Bimanual Microincision versus Standard Coaxial Small-Incision Cataract Surgery: Meta-Analysis of Randomized Controlled Trials

Abstract

Purpose This meta-analysis aimed to evaluate the outcomes of bimanual microincision cataract surgery (B-MICS) through a 1.2- to 1.5-mm incision versus standard coaxial small-incision cataract surgery (C-SICS) through a 2.8- to 3.2-mm incision. Methods A comprehensive literature search was performed according to the Cochrane Collaboration methodology to identify randomized controlled clinical trials comparing B-MICS with standard C-SICS. Main outcome measures were mean surgical time, mean phacoemulsification power, effective phacoemulsification time, best-corrected visual acuity, surgically induced astigmatism (SIA), mean laser flare photometry values, mean endothelial cell loss, mean increased central corneal thickness, and intraoperative and postoperative complications. Results We identified 14 randomized controlled clinical trials that included 1235 eyes diagnosed with cataracts. No statistically significant differences were detected between the 2 surgical procedures in terms of best-corrected visual acuity (p>0.05), SIA at postoperative 1 month (p = 0.09), laser flare photometry values (p = 0.38), mean endothelial cell loss (p = 0.53), increased central corneal thickness at postoperative 1 month (p = 0.64) or 3 months (p = 0.88), intraoperative complications (p = 0.68), and postoperative complications (p = 0.30); however, statistically significant differences were apparent for mean surgical time (p<0.00001), mean phacoemulsification power (p = 0.008), effective phacoemulsification time (p = 0.0009), SIA at postoperative 3 months (p = 0.02), and increased central corneal thickness at postoperative 1 day (p = 0.04). Conclusions The meta-analysis shows that the 2 techniques have similar outcomes in terms of final visual acuity and complications. Bimanual MICS has the advantage of less SIA and phaco time whereas C-SICS has the advantage of quicker surgery and less likelihood of early-onset corneal edema.