Combined Microinvasive Glaucoma Surgery With Phacoemulsification in Open-Angle Glaucoma: A Systematic Review and...

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Surgical Innovation

Background:

• Open-angle glaucoma (OAG) management often requires lowering intraocular pressure (IOP) to prevent optic nerve damage.
• Phacoemulsification is a common cataract surgery, but may not sufficiently control IOP in OAG.
• Microinvasive glaucoma surgeries (MIGS) offer less invasive alternatives or adjuncts to traditional glaucoma procedures.

Purpose of the Study:

• To systematically review and compare the efficacy and safety of combined phacoemulsification-MIGS versus phacoemulsification alone in OAG.
• To evaluate IOP reduction and medication usage as primary efficacy endpoints.
• To assess the incidence of sight-threatening and other adverse events as safety endpoints.

Main Methods:

• A systematic review and meta-analysis of MIGS articles published up to April 19, 2024.
• MIGS were categorized by mechanism: trabecular meshwork (TM) bypass, non-gonioscopy-assisted transluminal trabeculotomy (non-GATT), and GATT.
• Efficacy measured by IOP and medication reduction; safety by adverse event rates.

Main Results:

• 95 studies with 9733 eyes showed combined phacoemulsification-MIGS effectively reduced IOP and medications at 1-year follow-up.
• GATT demonstrated the most significant IOP reduction, while TM bypass had the lowest hyphema rates.
• All MIGS groups exhibited comparable or lower rates of sight-threatening events and secondary glaucoma surgery versus control.

Conclusions:

• Combined phacoemulsification-MIGS provides significant efficacy benefits for OAG patients without increasing vision-threatening complications.
• Limitations include heterogeneity in study design and outcome reporting, and a scarcity of long-term follow-up data.
• Current evidence supports the use of combined phacoemulsification-MIGS as a safe and effective treatment option for OAG.