Systematic Review and Meta-Analysis of Comparing Phacoemulsification Combined with goniosynechialysis to other mainstream procedures in treating patients with angle-closure glaucoma

Abstract

Background:The aim of this meta-analysis is to compare the efficacy and safety of combined phacoemulsification (Phaco) with goniosynechialysis (GSL) to either Phaco or to Phaco combined with trabeculectomy or trabeculectomy alone in patients with angle closure glaucoma (ACG).Methods:Five main electronic databases were searched for the eligible studies. Intraocular pressure (IOP) decrease was set as the primary outcome, while anti-glaucomatous medication decrease, changes of anterior chamber depth (ACD), range of peripheral anterior synechia (PAS), and complication occurrence were the secondary outcomes. Standard mean difference (SMD) and relative risk (RR) were the size effects for continuous and binomial data, respectively. Either fixed-effects model or random-effects model was chosen to pool the data based on the heterogeneities.Results:A total of 7 eligible studies were included. The combined data showed the IOP decreased more significantly after Phaco-GSL than that after Phaco alone (SMD = –0.42,95%CI: –0.70 – 0.14, I2 = 17.6%, Z = 2.90, P = .004). However, there were no distinct differences regarding medication decrease (SMD = –0.25,95%CI: –0.70 – 0.21, I2 = 0%, Z = 1.06, P = 0.29), ACD, the range of PAS and complication occurrence rate when compared Phaco-GSL to Phaco. Moreover, Phaco-GSL was comparable to Phaco-trabeculectomy/trabeculectomy in decreasing IOP (SMD = –0.08, 95%CI = –0.32 – 0.15, I2 = 0%, Z = 0.70, P = .49).Conclusions:Phaco-GSL might be an optimal procedure to treat ACG with concomitant cataract due to its bleb-less nature, and its capacity for lowering IOP seems superior to Phaco alone and comparable to Phaco-trabeculectomy/trabeculectomy.

Changes in Anterior Chamber Angle and Choroidal Thickness in Patients with Primary Angle-Closure Glaucoma after Phaco-Goniosynechialysis

“…Comparing corneal endothelial counts of the two groups at different postoperative time points revealed that GSL did not increase damage to the corneal endothelium, indicating that phacoemulsification combined with GSL is safe. In line with our findings, White et al [ 13 ] reported that phacoemulsification combined with GSL reduced IOP and the need for IOP-lowering drugs and surgery; in addition, Liu et al [ 14 ] reported that phacoemulsification combined with GSL was the best surgical method for the treatment of angle-closure glaucoma with cataracts. The IOP-lowering ability of this operation was comparable to that of phacoemulsification combined with trabeculectomy.…”

Ultrasound Biomicroscopy Might Predict the Outcome of Phacoemulsification-Visco Dissection in Medically Controlled Primary Angle-Closure Glaucoma Eye With Extensive Peripheral Anterior Synechia

“…Surgical treatment approaches in those patients include phacoemulsification, trabeculectomy, Phaco-trabeculectomy, goniosynechialysis, and Phaco-goniosynechialysis ( 14 ). A meta-analysis of angle-closure glaucoma reported that IOP in the PEGS group decreased significantly more than in Phaco alone group, and there was no statistical difference between PEGS group and Phaco-trabeculectomy/ trabeculectomy group ( 15 ). This is in accordance with our study that Phaco-visco dissection has a satisfactory IOP decrease and a possible improvement of trabecular meshwork function in both groups.…”

Glaucoma Surgery

“…Goniosynechiolysis (GSL) is another tool that might be combined with the phacoemulsification procedure, especially when a significant amount of anterior synechiae is still present during intraoperative gonioscopy after the cataract is removed [39]. Combining GSL to phacoemulsification seems to be superior to phacoemulsification alone and comparable to trabeculectomy or phacotrabeculectomy in terms of IOP reduction in chronic angle-closure patients [40].…”