Phacoemulsification with endoscopic cyclophotocoagulation versus phacoemulsification with trabeculectomy in cataract and glaucoma patients: A systematic review and meta-analysis

PURPOSE:The study aimed to compare the efficacy and safety of two combined cataract and glaucoma surgical techniques: endoscopic cyclophotocoagulation with phacoemulsification (phaco-ECP) and trabeculectomy with phacoemulsification (phaco-trab).MATERIALS AND METHODS:Searches were performed in PubMed, EMBASE, Cochrane, and Web of Science databases for studies comparing phaco-ECP to phaco-trab. Outcomes of interest included intraocular pressure (IOP), the number of glaucoma medications, the necessity for secondary surgery, and general complications. Statistical analysis utilized ReviewManager (version 5.4).RESULTS:The review included 6 studies (1 randomized clinical trial and 5 observationals), totaling 353 subjects and 359 eyes. Of these, 184 underwent phaco-ECP and 175 underwent phaco-trab. Initial postoperative findings showed a significantly higher IOP reduction in the phaco-trab group compared to the phaco-ECP group one day after surgery (mean difference: 7.67; P = 0.01). However, no significant differences were observed at 1-month and 6-month follow-ups. The analysis also found no significant differences in the number of glaucoma medications at the last visit or in the necessity for a second surgery. A significant difference in total general complications was observed, favoring the phaco-ECP group (odds ratio 0.11; P = 0.01).CONCLUSIONS:Both Phaco-ECP and phaco-trab surgeries demonstrated comparable long-term outcomes concerning IOP reduction, medication requirements, and the necessity for secondary surgeries. However, phaco-trab was associated with a more immediate decline in IOP post-surgery, though it carried a higher complication rate.