The decision between undergoing combined glaucoma and cataract surgery versus cataract surgery alone is complex. Therefore, it is important to compare the effectiveness of these two interventions to aid clinicians and patients in choosing the better treatment approach. To assess the relative effectiveness and safety of combined surgery versus cataract surgery phacoemulsification alone for co-existing cataract and glaucoma.
The secondary objectives include cost analyses for different surgical techniques for co-existing cataract and glaucoma.
Treatment Options for Glaucoma Patients
We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 3 October We checked the reference lists of the included trials to identify further relevant trials. We used the Science Citation Index to search for references to publications that cited the studies included in the review.
We also contacted investigators and experts in the field to identify additional trials. We included randomized controlled trials RCTs of participants who had open-angle, pseudoexfoliative, or pigmentary glaucoma and age-related cataract. The comparison of interest was combined cataract surgery phacoemulsification and any type of glaucoma surgery versus cataract surgery phacoemulsification alone. Two review authors independently assessed study eligibility, collected data , and judged risk of bias for included studies. We used standard methodological procedures expected by the Cochrane Collaboration.
We included nine RCTs , with a total of participants eyes , and follow-up periods ranging from 12 to 30 months. We graded the overall quality of the evidence as low due to observed inconsistency in study results, imprecision in effect estimates, and risks of bias in the included studies. All of these studies found a statistically significant greater decrease in mean IOP postoperatively in the combined surgery group compared with cataract surgery alone; the mean difference MD was No study reported the proportion of participants with a reduction in the number of medications used after surgery, but two studies found the mean number of medications used postoperatively at one year was about one less in the combined surgery group than the cataract surgery alone group MD None of the studies reported the mean change in visual acuity or visual fields.
However, six studies reported no significant differences in visual acuity and two studies reported no significant differences in visual fields between the two intervention groups postoperatively data not analyzable. The effect of combined surgery versus cataract surgery alone on the need for reoperation to control IOP at one year was uncertain RR 1. Also uncertain was whether eyes in the combined surgery group required more interventions for surgical complications than those in the cataract surgery alone group RR 1. No study reported any vision-related quality of life data or cost outcome.
Complications were reported at 12 months two studies , 12 to 18 months one study , and two years four studies after surgery. Due to the small number of events reported across studies and treatment groups, the difference between groups was uncertain for all reported adverse events. Combined glaucoma and cataract surgery versus cataract surgery alone for eyes with cataract and glaucoma Review question The aim of this systematic review was to compare the effectiveness and safety of combined glaucoma and cataract surgery compared with cataract surgery alone. Authors' conclusions:. Search strategy:.
Cataract Surgery and Glaucoma
Data collection and analysis:. Main results:. She acknowledged no financial interest in the products or companies mentioned herein. Smit may be reached at ; bsmit spokaneeye. Aaron M. He acknowledged no financial interest in the products or companies mentioned herein. Marble may be reached at amarble zagmail.
Bradley P. Roth may be reached at bradroth uw.
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