Comparative Study of Visual Outcomes and Surgically-Induced Astigmatism Following Manual Small-Incision Cataract Surgery (MSICS) and Phacoemulsification (PHACO)

Abstract

Background: Cataract remains the leading cause of blindness worldwide. Surgical treatment is the only effective method for cataract removal, and the two most common techniques are Manual Small-Incision Cataract Surgery (MSICS) and Phacoemulsification (PHACO). While PHACO is the standard in developed countries, MSICS is increasingly popular in developing countries due to its lower cost and reduced requirement for advanced surgical equipment. This study aims to compare the visual outcomes and surgically-induced astigmatism (SIA) between MSICS and PHACO and to evaluate the relative efficacy of both methods in cataract surgery. Methods: A total of 64 eyes from 63 consecutive cataract patients were enrolled and divided into two groups: PHACO (32 eyes) and MSICS (32 eyes). Preoperative and postoperative parameters, including uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and keratometric readings (for calculating SIA), were assessed. Postoperative follow-up was performed at 1 day, 1 week, 1 month, and 3 months. Data were analyzed using statistical methods, including Student’s t-test for continuous variables and the χ²-test for categorical data. Results: Both groups showed significant improvement in visual acuity after 3 months. The PHACO group had better UCVA and BCVA compared to the MSICS group (P<0.01). The mean surgically-induced astigmatism was 2.08 D in the PHACO group and 2.96 D in the MSICS group, with no significant difference in either the amount (P=0.166) or axis (P=0.195) of SIA between the groups. The MSICS group had higher postoperative complication rates, including keratitis and decentered intraocular lenses (IOL). Conclusion: MSICS is an effective, fast, and economical alternative to PHACO, offering comparable visual outcomes and manageable SIA. It is particularly suited for use in resource-limited settings and in cases of dense cataracts.

Keywords: manual small-incision cataract surgery, phacoemulsification, surgically-induced astigmatism.