Abstract
Purpose This meta-analysis aimed to compare the efficacy and safety of phacoemulsification with goniosynechialysis (Phaco-GSL) with those of phacoemulsification alone (Phaco-alone) in patients with angle-closure glaucoma and cataract. Methods Randomized controlled trials (RCTs) were selected through a search of electronic databases. Trial eligibility and risk of bias were assessed using Cochrane review methods. Primary measures included the intraocular pressure (IOP), number of antiglaucoma medications, peripheral anterior adhesion (PAS) extent, and their pre- and postoperative changes. For continuous parameters, we calculated weighted mean differences and 95% confidence intervals. Statistical analysis was performed using RevMan 5.3 software. Results Eight RCTs were included, where 224 and 236 eyes were in the Phaco-GSL and Phaco-alone groups, respectively. Both postoperative IOP and number of medications were not significantly different between the study groups at the six- and twelve-month follow-up. However, the 12-month postoperative PAS extent was significantly smaller in the Phaco-GSL group than in the Phaco-alone group. Similarly, changes from the preoperative to 12-month postoperative PAS extent were significantly greater in the Phaco-GSL group than in the Phaco-alone group, but IOP and the number of medication changes were not different. Conclusions Our results provide evidence that Phaco-GSL provides advantages over Phaco-alone treatment regarding PAS reduction. In terms of IOP and medication reduction, both groups were comparable. Thus, Phaco-GSL can be considered for the treatment of patients with angle-closure glaucoma and cataract due to its ease, safety, and potential benefit for the anterior chamber angle.
Highlights
Glaucoma is a group of diseases characterized by deformation and atrophy of the optic nerve head due to a rise in intraocular pressure (IOP), leading to visual field defects and visual impairment
Ophthalmologists have found that phacoemulsification alone may sometimes not be able to open the chamber angle sufficiently to control the IOP, so they suggested to combine this approach with goniosynechialysis (GSL) or even trabeculectomy [7,8,9]
A literature search of the PubMed, EMBASE, and Cochrane Library databases up to March 25, 2020, was performed to identify relevant studies. e following terms were used for this search: “primary angle-closure glaucoma,” “chronic angle-closure glaucoma,” “angle-closure glaucoma,” “primary angle closure,” “phacoemulsification,” “cataract extraction,” “cataract surgery,” “goniosynechialysis,” and “viscogonioplasty.” Results from the electronic databases were imported into a reference management program (EndNote X4; omson Reuters, New York, NY, USA), where duplicate articles were manually deleted
Summary
Glaucoma is a group of diseases characterized by deformation and atrophy of the optic nerve head due to a rise in intraocular pressure (IOP), leading to visual field defects and visual impairment. It is the second most frequent blinding eye disease in the world and poses a serious threat to visual health in humans [1]. For angle-closure glaucoma, common causes are a shallow anterior chamber and extended range of permanent peripheral anterior adhesion (PAS), leading to a blocked outflow of aqueous humour and consecutive increase in IOP [2]. Is causes a continuous increase in posterior chamber pressure and further compression of the peripheral iris, leading to anterior chamber angle stenosis or even closure [3]. erefore, cataract removal has been used to deepen the anterior chamber and open the iridocorneal angle, thereby reducing the IOP [4,5,6].
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