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Surgical interventions for age-related cataract.
T Snellingen1, J R Evans, T Ravilla
1Institute of Clinical Medicine, University of Tromso, ISM UiTo, Tromso, Troms, Norway, 9037. torkel.snellingen@ism.uit.no
The Cochrane Database of Systematic Reviews
|June 22, 2002
Summary
Phacoemulsification surgery offers better visual outcomes than extracapsular surgery for age-related cataracts. Further research is needed to compare various intraocular lens procedures, especially in developing regions.
Area of Science:
- Ophthalmology
- Surgical Interventions
- Public Health
Background:
- Cataract remains a leading cause of global blindness, particularly in developing countries.
- The incidence of cataract blindness is projected to increase due to demographic shifts.
- Currently, surgery is the sole treatment for cataracts, with no proven preventive interventions.
Purpose of the Study:
- To systematically compare the effectiveness of different surgical techniques for age-related cataracts.
- To evaluate visual outcomes and cost-effectiveness of various cataract surgery methods.
Main Methods:
- Comprehensive literature search of multiple databases (Cochrane, MEDLINE, EMBASE) and expert consultation.
- Inclusion of randomized controlled trials (RCTs) evaluating surgical treatments for age-related cataracts.
- Independent data extraction by two reviewers, with data synthesized using relative risks, odds ratios, and weighted mean differences; fixed-effect model employed.
Main Results:
- Six RCTs involving 7828 participants were analyzed.
- Phacoemulsification demonstrated superior visual outcomes compared to extracapsular surgery.
- Extracapsular surgery with posterior chamber lens implant and intracapsular surgery with anterior chamber intraocular lens implant yielded acceptable visual results.
- Poor visual outcomes (<6/60) ranged from 0.5-4% in South Asian trials; higher rates observed with more surgeons involved.
Conclusions:
- Phacoemulsification shows better visual outcomes than extracapsular extraction with sutures, though evidence is from a single trial in a developed setting.
- Extracapsular cataract extraction with a posterior chamber lens implant is superior to intracapsular extraction with aphakic glasses.
- Intracapsular extraction with an anterior chamber lens implant is a safe alternative to intracapsular extraction with aphakic glasses.
- Further research, particularly from developing regions, is required to compare intraocular lens surgery with other main procedures.