Surgical Interventions for Age-Related Cataracts: An Expert's Guide

As an expert in the field of ophthalmology, I'm often asked about the best surgical interventions for age-related cataracts. Age-related cataracts are a common condition affecting older individuals, and in most cases, surgery is the only treatment. In this article, I'll discuss the different types of surgical interventions available, their benefits and drawbacks, and the cost of each procedure.

The two main surgical interventions for age-related cataracts are

extracapsular cataract extraction (ECCE)

and

phacoemulsification

. ECCE involves making a small incision in the cornea to remove the lens nucleus without fragmenting it. This leaves the capsule intact, which can help the eyes heal. However, a small incision does carry an increased complication rate. The Phako method is a more minor incision requiring a 3.2 mm precise corneal incision. This results in less scarring and reduces postoperative inflammation.

During the first 6 months after surgery, the phaco-tab group had better visual acuity and fewer complications than the ECCE group. After that, however, a higher percentage of patients required spectacles. Moreover, patients in the ECCE group were left with more excess astigmatism. Hence, the visual outcomes were worse in the ECCE group throughout the follow-up.

In addition, a significant proportion of the ECCE group required sutures for protrusion and wound leak. Eight of the 244 patients in the ECCE group required sutures, whereas only five in the phaco-tab group needed sutures.

Despite the higher preoperative complication rate, the ECCE procedure did not require a substantial relearning curve. The increased rate of astigmatism after surgery is probably due to the requirement for an open eye during surgery.

Cost Analysis

The cost of phacoemulsification, ECCE, and the combined procedure was analyzed. Each operation required a different resource input. These inputs included the operating theatre/surgical episode, the average cost of the system, the resource input category of outpatients, and the average depreciation of the equipment. The prices were compared with the National Health Service and were assessed by a cost of good visual outcome analysis.

Phacoemulsification

Phacoemulsification is the most common surgical intervention for age-related cataracts. It uses ultrasound energy to break up the cataract. An IOL is then inserted into the lens capsule.

Extracapsular cataract extraction is another surgical option for older patients. This type of surgery involves making a small incision in the cornea, allowing for the removal of the cataract in one piece.

Although extracapsular cataract extraction is more beneficial for older patients, it is unsuitable for all cases. Phacoemulsification is the method most used in developed countries and provides comparable visual outcomes.

However, there are some limitations to each technique. The results are also subject to the skill of the eye surgeon performing the operation. In addition, studies have not consistently shown lower complications or faster recovery.

Manual Minor Incision Cataract Surgery

Manual minor incision cataract surgery (SICS) is less expensive and offers a low-risk alternative to phacoemulsification. This surgery is especially useful in developing countries.

17 randomized controlled trials (RCTs) were reviewed on 9627 people. The trials were conducted in various settings, including Europe and America as well as developing countries.

Several of these studies reported similar results. However, some authors felt that long-term follow-up could have been easier to assess. Another issue was that assessors in some studies were masked.

A systematic review of these 17 RCTs was completed by two independent authors. The researchers found that PHACO provided a higher visual outcome than extracapsular cataract surgery.