Phacoemulsification versus combined phacotrabeculectomy in the treatment of primary angle-closure glaucoma with cataract: a Meta-analysis

AIM: To compare the efficacy and safety of phacoemulsification(Phaco) against combined phacotrabeculectomy(Phacotrabe) in primary angle-closure glaucoma(PACG) with coexisting cataract.·METHODS: By searching electronically the Pub Med,EMBASE, Scientific Citation Index and Cochrane Library published up from inception to January 2014, all randomized controlled trials that matched the predefined criteria were included. The quality of included trials was evaluated according to the guidelines developed by the cochrane collaboration. And the outcomes estimating efficacy and safety of two different surgical treatments were measured and synthesised by Rev Man 5.0.· RESULTS: Five randomized controlled trials were selected and included in Meta-analysis with a total of468 patients(468 eyes) with both PACG and cataract. We found that Phacotrabe had a greater intraocular pressure(IOP) lowing effect [preoperative IOP: weighted mean difference(WMD)=0.58, 95% confidence intervals(95% CI,-0.53 to 1.69), P =0.31; postoperative IOP: WMD =1.37,95% CI(0.45 to 2.28), P =0.003], a lower number of antiglaucoma medications [risk ratio(RR)=0.05, 95% CI(0.02 to 0.18), P <0.00001] needed postoperatively and less serious damage of optic nerve [RR =0.48, 95% CI(0.21 to 1.07), P =0.07], but a higher risk of complications[odds ratio(OR)=0.04, 95% CI(0.01 to 0.16), P <0.00001]compared with Phaco. The rest studies indicated that there had no significantly difference between the two surgical methods for postoperative best-corrected visual acuity(BCVA) [WMD =-0.05, 95% CI(-0.14 to 0.05), P =0.32] and loss of visual field [RR=1.06, 95% CI(0.61 to1.83), P =0.83].·CONCLUSION: Phaco alone compared with Phacotrabe had a better effect in IOP reduction, whereas the securitydecline. Considering the number of sample size, our results remains to be further studied.