title: Comparison of cataract surgery techniques: safety, efficacy, and cost-effectiveness.
abstract: OBJECTIVE
  To compare the safety, efficacy, and cost-effectiveness of manual sutureless small-incision cataract surgery (SICS) and phacoemulsification (Phaco) as treatment options for cataract surgery with focus on intumescent, mature, and hypermature lenses (white cataracts).
  
  
  METHODS
  A systematic search of research articles was conducted to develop an internal database for the investigators' appraisal. Literature searches were conducted by using key words and MeSH terms including cataracts, phacoemulsification, small-incision cataract incision, visual acuity, costs, training, time, and barriers to cataract surgery. The final synthesis included 42 manuscripts.
  
  
  RESULTS
  All studies show that both Phaco and SICS are safe and effective techniques to rehabilitate cataract patients, but Phaco is costlier, with its preoperative and postoperative medicines, anesthetic agents, viscoelastic materials, disposables, instrumentation, and intraocular lens (IOLs), and had a steeper learning curve. Small-incision cataract surgery, in comparison, has been shown to be faster and more cost-effective. It is useful in intumescent white, black, brown, and lens-induced glaucoma cataracts and could incorporate recent trends like topical and sub-Tenon anesthesia and temporal incisions. Both give equal best-corrected visual acuity but unaided vision has been shown to be slightly better in Phaco due to lesser astigmatism.
  
  
  CONCLUSIONS
  The literature points to SICS being more useful for intumescent and hard cataracts and is the preferred technique for less-resourced settings. Small-incision cataract surgery is comparable to Phaco in almost all aspects except postoperative astigmatism.
authors.affiliation: African Vision Research Institute, Durban - South Africa.
authors.forename: Jyoti
authors.initials: J
authors.lastname: Jaggernath
authors.forename: Parikshit
authors.initials: P
authors.lastname: Gogate
authors.forename: Vadi
authors.initials: V
authors.lastname: Moodley
authors.forename: Kovin S
authors.initials: KS
authors.lastname: Naidoo
mesh_terms: D002387:Cataract Extraction / Q000009:adverse effects / Q000191:economics* / Q000379:methods*; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006801:Humans; D019654:Lens Implantation, Intraocular / Q000379:methods; D008875:Middle Aged; D018918:Phacoemulsification / Q000009:adverse effects / Q000191:economics / Q000379:methods; D012029:Refraction, Ocular / Q000502:physiology; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology