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Manual Small Incision Cataract Surgery: A Review

Venkatesh, Rengaraj MD*; Chang, David F. MD; Muralikrishnan, Radhakrishnan MHM, MSc‡þ; Hemal, Kenia MBBS*; Gogate, Pariskshit MS, FRCS (Edin)§; Sengupta, Sabyasachi DO; DNB

The Asia-Pacific Journal of Ophthalmology: March/April 2012 - Volume 1 - Issue 2 - p 113–119
doi: 10.1097/APO.0b013e318249f7b9
Review Article
Editor's Choice

We aim at reviewing published peer-reviewed studies that evaluate the safety and efficacy of manual small incision cataract surgery (MSICS). Literature searches of the PubMed and the Cochrane Library databases were conducted with no date restrictions; the searches were limited to articles published in English only. All publications with at least level II and III evidence were studied and surgical techniques were analyzed. MSICS was also compared with phacoemulsification and large incision extracapsular cataract surgery (ECCE) with respect to visual outcome, surgery time, cost, intra and postoperative complications and suitability for high volume surgical practices in the developing world.

The overall safety profile of MSICS was found to be excellent with intra and postoperative complication rates comparable to phacoemulsification and ECCE. Multiple studies reported the safety and efficacy of MSICS for complicated cases, such as brunescent and white cataract and cataracts associated with phacolytic and phacomorphic glaucoma. Compared to phacoemulsification MSICS was associated with lower and shorter operative times. Visual outcomes were excellent and comparable to phacoemulsification with up to 6 months follow up.

The literature provides outcome analysis of a variety of different MSICS techniques. As a whole, MSICS provides excellent outcomes with a low rate of surgical and postoperative complications. Particularly in the developing world, MSICS appears to provide outcomes that are of comparable quality to phacoemulsification at a much lower cost.

From the *Aravind Eye Hospital, Pondicherry, India; †The University of California, San Francisco, CA; ‡Cambridge Institute of Public Health, University of Cambridge, United Kingdom; §Dr. Gogate’s Eye Clinic, Pune; and ¶Vision Research Foundation, Sankara Nethralaya, Chennai, India.

Received for publication December 12, 2011; accepted January 4, 2012.

Reprints: Rengaraj Venkatesh, MD, Aravind Eye Hospital, Thavalakuppam, Pondicherry 605 007, India. E-mail:

D.F.C. is also in private practice in Los Altos, CA.

The authors have no funding or conflicts of interest to declare.

© 2012Asia-Pacific Academy of Ophthalmology
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