Phacoemulsification versus Extracapsular Cataract Extraction: A Comparative Study of Surgical Outcomes, Surgical Site Infection Rate, and Associated Causes
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Background: Phacoemulsification and extracapsular cataract extraction (ECCE) remain established approaches to cataract surgery, with differences in incision size, recovery, intraocular-lens requirements, resource needs, and postoperative outcomes. Objective: To compare early postoperative ocular outcomes and study-defined postoperative infection between phacoemulsification and ECCE and to evaluate factors associated with infection. Methods: A comparative observational study included 250 adults undergoing cataract surgery at Lahore General Hospital, with 125 patients in each surgical group. Preoperative and approximately one-week postoperative assessments included intraocular pressure (IOP), ocular findings, corrected vision, contrast sensitivity, eye alignment, satisfaction, quality-of-vision ratings, and postoperative ocular infection. Results: Corrected visual outcome was documented in 121/125 (96.8%) patients undergoing phacoemulsification compared with 111/125 (88.8%) undergoing ECCE (p=0.014). Satisfaction was 72.8% versus 52.0% (p<0.001). Study-defined postoperative ocular infection occurred in 27/125 (21.6%) versus 51/125 (40.8%), corresponding to a risk ratio of 0.53 (95% CI 0.36–0.79) and an absolute risk difference of −19.2 percentage points. Increased conjunctival vascularity was less frequent after phacoemulsification (12.8% vs 23.2%, p=0.032). Iris atrophy and overall quality-of-vision category distributions did not differ significantly. Previous eye surgery and improper sterilization were strongly associated with the study-defined infection outcome. Conclusion: Phacoemulsification was associated with better early corrected-vision and satisfaction outcomes and a lower rate of study-defined postoperative ocular infection than ECCE. The infection findings require cautious interpretation because the case definition, treatment allocation, and temporal relationships of several associated factors were incompletely characterized.
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