Key result
Phacoemulsification is linked to ~34% fewer postoperative complications versus extracapsular cataract extraction.
Why the study?
Cataracts cause significant blindness in low-resource settings, but limited data exist on postoperative complications and comparative outcomes between phacoemulsification and extracapsular cataract extraction in Tanzania.
Does phacoemulsification improve visual acuity and reduce complications compared to extracapsular cataract extraction in adult patients undergoing cataract surgery?
Cohort (n=308)
No
Does phacoemulsification improve visual acuity and reduce complications compared to extracapsular cataract extraction in adult patients undergoing cataract surgery?
Effect estimate: ARR 0.66 (95% CI 0.50-0.88)
p-value: p=0.004
Phacoemulsification demonstrated superior visual outcomes and a lower risk of postoperative complications compared to extracapsular cataract extraction in a resource-limited setting.
May support phacoemulsification to lower complications in resource-limited settings; leaves open need for randomized confirmation.
Objective This study aims to assess the incidence, types, and associated risk factors of postoperative complications following cataract surgery at Kilimanjaro Christian Medical Centre (KCMC) from 2023 to 2024 Background Cataracts remain a leading cause of blindness globally, with disproportionate burdens in low-resource settings. Despite advancements in surgical techniques like phacoemulsification (PHACO), extracapsular cataract extraction (ECCE) remains widely used in sub-Saharan Africa. Limited data exist on postoperative complications and comparative outcomes in Tanzania. Methods A prospective cohort study was conducted at Kilimanjaro Christian Medical Centre (August 2023–July 2024) involving 308 adults undergoing ECCE or PHACO. Participants were followed for six months postoperatively. Primary outcomes included visual acuity (VA) and complications (e.g., corneal edema, raised intraocular pressure [IOP]). Multivariable logistic regression identified risk factors for poor outcomes. Results The cohort (median age: 68 years; 51.6% male) underwent ECCE (65.3%) or PHACO (34.7%). PHACO demonstrated superior outcomes: patients undergoing ECCE had 2.5-fold higher odds of poor VA (adjusted OR: 2.4, 95% CI: 1.21–5.01, p=0.013) and 34% higher complication risk (adjusted RR: 0.66, 95% CI: 0.50–0.88, p=0.004). Complications occurred in 58.8%, primarily corneal edema (40.6%) and posterior capsular opacity (38%). Specialist-performed surgeries reduced complications by 62% versus trainees (p<0.001). Conclusion PHACO outperformed ECCE in visual outcomes and safety, with specialist expertise further reducing risks. Findings support prioritizing PHACO adoption, enhancing surgical training, and standardizing postoperative care in resource-limited settings. Multicenter randomized trials are needed to validate these results.
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kaduga et al. (2025) conducted a cohort in Cataract (n=308). Phacoemulsification (PHACO) vs. Extracapsular cataract extraction (ECCE) was evaluated on Postoperative complications (ARR 0.66, 95% CI 0.50-0.88, p=0.004). Phacoemulsification significantly reduced the risk of postoperative complications by 34% compared to extracapsular cataract extraction.
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