Extracapsular cataract extraction compared with small incision surgery by phacoemulsification: a randomised trial
D C Minassiana, P Rosenc, J K G Dartb, A Reidyd, P Desaid, M Sidhue
a Institute
of Ophthalmology, University College London, UK, b Moorfields Eye Hospital, London, c Oxford Eye Hospital, d Moorfields
Eye Hospital, London, e Southampton University Hospitals Trust
Correspondence to: D C Minassian, Department of Preventive Ophthalmology, Institute of Ophthalmology, University College London, Bath Street, London EC1V 9EJ, UK
Accepted for publication 12 February 2001
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.
METHODSIn 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.
RESULTSPhako 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.
CONCLUSIONPhako is clinically superior to ECCE and is cost effective.
© 2001 by British Journal of Ophthalmology
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