Efficacy and Safety of Manual Small-Incision Cataract Surgery With Trabeculectomy Versus Phacotrabeculectomy in Patients With Glaucoma and Cataract: A Systematic Review and Meta-Analysis.

ABSTRACT

The coexistence of two globally leading causes of blindness, glaucoma and cataracts, is common. Combining trabeculectomy with cataract surgery is a common practice while determining the preferred surgical management for patients is a complex consideration. Therefore, a systematic review and meta-analysis were conducted to compare the efficacy and safety of two surgical procedures, manual small-incision cataract surgery (MSICS) combined with trabeculectomy and phacotrabeculectomy. A comprehensive search was performed in PubMed, Science Direct, and Cochrane Library published up to March 2023. Articles not indexed in those databases were also searched. Pooled odds ratios (OR) and mean differences (MD) with corresponding 95% confidence interval (CI) were also retrieved to compare the outcomes estimating efficacy and safety. Biases in selected studies were assessed. A total of seven studies consisting of 352 eyes for MSICS with trabeculectomy and 348 eyes for phacotrabeculectomy were included. Postoperative intraocular pressure (IOP) was comparable between the two techniques (MD -0.45; 95% CI -1.07 to 0.16; p = 0.15). Postoperative best corrected visual acuity (BCVA) <6/12 (OR 1.26; 95% CI 0.62 to 2.53; p = 0.52), complete success (OR 0.92; 95% CI 0.51 to 1.67; p = 0.78), and postoperative complications (OR 1.27; 95% CI 0.75 to 2.15, p = 0.38) did not differ significantly. This meta-analysis indicated comparable efficacy and safety profile between MSICS with trabeculectomy and phacotrabeculectomy. Further high-quality studies are required to confirm these findings.