BACKGROUND: The purpose of this study was to compare manual small incision cataract surgery (MSICS) with phacoemulsification and manual extracapsular extraction in terms of corneal edema, endothelial loss, and induced astigmatism.

MATERIAL AND METHODS: A prospective study carried out in the ophthalmology department of the military hospital of Rabat in Morocco, including 15 eyes of 15 patients with brown cataracts. All patients were operated on by the same surgeon: 5 by phacoemulsification (PKE), 5 by manual extracapsular extraction (EEC) via corneal incision, and 5 by MSICS via tunneled sclero-corneal incision. Each patient underwent pre-, intra- and post-operative evaluation including: 1 — measurement of astigmatism before surgery and 3 months after (after removal of EEC threads); 2 — specular microscopy before and 3 months after surgery; 3 — clinical assessment of corneal edema before and at each follow-up: 1st and 7th day, 1st and 3rd month; 4 — evaluation of operating time.

RESULTS: 9 men and 6 women were included. Mean age was 67 years. The mean axial length was 22.98mm. All surgeries were uneventful, and all patients were implanted in the capsular bag with a monofocal implant. Initial endothelial cell count was comparable in the 3 groups (p = 0.48). The endothelial loss was most significant in the PKE group (16%), followed by the EEC group (5.1%) and then the MSICS group (4.5%) (p < 0.01). The change in corneal astigmatism was most significant in the EEC group (2.1D), followed by the MSICS group (0.88 D), then the PKE group (0.65 D) (p = 0.01). In the PKE group, all patients showed moderate to severe corneal edema at 1st postoperative, and in 2 cases, the edema persisted at the 7th day and then regressed at the 1st and 3rd month. Only 2 cases of moderate edema at day 1 in the EEC group, and 1 case in the MSICS group, regressed at the 7th day. Phacoemulsification was the least time-consuming, with an average operating time of 13 minutes, compared with 28 minutes for MSICS and 34 minutes for EEC (p < 0.01).

CONCLUSION: MSICS is a technique that resembles manual EEC, with a self-sealing tunneled scleral-corneal incision that avoids a full-thickness corneal incision and, consequently, sutures at the end of the procedure. It requires a learning curve. Our results concur with most of the data in the literature. MSICS is a safe technique, but it remains little used in cataract surgery. We believe that it should be preferred in patients with dense cataracts.