A Comparative Analysis of Refractive Errors Before and After Cataract Surgery: Phacoemulsification Versus Manual SICS in a Tertiary Care Hospital

Background: Cataracts are a leading cause of preventable blindness worldwide, with surgical intervention being the only effective treatment. Phacoemulsification and manual small-incision cataract surgery (MSICS) are the two most common techniques for cataract removal. While phacoemulsification is preferred in advanced settings due to its precision and faster recovery, MSICS remains a cost-effective alternative in resource-constrained environments. Aim: To compare pre-operative and post-operative refractive and visual outcomes in cataract patients undergoing phacoemulsification and MSICS in a tertiary care hospital. Methods: This prospective study was conducted at Nalanda Medical College and Hospital, Patna, from July 2023 to July 2024, involving 120 participants divided into two groups: 60 undergoing phacoemulsification and 60 undergoing MSICS. Pre-operative and post-operative visual acuity and refractive errors were assessed. Data collection included patient demographics, keratometry, and intraocular lens power calculations. Outcomes were analyzed at 1 month and 3 months post-surgery using SPSS version 23.0, with statistical significance set at p < 0.05. Results: The mean post-operative visual acuity was significantly better in the phacoemulsification group (0.22 logMAR) compared to the MSICS group (0.30 logMAR, p = 0.001). Post-operative spherical equivalent was significantly lower in the phacoemulsification group (-0.4 D) compared to MSICS (-1.0 D, p = 0.002). Post-operative astigmatism >1.5D was observed in 5% of the phacoemulsification group and 13% of the MSICS group (p = 0.02). Surgical complications were minimal and comparable between the groups (p = 0.10). Conclusion: Phacoemulsification provides superior visual acuity and refractive outcomes compared to MSICS, with reduced post-operative astigmatism. However, MSICS remains a viable alternative, especially in low-resource settings, due to its cost-effectiveness and safety profile. Recommendations: Phacoemulsification should be prioritized in well-equipped healthcare settings, while MSICS continues to play a vital role in addressing cataract blindness in resource-limited regions. Training programs should focus on enhancing surgeon expertise in both techniques.