Conventional manual small-incision cataract surgery.

Sir,

We read with interest the article by Yang et al.[1] describing good visual outcomes in manual cataract extraction via a subconjunctival limbus oblique incision (SCOLI) for mature cataracts. Although the authors’ results are impressive, we would like to highlight that conventional manual small-incision cataract surgery (MSICS) can also produce very good visual and refractive outcomes.

Several studies have demonstrated that MSICS is safe and effective, even in advanced or complicated cataracts. Venkatesh et al.[2] described excellent visual outcomes of MSICS performed on a group of patients with brown and brunescent cataracts, with 97.1% achieving visual acuity (VA) of 6/18 or better with low complication rates. Another paper, also reported excellent outcomes in white cataracts,[3] with 98.2% achieving corrected distance VA of 6/18 or better. MSICS has also been shown to be safe in patients with phacolytic glaucoma,[4] demonstrating good visual outcomes with 87.9% of patients achieving good visual outcomes of 20/60 or better, while intraocular pressure was controlled without the need for long-term anti-glaucoma medications.

Although the authors reported SCOLI induces less iatrogenic astigmatism due to its supero-oblique incision,[1] Ruit et al.[5] had demonstrated that conventional MSICS can similarly reduce induced astigmatism by adopting a temporal approach. A recent Cochrane review[6] further suggests that conventional MSICS results in less surgically-induced astigmatism compared to extra-capsular cataract extraction.

In summary, we congratulate the authors in promoting and teaching alternative techniques of cataract surgery that are safe, efficacious, and cost-effective. In conjunction with the International Agency for the Prevention of Blindness and the World Health Organization Programme for Blindness and Deafness, this is part of a strategy to reduce cataract blindness globally. We feel that it is important for clinicians to consider the option of MSICS as part of their surgical repertoire.