.1016/s0886-3350(13)80613-x. [DOI] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

[Authors' correction]
brjopthal_85_7_822__index.html (1.6KB, html)

Articles from The British Journal of Ophthalmology are provided here courtesy of BMJ Publishing Group

RESOURCES