Ophthalmology Research: An International Journal

Aim: To compare the efficacy and safety of phacoemulsification (PHACOE) versus manual small-incision cataract surgery (PHACOA) at the Chad–China Friendship University Hospital Centre (CHU‑ATC) in N’Djamena, Chad.

Study Design: A prospective, descriptive, cross-sectional study conducted over 6 months, from 1 February to 31 July 2025, at the CHU‑ATC.

Methods: All patients aged ≥40 years with preoperative visual acuity <3/10 who underwent either PHACOE or PHACOA, were followed for at least 30 days postoperatively, and provided informed consent were included. Traumatic, congenital and pathological cataracts, as well as cases with detectable ocular pathology (corneal opacity), were excluded from the study.

Results: Among 332 cataract surgeries, 279 eyes from 261 patients (mean age 58.8 ± 16.4 years) met the inclusion criteria. Of these, 53.7% (n = 150) underwent PHACOE and 46.3% (n = 129) underwent PHACOA. Intraoperative complications occurred in 8.5% of PHACOE procedures versus 8.0% of PHACOA procedures (p = 0.420), with capsular rupture being the most frequent (8.5% vs 6.0%, respectively). On postoperative day 30, uncorrected visual acuity ≥3/10 was achieved in 86.0% of PHACOE eyes versus 77.3% of PHACOA eyes (p = 0.101). With optical correction, visual acuity ≥3/10 was obtained in 87.6% of PHACOE eyes versus 79.3% of PHACOA eyes (p = 0.086). The mean gain in visual acuity was 11.8 lines for PHACOE compared with 9.6 lines for PHACOA (p = 0.10).

Conclusion: Phacoemulsification provided better visual recovery than manual small-incision cataract surgery, while both techniques showed low perioperative complication rates. PHACOE outcomes met WHO standards for postoperative visual results, and PHACOA outcomes approached these standards. Given its lower cost, PHACOA represents a viable alternative in resource-limited settings such as Chad.