Cataract surgery without a phacoemulsification device during a humanitarian mission in benin: outcomes of manual small-incision cataract surgery and extracapsular cataract extraction

Abstract Background To describe preoperative triage and compare early postoperative complications after manual small-incision cataract surgery (MSICS) and extracapsular cataract extraction (ECCE) performed during a humanitarian mission in Benin, where no phacoemulsification device was available. Methods Medical records and operative reports from 1,280 individuals examined during a humanitarian cataract mission in Porto-Novo, Benin, between November 25 and December 6, 2024, were retrospectively reviewed. Patients were triaged according to cataract-related best-corrected visual acuity, systemic risk factors, and ocular findings. After exclusion of patients with capillary glucose > 300 mg/dL, blood pressure > 200/120 mmHg, or preoperative retinal detachment, 287 patients were considered suitable for surgery and 125 underwent surgery. Patients were classified by technique as MSICS ( n = 79) or ECCE ( n = 46). Postoperative complications documented on postoperative day 1 or during the mission were compared using two-sided Fisher exact tests. Results Among the 125 operated patients, 79 underwent MSICS and 46 underwent ECCE. Aphakia occurred in 6 patients (4.8%), IOL dislocation in 3 (2.4%), marked endothelial edema in 11 (8.8%), postoperative IOP elevation in 12 (9.6%), and corneal suture dehiscence in 1 (0.8%). Marked endothelial edema was more frequent after ECCE than MSICS (8/46 [17.4%] vs. 3/79 [3.8%]; p = 0.018). No significant between-group differences were observed for aphakia ( p = 0.192), IOL dislocation ( p = 0.554), IOP elevation ( p = 0.533), or corneal suture dehiscence ( p = 0.368). No cases of IOL drop into the vitreous cavity, nuclear drop, intravitreal hemorrhage, toxic anterior segment syndrome, or endophthalmitis were observed in either group. Conclusion In settings without a phacoemulsification device, MSICS and ECCE can be performed during humanitarian missions when experienced surgeons, careful preoperative triage, and appropriate postoperative assessment are available. MSICS may offer practical advantages where follow-up is limited because it generally avoids routine corneal suture removal. Because technique and surgeon were not independently separable in this nonrandomized study, the observed differences should not be interpreted as purely technique-related.