Review Article May 27, 2026 May 27, 2026

Manual small incision cataract surgery versus phacoemulsification on mature cataract: a systematic review and meta-analysis

DOI: 10.37039/1982.8551.20260048

ABSTRACT

This systematic review and meta-analysis compared Manual Small Incision Cataract Surgery (MSICS) with phacoemulsification for the management of mature cataracts, evaluating outcomes such as visual acuity, surgical complications, endothelial cell loss, central corneal thickness, surgery duration, and cost-effectiveness. A comprehensive search was conducted across PubMed®, Web of Science, Embase, and the Cochrane Library through November 23, 2023, without language restrictions. Of 163 articles initially retrieved, five studies met the inclusion criteria, encompassing a total of 577 eyes. Pooled results showed no significant difference in best-corrected visual acuity between MSICS and phacoemulsification groups (OR 0.75; p = 0.71; I² = 0%). However, MSICS was associated with significantly lower postoperative endothelial cell loss (mean difference of −141.66; p = 0.003; I² = 61%) and shorter surgery time (mean difference of -3.35; p < 0.00001; I² = 0%). No significant differences were observed regarding central corneal thickness (mean difference of -5.77; p = 0.07; I² = 0%) or complication rates. These findings support MSICS as a safe, effective, and economically favorable surgical approach for mature cataracts, particularly in settings where resources or surgical infrastructure are limited.

PROSPERO registry: #CRD42023484137