Phacoemulsification versus manual small-incision cataract surgery for age-related cataract: meta-analysis of randomized controlled trials


  • Competing/conflicts of interest: No stated conflict of interest.
  • Funding sources: No stated funding sources.

Correspondence: Dr Jian-qiu Cai, The Second Affiliated Hospital, Yuying Children's Hospital of Wenzhou Medical College, #109 Xueyuan West Road, Zhejiang 325000, China. Email:



To compare outcomes of phacoemulsification (PE) with manual small-incision cataract surgery (MSICS) for age-related cataract.




Patients from previously reported randomized controlled trials (RCTs) of PE and MSICS with clinical outcomes.


A comprehensive literature search of Cochrane Library, PubMed and EMBASE to identify relevant RCTs comparing PE and MSICS. A meta-analysis was performed on the results and a RevMan 5.0 software (version 5.0; Cochrane Collaboration, Oxford, UK) was used for data analysis.

Main Outcome Measures

Primary outcome measures included best corrected vision acuity (BCVA), uncorrected visual acuity (UCVA). Secondary outcome measures included surgically induced astigmatism (SIA), percentage of endothelial cell count (ECC) loss and complications.


Six RCTs describing a total of 1315 eyes were identified. There were no significant differences between the techniques regarding the BCVA 6/9 or better (P = 0.69) and less than 6/18 (P = 0.68), percent of ECC loss (P = 0.45), intraoperative or postoperative complications (P = 0.44 and P = 0.87, respectively). However, a greater proportion of patients in the PE group had final UCVA ≥ 6/9 (P = 0.03), whereas a greater proportion of patients in the MSICS group had final UCVA < 6/18 (P = 0.03). Moreover, PE group induced less SIA (P < 0.00001).


PE is superior to MSICS in UCVA and causes less SIA, but there were no significant differences in visual rehabilitation, ECC loss and complication rates between the two techniques.