RCT review of surgery for open angle glaucoma

1 December 2022 | Su Young | EYE - Glaucoma | Intraocular pressure, Open angle glaucoma, meta-analysis, microstent, phacoemulsification

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This systematic review and meta-analysis examined eight randomised controlled trials (RCTs) to compare the intraocular pressure (IOP) reducing effect of three types of microstent implantation (Hydrus, iStent, CyPass) combined with phacoemulsification versus phacoemulsification alone for patients with open-angle glaucoma (OAG) and cataract. Four studies examined iStent, three studies examined Hydrus and one study examined the Cypass device (which has since been withdrawn in the UK). All three phaco and microstents demonstrated more reduction of IOP compared to phaco alone, based on all eight RCTs. This was shown in the iStent implantation with phacoemulsification group (MD, −0.80; 95%CI, −1.31 to −0.29; p < .05), Hydrus microstent implantation with phacoemulsification group (MD, −2.08; 95%CI, −2.58 to −1.58; p < .05), and CyPass implantation with phacoemulsification group (MD, −2.20; 95%CI, −2.83 to −1.57; p < .05). Seven RCTs examined medication-free status following surgery. The authors report more medication-free patients in the combined surgery groups compared to phacoemulsification alone, with the overall risk ratio (RR) of 1.54 (95%CI, 1.34 to 1.77, p < .05). The authors reported more patients with 20% IOP reduction in iStent implantation with phacoemulsification group (RR, 1.30; 95%CI, 1.09 to 1.54; p < .05), Hydrus microstent implantation with phacoemulsification group (RR, 1.39; 95%CI, 1.26 to 1.55; p < .05) and CyPass implantation with phacoemulsification group (RR, 1.28; 95%CI, 1.10 to 1.48; p < .05) than that of the phacoemulsification alone group during the whole observation period based on six RCTs. The authors conclude that combined surgery may be recommended for patients with OAG and co-existing cataract.