Intraoperative Complications In Manual Small-Incision Cataract Surgery: A Systematic Review And Meta-Analysis
Published 2026 - 44th Congress of the ESCRS
Reference: PP21.08 | Type: Free paper | DOI: 10.82333/cqfz-y424
Authors: Dr Lars Christian Boberg-Ans* 1 , Dr Bjarke Meinertz Smith 2 , Dr Heriel Zacharia Ammi 3 , Dr Andrew Cyrus Makupa 4 , Prof. Van Charles Lansingh 5 , A/Prof. Gøril Elisabeth Boberg-Ans 6 , Dr Andreas Arnold-Vangsted 7 , Prof. Yousif Subhi 8
1Ophthalmology,University Hospital of Southern Denmark,Sønderborg,Denmark;Ophthalmology,Innlandet Hospital Trust,Elverum,Norway;Red Synet / Eye Rescue,Copenhagen,Denmark, 2Ophthalmology,University Hospital of Southern Denmark,Vejle,Denmark, 3Eye Rescue Clinic,Karatu Lutheran hospital,Karatu,Tanzania, United Republic of, 4Ophthalmology,Kilimanjaro Christian Medical Centre,Moshi,Tanzania, United Republic of, 5HelpMeSee,New Jersey,United States;Public Health Sciences,University of Miami Miller School of Medicine,Miami,United States;Center for population Health research,National institute of public health research,Cuernavaca,Mexico;Ophthalmology,Moran Eye Center, University of Utah,Utah,United States, 6Red Synet / Eye Rescue,Copenhagen,Denmark, 7Ophthalmology,University Hospital of Southern Denmark,Sønderborg,Denmark, 8Ophthalmology,University Hospital of Southern Denmark,Sønderborg,Denmark;Department of Regional Health Research,University of Southern Denmark,Odense,Denmark
Purpose
To estimate pooled rates of intraoperative complications associated with manual small incision cataract surgery (MSICS).
Setting
Systematic review and meta-analysis
Methods
We conducted a systematic review and meta-analysis in accordance with the PRISMA guidelines. Scientific literature databases were searched on 27 February 2026 for studies reporting intraoperative complications following manual small incision cataract surgery (MSICS). Eligible studies underwent qualitative synthesis and single-arm random-effects meta-analyses of complication proportions. Pre-specified outcomes included wound-related complications, capsular complications, posterior capsule rupture, vitreous loss, and nucleus-delivery related events. Study selection, data extraction, and risk of bias assessment were performed independently by two authors and adjudicated by a senior author.
Results
A total of 32 studies comprising 1.479.033 eyes undergoing MSICS were included. Reported intraoperative complication rates varied across studies and surgical settings. Pooled estimates demonstrated low overall rates of major intraoperative complications, including posterior capsule rupture and vitreous loss. Heterogeneity was moderate to high for most outcomes, reflecting differences in case mix, surgeon experience, and study design.
Conclusions
Intraoperative complication rates following MSICS are generally low but vary across settings. This systematic review and single-arm meta-analysis provides pooled baseline estimates that may serve as benchmarks for quality assurance, surgical training, and future comparative studies.