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

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 ad vances have led to the increasing use of phacoemulsification (Phako) to emu lsify and remove the lens The technique requires a smaller incision, but re quires substantial capital investment in theatre equipment. in this randomi sed trial we assessed the clinical outcomes and carried out an economic eva luation 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. T he main comparative outcomes were visual acuity, refraction, and complicati on rates. Resource use was monitored in the two trial centres and in an ind ependent comparator centre. Costs calculated included average cost per proc edure, at each stage of follow up. Results-Phako was found to be clinically superior. Surgical complications a nd capsule opacity within 1 year after surgery were significantly less freq uent, and a higher proportion achieved an unaided visual acuity of 6/9 or b etter (<0.2 log-MAR) in the Phako group. Postoperative astigmatism was more stable in Phako. The average cost of a cataract operation and postoperativ e care within the trial was similar for the two procedures. With the input of additional spectacles for corrected vision at 6 months after surgery, th e average cost per procedure was pound 359.89 for Phako and pound 367.57 fo r ECCE. Conclusion-Phako is clinically superior to ECCE and is cost effective.