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

• 作者: Nuo Wang Song-Bai Jia
• 来源期刊: 国际眼科杂志:英文版
• 学科: 医学
• 关键词: ANGLE-CLOSURE GLAUCOMA CATARACT PHACOEMULSIFICATION GONIOSYNECHIALYSIS META-ANALYSIS
• 年，卷（期）: gjykzzywb_2019,（5）
• 页码范围: 826-833
• 页数: 8页
• 分类号: R779.6

摘要

AIM: To compare the benefits and potential harms of routine phacoemulsification(phaco) alone and combined surgery with goniosynechialysis(GSL) for angle-closure glaucoma(ACG) and coexisting lens opacity, as shown in different randomized controlled trials(RCTs).METHODS: A systematic review was conducted searching several databases including PubMed, Cochrane Library, EMBASE, ClinicalTrials.gov from the inception to September 2018 for RCTs with data published on the effects and safety of phaco and intraocular lens implantation combined with GSL or routine cataract surgery alone. Several studies were recruited which reported data at baselines and postoperative follow-up, including the mean values of postoperative intraocular pressure(IOP) and mean numbers of antiglaucoma medications using postoperatively. The numbers of complications happening were also included. Fixedeffect and random-effect models were applied, and the quality of evidence was evaluated.RESULTS: Analysis of the seven included RCTs, with a total number of 321 participants(358 eyes) diagnosed with ACG and cataract, received a solo procedure(phaco group) or a combined surgery(phaco-GSL group) randomly, and follow-up periods ranging from 2 to 12 mo postoperatively. The involved studies showed that the mean value of IOP between the two groups at 3(four studies, one study follow-up at 2 mo postoperative was included), 6, 12 mo postoperative were not significantly different. Only two studies reported the change in IOP value at 12 mo compared with baseline but showed nosignificant differences between the two interventions. Although three studies did not have the significant difference in the number of medications using to reduce IOP at 3 mo postoperatively, two studies reported that the participants using fewer anti-glaucoma medications at 12 mo postoperative in the phaco group than in the phacoGSL surgery group.CONCLUSION: The analysis provides a low to moderatequality evidence that phaco-GSL surgery lead to an equivalent IOP-lowering effect. The phaco-GSL