EBO technical review of the validity of Recommendation #14 of the Clinical Practice Guidelines for the Management of Cataract among Adults

The Evidence-Based Ophthalmology Group, Philippine Academy of Ophthalmology


To assess the current validity of Recommendation #14, which states that both phacoemulsification and extracapsular cataract extraction (ECCE) are acceptable techniques among patients undergoing cataract surgery.


Updating the guideline recommendation was done in two stages: (1) identifying significant new evidence by conducting a systematic review of the literature, and (2) assessing whether the new evidence warrants updating or withdrawal by using the delphi method in soliciting the opinion of experts from the original panel that developed the guidelines. We reran the search for primary studies comparing ECCE to phacoemulsification from January 2001 to May 2005. Trials were identified from the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register) on The Cochrane Library and Medline. Based on the results of the identified evidence, Recommendation #14 was classified as “Retain, append new evidence.” The proposed revision was sent to all members of the original panel for approval.


Two new metaanalyses and one prospective randomized controlled trial were identified, retrieved, and appraised. Two trials comparing the costs and benefits of ECCE with those of manual small-incision cataract surgery were included to introduce the latter technique as an additional option in addressing the cataract backlog in the Philippines. Among the 21 members of the original panel that developed the guidelines, 15 (71%) responded. All agreed to retain and update Recommendation #14 by appending new evidence. The remaining six (29%) were not able to submit their responses in time for this update.


Recommendation #14 of the Clinical Practice Guidelines for the Management of Cataract among Adults should be retained but relevant new information for clinicians needs to be appended.

Keywords: Guidelines, Cataract, Phacoemulsification, Extracapsular cataract extraction