Phacoemulsification Versus Manual Small Incision Cataract Surgery: An Umbrella Review of Systematic Reviews
Osman Haji1, Ling Paulina Gronczewska2, Alexander S Green3
1General Practice, King's College Hospital NHS Foundation Trust, London, GBR.
Cureus
|December 15, 2025
Summary
Phacoemulsification and manual small incision cataract surgery (MSICS) offer similar postoperative visual acuity outcomes. The choice between these cataract surgery techniques depends on surgeon expertise and available resources.
Area of Science:
- Ophthalmology
- Surgical Techniques
- Evidence Synthesis
Background:
- Phacoemulsification and manual small incision cataract surgery (MSICS) are leading global cataract removal methods.
- Comparative visual acuity (VA) outcomes between phacoemulsification and MSICS remain a subject of ongoing research and debate.
Purpose of the Study:
- To conduct an umbrella review synthesizing evidence from systematic reviews and meta-analyses.
- To compare postoperative visual acuity outcomes between phacoemulsification and MSICS in adult cataract surgery patients.
Main Methods:
- Searched major databases (PubMed, Cochrane, Web of Science, Embase) for relevant systematic reviews and meta-analyses.
- Included four systematic reviews/meta-analyses published between 2013-2015, focusing on postoperative VA (uncorrected and best-corrected) at various time points.
- Assessed methodological quality using the A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2).
Main Results:
- No consistent statistically significant differences in best-corrected visual acuity (BCVA) were found between the two techniques at any follow-up interval.
- Phacoemulsification showed a minor early advantage in uncorrected visual acuity (UCVA) in two reviews, but this was not sustained.
- Complication rates were comparable between phacoemulsification and MSICS.
Conclusions:
- Current evidence from systematic reviews indicates that phacoemulsification and MSICS provide similar postoperative visual acuity results.
- The selection of cataract surgery technique should consider factors beyond visual outcomes, such as surgeon proficiency, patient factors, and healthcare setting resources.
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