Article Text

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

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.

  • extracapsular cataract extraction
  • phacoemulsification
  • randomised trial
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Supplementary materials

  • The authors of this paper have mistakenly excluded from the citation two additional authors, and they wish to publish a correction adding these two:

    The corrected citation should be as follows:

    Minassian DC, Rosen P, Dart JKG Reidy A, Desai P, Sidhu M, Kaushal, S and Wingate N. Extracapsular cataract extraction versus small incision cataract surgery by phacoemulsification: a randomised controlled trial. BJO 2001;85:822-829.

    The affiliation for the 2 additional authors are:
    Sunny Kaushal, Oxford Eye Hospital
    Nicholas Wingate, Moorfields Eye Hospital, London

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