Complication rates of phacoemulsification and manual small-incision cataract surgery at Aravind Eye Hospital

J Cataract Refract Surg. 2012 Aug;38(8):1360-9. doi: 10.1016/j.jcrs.2012.04.025.


Purpose: To analyze the rate of intraoperative complications, reoperations, and endophthalmitis with phacoemulsification, manual small-incision cataract surgery (SICS), and large-incision extracapsular cataract extraction (ECCE).

Setting: Aravind Eye Hospital, Madurai, India.

Design: Retrospective cohort study.

Methods: This study comprised consecutive cataract surgeries performed during a 12-month period. All surgical complications and endophthalmitis cases were tabulated and analyzed for each of 4 surgeon groups (staff, fellows, residents, visiting trainees). Within each surgeon group, complication rates with phacoemulsification, manual SICS, and ECCE were compared.

Results: The surgical distribution was 20,438 (26%) phacoemulsification, 53,603 (67%) manual SICS, and 5736 (7%) ECCE. The overall intraoperative complication rate was 0.79% for staff, 1.19% for fellows, 2.06% for residents, and 5% for visiting trainees. Extracapsular cataract extraction had the highest overall rate of surgical complications (2.6%). The overall complication rate was 1.01% for manual SICS and 1.11% for phacoemulsification. However, the combined complication rate for trainees was significantly higher with phacoemulsification (4.8%) than with manual SICS (1.46%) (P<.001). The corrected distance visual acuity was better than 6/12 in 96% after phacoemulsification complications and 89% after manual SICS complications (P<.001). There were 27 cases (0.04%) of endophthalmitis but no statistical differences between surgical methods or surgeon groups.

Conclusions: For staff surgeons experienced with both phacoemulsification and manual SICS, intraoperative complication rates were comparably low. However, for trainee surgeons, the complication rate was significantly higher with phacoemulsification, suggesting that manual SICS may be a safer initial procedure to learn for inexperienced cataract surgeons in the developing world.

Financial disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Publication types

  • Comparative Study

MeSH terms

  • Cataract Extraction / adverse effects*
  • Cataract Extraction / education
  • Clinical Competence
  • Education, Medical, Graduate
  • Endophthalmitis / etiology*
  • Female
  • Hospitals, Special
  • Humans
  • India
  • Internship and Residency
  • Intraoperative Complications*
  • Lens Implantation, Intraocular
  • Male
  • Microsurgery / adverse effects
  • Middle Aged
  • Ophthalmology / education
  • Phacoemulsification / adverse effects*
  • Phacoemulsification / education
  • Postoperative Complications*
  • Reoperation
  • Retrospective Studies