Evaluating the outcomes of manual small incision cataract surgery for advanced cataract in New Zealand

Purpose: To evaluate patient demographics, visual and keratometric outcomes, and complications of manual small incision cataract surgery (mSICS) to treat advanced cataract in New Zealand. Study design: A total of 289 eyes undergoing consecutive mSICS by a single surgeon in Rotorua Eye Clinic in New Zealand between January 2011 and October 2015 were prospectively included. Methods: Patient demographics, visual and keratometric outcomes including corrected distance visual acuity (CDVA) and vector analysis of surgically induced astigmatism (SIA), were analysed. Predicted and observed risk-adjusted surgical complications were compared. Results: The mean patient age at time of surgery was 73.6 years. New Zealand European constituted the single largest ethnic group at 51.6% (n = 149). Māori were the second largest ethnic group at 35.6% (n = 103). Overall, 88.2% (n = 255) of patients achieved postoperative CDVA of 6/12 or better at 4 weeks following surgery. Themean postoperative logMAR CDVA was 0.17 ± 0.37 SD (6/9 + 2 Snellen equivalent). The mean SIA magnitude was 0.99 D (SD = 0.76 D). Preoperative risk of posterior capsule rupture was 5.2% but no cases were observed. Iris prolapse was noted in 1 case (0.4%) and endophthalmitis in 2 cases (0.7%). Conclusions: This is the largest study of mSICS in a developed country to date. mSICS is a safe and effective technique for advanced cataract extraction in a developed country with excellent visual outcomes. The incidence of posterior capsular rupture was below the predicted rate; however, endophthalmitis was higher than expected for a cohort of this size.