In a prospective, randomized multi-centric study, consecutive patients with uveitic
cataract were randomized to receive
phacoemulsification or manual SICS by either of two surgeons well
versed with both the techniques. A minimum
inflammation free period of 3mo (defined as less than 5 cells per high power field in anterior chamber) was a pre-requisite for eligibility for surgery. Superior scleral tunnel incisions were used for both techniques. Improvement in visual acuity post-operatively was the primary outcome measure and the rate of post-operative complications and
surgical time were secondary outcome measures, respectively. Means of groups were compared using t-tests. One way analysis of variance (ANOVA) was used when there were more than two groups. Chi-square tests were used for proportions. Kaplan Meyer survival analysis was done and means for survival time was estimated at 95% confidence interval (CI). A P value of <0.05 was considered statistically significant.
RESULTS: One hundred and twenty-six of 139 patients (90.6%) completed the 6-month follow-up. Seven patients were lost in follow up and another six excluded due to either follow-up less than six months (n=1) or inability implant an
intraocular lens (IOL) because of insufficient capsular support following posterior
capsule rupture (n=5). There was significant improvement in vision after both the procedures (paired t-test; P<0.001). On first postoperative day, uncorrected distance visual acuity (UDVA) was 20/63 or better in 31 (47%) patients in Phaco group and 26 (43.3%) patients in SICS group (P=0.384). The mean surgically induced
astigmatism (SIA) was 0.86±0.34 dioptres (D) in the
phacoemulsification group and 1.16±0.28 D in SICS group. The difference between the groups was significant (t-test, P=0.002). At 6mo, corrected distance visual acuity (CDVA) was 20/60 or better in 60 (90.9%) patients in Phaco group and 53 (88.3%) in the manual SICS group (P=0.478). The mean
surgical time was significantly shorter in the manual SICS group (10.8±2.9 versus 13.2±2.6min) (P<0.001). Oral
prednisolone, 1 mg/kg
body weight was given 7d prior to surgery, continued post-operatively and tapered according to the inflammatory response over 4-6wk in patients with previously documented
macular edema, recurrent
uveitis, chronic
anterior uveitis and
intermediate uveitis. Rate of complications like
macular edema (Chi-square, P=0.459), persistent
uveitis (Chi-square, P=0.289) and posterior
capsule opacification (Chi-square, P=0.474) were comparable between both the groups.
CONCLUSION: Manual SICS and
phacoemulsification do not differ significantly in complication rates and final CDVA outcomes. However, manual SICS is significantly faster. It may be the preferred technique in settings where surgical volume is high and access to
phacoemulsification is limited, such as in eye camps. It may also be the appropriate technique for uveitic
cataract under such circumstances.