Phacoemulsification with or without goniosynechialysis for angle-closure glaucoma: a global Meta-analysis based on...

Area of Science:

• Ophthalmology
• Glaucoma Research
• Surgical Outcomes

Background:

• Angle-closure glaucoma (ACG) with coexisting lens opacity requires effective treatment strategies.
• Phacoemulsification (phaco) alone and combined with goniosynechialysis (GSL) are surgical options.
• Randomized controlled trials (RCTs) are crucial for comparing surgical interventions.

Purpose of the Study:

• To systematically compare the efficacy and safety of phacoemulsification alone versus combined phacoemulsification and goniosynechialysis (phaco-GSL) for ACG.
• To evaluate intraocular pressure (IOP) reduction and medication usage post-surgery.
• To assess potential harms and complications associated with each surgical approach.

Main Methods:

• A systematic review of RCTs was performed using databases like PubMed, Cochrane Library, and EMBASE.
• Studies published up to September 2018, reporting postoperative IOP and anti-glaucoma medication use, were included.
• Data from 7 RCTs involving 321 participants (358 eyes) were analyzed using fixed-effect and random-effect models.

Main Results:

• No significant difference in mean IOP was observed between phaco alone and phaco-GSL groups at 3, 6, or 12 months postoperatively.
• While some studies showed no significant difference in medication use at 3 months, two studies indicated fewer medications were needed at 12 months in the phaco-alone group.
• The quality of evidence was rated as low to moderate.

Conclusions:

• Phaco-GSL surgery offers an equivalent IOP-lowering effect compared to phacoemulsification alone.
• Combined phaco-GSL surgery may not lead to a long-term reduction in anti-glaucoma eyedrop consumption.
• Additional GSL may not be necessary for primary angle-closure glaucoma patients; further RCTs with larger cohorts and longer follow-up are warranted.