rss
Br J Ophthalmol 2001;85:822-829 doi:10.1136/bjo.85.7.822
  • Original Article
    • Clinical science

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

  1. D C Minassiana,
  2. P Rosenc,
  3. J K G Dartb,
  4. A Reidyd,
  5. P Desaid,
  6. M Sidhue
  1. aInstitute of Ophthalmology, University College London, UK, bMoorfields Eye Hospital, London, cOxford Eye Hospital, dMoorfields Eye Hospital, London, eSouthampton University Hospitals Trust
  1. D C Minassian, Department of Preventive Ophthalmology, Institute of Ophthalmology, University College London, Bath Street, London EC1V 9EJ, UK
  • Accepted 12 February 2001

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.

Footnotes

    This Article

    1. Abstract
    2. Full text
    3. PDF
    5. Authors' correction

    Responses

    1. Submit a response
    2. No responses published

    Register for free content

    The full back archive is now available for all BMJ Journals. Institutional subscribers may access the entire archive as part of their subscription. Personal subscribers will also have access to all content when logged in. Non-subscribers who register have free access to all articles published before 2006 right back to volume 1 issue 1. Register here to access the free archive of all BMJ Journals.

    Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.