***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: A r and omised single blinded clinical trial to compare the cost of  cataract surgery  between  extracapsular cataract extraction ( ECCE ) and phacoemulsification ( PEA ) was conducted at Hospital Universiti Kebangsaan Malaysia ( HUKM ) between March and December 2000 . A total of 60 patients were included in this study . The cost of a cataract surgery  incurred by hospital , patients and households up to two months after discharge were included . The costs of training , loss of patients ' income after discharge and intangible costs were excluded . Results showed that the average cost for one  ECCE  operation is RM1,664.46 ( RM1,233.04-RM2,377.64 ) and for PEA is RM1,978.00 ( RM1,557.87-RM3,334.50 ) . During this short period of follow up , it can be concluded that ECCE is significantly cheaper than PEA by an average difference of RM 313.54 per patient ( p < 0.001 ) . Cost of equipment and low frequency of PEA  technique done in HUKM were the two main reasons for the high unit cost of PEA as compared to ECCE Objective To examine the prevalence of outcome reporting bias — the selection for publication of a subset of the original recorded outcome variables on the basis of the results — and its impact on Cochrane review s. Design A nine point classification system for missing outcome data in r and omised trials was developed and applied to the trials assessed in a large , unselected cohort of Cochrane systematic review s. Research ers who conducted the trials were contacted and the reason sought for the non-reporting of data . A sensitivity analysis was undertaken to assess the impact of outcome reporting bias on review s that included a single meta- analysis of the review primary outcome . Results More than half ( 157/283 ( 55 % ) ) the review s did not include full data for the review primary outcome of interest from all eligible trials . The median amount of review outcome data missing for any reason was 10 % , whereas 50 % or more of the potential data were missing in 70 ( 25 % ) review s. It was clear from the publications for 155 ( 6 % ) of the 2486 assessable trials that the research ers had measured and analysed the review primary outcome but did not report or only partially reported the results . For reports that did not mention the review primary outcome , our classification regarding the presence of outcome reporting bias was shown to have a sensitivity of 88 % ( 95 % CI 65 % to 100 % ) and specificity of 80 % ( 95 % CI 69 % to 90 % ) on the basis of responses from 62 trialists . A third of Cochrane review s ( 96/283 ( 34 % ) ) contained at least one trial with high suspicion of outcome reporting bias for the review primary outcome . In a sensitivity analysis undertaken for 81 review s with a single meta- analysis of the primary outcome of interest , the treatment effect estimate was reduced by 20 % or more in 19 ( 23 % ) . Of the 42 meta-analyses with a statistically significant result only , eight ( 19 % ) became non-significant after adjustment for outcome reporting bias and 11 ( 26 % ) would have overestimated the treatment effect by 20 % or more . Conclusions Outcome reporting bias is an under-recognised problem that affects the conclusions in a substantial proportion of Cochrane review s. Individuals conducting systematic review s need to address explicitly the issue of missing outcome data for their review to be considered a reliable source of evidence . Extra care is required during data extraction , review ers should identify when a trial reports that an outcome was measured but no results were reported or events observed , and contact with trialists should be encouraged BACKGROUND Cataract extraction constitutes the largest surgical workload in ophthalmic units throughout the world . Extracapsular cataract extraction ( ECCE ) , through a large incision , with insertion of an intraocular lens has been the most widely used method from 1982 until recently . Technological advances have led to the increasing use of phacoemulsification ( Phako ) to emulsify and remove the lens The technique requires a smaller incision , but requires substantial capital investment in theatre equipment . In this r and omised trial we assessed the clinical outcomes and carried out an economic evaluation of the two procedures . METHODS In this two centre r and omised trial , 232 patients with age related cataract received ECCE , and 244 received small incision surgery by Phako .  The main comparative outcomes were visual acuity , refraction , and complication rates . Re source use was monitored in the two trial centres and in an independent comparator centre . Costs calculated included average cost per procedure , at each stage of follow up . RESULTS Phako was found to be clinical ly superior . Surgical complications and capsule opacity within 1 year after surgery were significantly less frequent , and a higher proportion achieved an unaided visual acuity of 6/9 or better ( < 0.2 logMAR ) in the Phako group . Postoperative astigmatism was more stable in Phako . The average cost of a cataract operation and postoperative care within the trial was similar for the two procedures . With the input of additional spectacles for corrected vision at 6 months after surgery , the average cost per procedure was £ 359.89 for Phako and £ 367.57 for ECCE . CONCLUSION Phako is clinical ly superior to ECCE and is cost effective PURPOSE The authors studied 57,103 r and omly selected Medicare beneficiaries who underwent extracapsular cataract extraction in 1986 or 1987 to determine the possible association between performance of neodymium (Nd):YAG laser capsulotomy and the risk of subsequent retinal break or detachment . METHODS Cases of cataract surgery were identified from Medicare cl aims su bmi tted in 1986 and 1987 and were followed through the end of 1988 . Episodes of cataract surgery , posterior capsulotomy , and retinal complications were ascertained based on procedure and diagnosis codes listed in physician bills and hospital discharge records . Lifetable and Cox 's proportional hazards models were used to analyze the risk of retinal detachment or break in patients undergoing and not undergoing capsulotomy during the period of observation . RESULTS Of the 57,103 persons identified as having undergone extracapsular cataract extraction in 1986 or 1987 , 13,709 subsequently underwent Nd : YAG laser capsulotomy between 1986 and 1988 . A total of 337 persons had aphakic or pseudophakic retinal detachments between 1986 and 1988 and an additional 194 underwent repair of a retinal break . Proportional hazards modeling shows a 3.9-fold increase in the risk of retinal break or detachment among those who underwent capsulotomy ( 95 % confidence interval : 2.89 to 5.25 ) . Younger patient age , male sex , and white race also were associated with increased risk of retinal complications after extracapsular cataract extraction . CONCLUSION The authors conclude that there is a statistically significant increase in the risk of retinal detachment or break in those patients who undergo capsulotomy after cataract extraction . Therefore , capsulotomy should be deferred until the patient 's impairment caused by capsular opacification warrants the increased risk of retinal complications associated with performance of capsulotomy OBJECTIVES To investigate service uptake in a rural Indian population served by outreach eye camps  and to identify barriers to uptake . PARTICIPANTS AND METHODS A routine eye camp was conducted within 5 km of each of 48 r and omly selected villages of typically Hindu , backward-caste communities . Subsequently , participatory rural appraisal -community mapping , focus groups , matrix ranking , and semistructured interviews-was undertaken to explore community views of eye problems . An eye examination was conducted on persons with eye problems who did not attend the eye camp . Predictors of attendance were identified by multilevel regression analysis . RESULTS Of 749 adults with an eye problem , 51 ( 6.8 % ) attended the eye camp .  Independent predictors of attendance were being male ( odds ratio = 2.3 ; 95 % confidence interval , 1.2 - 4.5 ) and living within 3 km of the camp ( odds ratio = 4.5 ; 95 % confidence interval , 1.7 - 12.5 ) . Of the 552 persons who did not attend the eye camps and had an eye examination , 242 ( 43.8 % ) had low vision ( visual acuity < 6/18 to > or = 3/60 in presenting better eye ) and 38 ( 6.9 % ) were blind in both eyes . Cataract surgery was recommended for 197 ( 35.8 % ) of the persons who did not attend the eye camps . Of 109 persons with a previous cataract operation , 42 ( 38.5 % ) had low vision and 11 ( 10.1 % ) were blind . Fear ( principally of eye damage ) , cost ( direct and indirect ) , family responsibilities , ageism , fatalism , and an attitude of being able to cope ( with low or no vision ) were the principal barriers to attending the eye camps . CONCLUSIONS A high proportion of people who could have benefited from eye treatment were not using available services . Poor visual outcomes were observed in surgically treated persons This study was performed to investigate the correlation between the contamination of the anterior chamber and the technique of extracapsular cataract extraction ( ECCE ) . Three different methods were used : uncomplicated planned ECCE , phacoemulsification involving suturing method , and sutureless technique .  All patients had posterior chamber intraocular lenses implanted . Two hundred and thirty consecutive patients were included in this prospect i ve study , and preoperative smears of the conjunctiva and intraoperative aspirates of the anterior chamber were investigated . Sample s of the aqueous humor were taken at the beginning and at the end of the operation . Cultures were incubated and held for 14 days . More than 71 % of the preoperative smears were contaminated by coagulase-negative staphylococci , the most commonly isolated bacteria . However , 27 % of the patients had culture-positive anterior chamber aspirates intraoperatively , also with coagulase-negative staphylococci as the most frequent organisms . In no case did postoperative endophthalmitis develop . Preliminary results in a small population show that the contamination of the aqueous humor is statistically significantly less frequent if the cataract extraction is performed by phacoemulsification than if it is done without phacoemulsification . Another interesting finding is that anterior chamber contamination is not significantly more frequent , if a sutureless technique is used for cataract surgery PURPOSE To quantitatively compare postoperative inflammation after extracapsular cataract extraction ( ECCE ) with that after phacoemulsification in an Asian population . SETTING Singapore National Eye Center , Singapore . METHODS In this prospect i ve , r and omized , double-masked clinical trial , patients having cataract surgery were r and omized to receive ECCE ( n = 16 ) or phacoemulsification ( n = 18 ) . Diabetics were excluded . Two surgeons performed both types of surgery and implanted a 6.0 mm optic intraocular lens .  Inflammation was assessed qualitatively by slitlamp grading of cells and flare and quantitatively using the Kowa flare meter . One independent postoperative investigator performed the slitlamp examination and laser flare meter readings . RESULTS The ECCE and phacoemulsification groups were comparable ( P > .05 ) in age , sex , ethnicity , and preoperative flare levels . The combined slitlamp inflammatory scores ( anterior chamber cells and flare ) and mean laser flare meter readings showed the ECCE group had significantly higher mean flare measurements than the phacoemulsification group at days 4 ( P = .0012 ) , 8 ( P = .0013 ) , 15 ( P = .0013 ) , 30 ( P = .0004 ) , and 60 ( P = .0164 ) . Flare levels in the ECCE group returned to preoperative values by the second month ; the phacoemulsification group achieved preoperative levels by 1 month . The clinical inflammatory assessment score correlated closely to the flare level readings . CONCLUSION Phacoemulsification induced less inflammation than ECCE , with the difference most marked in the first month after surgery Purpose : To determine the cost efficiency and to compare the cost effectiveness of conventional extracapsular cataract surgery ( ECCE ) and phacoemulsification at three hospitals of the Malaysian Ministry of Health ( MOH ) . Methods : Patient demography , pre-operative visual acuity , intra-operative complications , post-operative complications and post-operative visual acuity were recorded for two hundred and forty seven of the 400 patients who underwent cataract surgery during a 2-week period . The cost of surgery , which included capital , staff and overhead , and patient care consumable costs were assessed prospect ively in 8 r and omly sample d patients over a 3-month period . Cost efficiency refers to cost per cataract surgery . Cost effectiveness refers to cost per successful cataract surgery . This is estimated by the ratio of cost efficiency to the proportion of successful cataract surgery . Successful surgery was defined as best-corrected visual acuity ( BCVA ) of better than 6/12 at 3 months post-operatively . Results : Proportion of patients who had post-operative visual acuity of 6/12 or better was higher in phacoemulsification group ( 94 % ) than in the ECCE group ( 81 % ) . Conventional extracapsular catar 
    Output:
    
Removing cataract by phacoemulsification may result in a better visual acuity compared to ECCE , with a lower complication rate .
The lower cost of ECCE may justify its use in a patient population where high-volume surgery is a priority , however , there are a lack of data comparing phacoemulsification and ECCE in lower-income setting