Manual small incision cataract surgery combined with trabeculectomy versus phacoemulsification combined with trabeculectomy for coexisting glaucoma and cataract: a systematic review and meta-analysis

BackgroundEvaluate the efficacy and safety of manual small incision cataract surgery combined with trabeculectomy (MSICS-trab) compared to Phacoemulsification combined with trabeculectomy (phaco-trab), on the management of glaucoma and coexisting cataract.Research design and methodsA systematic review and meta-analysis was realized following by PRISMA guideline recommendations and prospectively registered the study in PROSPERO (CRD42024504801). The PubMed, Web of Science, Cochrane, and Embase databases were searched for Randomized Clinical Trials (RCT) or non-RCT studies comparing MSICS-trab to phaco-trab on patients with coexisting glaucoma and cataracts. The mean difference with 95% confidence intervals was computed using a random-effects model. The statistical analysis was carried out using the RevMan software.ResultsFour studies were included with 568 patients, 283 (49.8%) received phaco-trab, while 285 (50.2%) received MSICS-trab. In the analysis of the MD of intraocular pressure at 1 week (p = 0.72), 1 month (p = 0.33), 12 months (p = 0.40), and at last visit (p = 0.69) there was no statistically significant difference between groups. A total of 150 complications were observed. Rates of general complications and serious complications were not significantly different between groups (p = 0.50).ConclusionsMSICS-trab and phaco-trab showed sustained IOP reduction and without increasing complications.