Comparison of endothelial cell loss after cataract surgery: phacoemulsification versus manual small-incision cataract surgery: six-week results of a randomized control trial

Purpose: To compare endothelial cell loss in cataract surgery by phacoemulsification and by manual small-incision cataract surgery (SICS).

Settings: Tertiary care ophthalmic center, India.

Methods: A complete ophthalmologic examination and endothelial specular microscopy were performed preoperatively and 1 and 6 weeks postoperatively in patients having cataract surgery. The endothelial cell count (ECC) was calculated manually and automatically using an LSM 12000 specular microscope. Patients were randomly allocated to have SICS or phacoemulsification using a random number table. Phacoemulsification was performed using the stop-and-chop technique and SICS, by viscoexpression.

Results: The study evaluated 200 patients, 100 in each group. The mean preoperative ECC by the manual counting method was 2950.7 cells/mm(2) in the phacoemulsification group and 2852.5 cells/mm(2) in the SICS group and by the automated counting method, 3053.7 cells/mm(2) and 2975.3 cells/mm(2), respectively. The difference at 6 weeks was 543.4 cells/mm(2) and 505.9 cells/mm(2), respectively, by the manual method (P = .44) and 474.2 cells/mm(2) and 456.1 cells/mm(2), respectively, by the automated method (P = .98). The corrected distance visual acuity at 6 weeks was better than 6/18 in 98.5% of eyes in the phacoemulsification group and 97.3% of eyes in the SICS group.

Conclusion: There were no clinically or statistically significant differences in ECC loss or visual acuity between phacoemulsification and SICS, although there was a small difference in the astigmatic shift.