ESCRS - PP15.05 - The Effect Of Phacoemulsification On The Intraocular Pressure Of Patients With Open-Angle Glaucoma: A Systematic Review And Meta-Analysis Of Randomized Controlled Trials

The Effect Of Phacoemulsification On The Intraocular Pressure Of Patients With Open-Angle Glaucoma: A Systematic Review And Meta-Analysis Of Randomized Controlled Trials

Published 2023 - 41st Congress of the ESCRS

Reference: PP15.05 | DOI: 10.82333/zhph-r861

Authors: Konstantinos Benekos 1 , Fannie Apostolidou Kiouti 2 , Anna- Bettina Haidich 2 , Anna Dastiridou 2 , Anastasios G. Konstas 2 , Andreas Katsanos* 3

1Department of Medicine,Aristotle University of Thessaloniki,Thessaloniki,Greece;Department of Medicine,University of Ioannina,Ioannina,Greece, 2Department of Medicine,Aristotle University of Thessaloniki,Thessaloniki,Greece, 3Department of Medicine,University of Ioannina,Ioannina,Greece

The aim of this systematic review and meta-analysis is to evaluate the effect of phacoemulsification and intraocular lens implantation on intraocular pressure (IOP) in patients with primary open-angle glaucoma (POAG), pseudoexfoliation glaucoma (PXG), normal tension glaucoma (NTG) or normal individuals.

We included the phacoemulsification arms of the randomized controlled trials (RCTs) that had included adult patients with POAG, PXG, NTG or normal individuals. The main outcome was the mean change in IOP at 12 months after phacoemulsification. We excluded studies that analyzed any other type of lens extraction or included patients that had undergone previous glaucoma surgery or complicated phacoemulsification.

A literature review of these databases was undertaken:

  • PubMed/MEDLINE
  • Ovid Embase
  • Cochrane Central Register of Controlled Trials (CENTRAL)
  • NIH ClinicalTrials.gov (http://www.clinicaltrials.gov/)
  • WHO International Clinical Trials Registry Platform (ICTRP) (http://www.who.int/ictrp/en/)
  • ISRCTN registry (http://www.isrctn.com)

Neither date restrictions nor study filters were applied to our search. We supplemented our search by screening the reference lists of relevant studies to check for any non-identified reports. The adjusted ROBINS-I tool was used for the evaluation of the risk of bias. A subgroup analysis of the included studies based on the usage of antiglaucoma drops before the IOP measurements was performed.

Ten arms of 10 RCTs involving 557 patients were included in this meta-analysis. Overall, the mean IOP decreased by 3.82 (95% CI 5.74 to 1.90, I2= 76.9%) 12 months after phacoemulsification. The sub-group analysis based on the existence of a washout period before IOP measurements showed that IOP decreased by 6.25 mmHg (95% CI 8.51 to 4.00, I2= 32.8%) in studies with washout, while it decreased by 2.51 mmHg (95% CI 4.66, 0.37, I2= 75.5%) in studies without washout. The sensitivity analysis of the second group excluding an outlying study with the highest individual effect estimate showed a decrease of 1.44 (95% CI 2.50 to 0.38, I2=0%).

There is evidence that cataract surgery can reduce IOP in patients with POAG, PXG or NTG. The net effect of phacoemulsification is masked and affected by the topical IOP-lowering medications used before IOP assessment. More future studies with washout as part of their protocol might be helpful to confirm our results.