Effectiveness and Complication Profiles of Cataract Surgery: A Systematic Review

Cataract is the most common cause of the reversible loss of sight globally. Given that phacoemulsification is regarded as the gold standard, manual small-incision cataract surgery (MSICS) still has an important role to play in resource limited settings. This systematical literature review assessed the outcomes in terms of effectiveness, visual outcomes, and complication rates of current cataract surgery techniques. Systematical search of literature was performed in Pub Med and ScienceDirect for papers published from 2021 to 2026, which compared cataract surgical techniques. Studies that included adult patients undergoing cataract surgery with follow-up data postoperatively for visual outcome and/or complications were included. The qualitative synthesis resulted in 607 records being screened and 32 studies being included which involved 200000 eyes. Study characteristics, surgical procedures and visual results and complications were retrieved and quantified. Appropriate methodological tools were used to evaluate the risk of bias. Both Phaco and MSICS had excellent visual improvement following the surgery, and the long-term visual recovery was similar in both groups except for rare cases where the surgery was complicated by retinal problems such as posterior capsular opacity (PCO) sometimes caused by intra-operative capsular balloon (IOB) removal. Phaco achieved superior results in early postoperative uncorrected visual acuity and smaller size of incision, resulting in less SIA. In dense nuclear cataract, however, MSICS was found to have lower endothelial cell loss without any loss in its cost-effectiveness in low resource areas. The most common complications reported were posterior capsule opacity and posterior capsule rupture. Advanced age and surgical complications were also related to outcomes. The techniques (phaco and MSICS) provided good visual outcomes after the cataract surgery. The surgical selection should be customized according to the severity of the cataract, the presence of intraocular co-morbidities and the surgeon's skills and health care resource availability.