Does Standalone Phacoemulsification Lower Intraocular Pressure In Glaucomatous Eyes? A Systematic Review And Meta-Analysis
Published 2025 - 43rd Congress of the ESCRS
Reference: PP17.12 | Type: Free paper | DOI: 10.82333/jc9m-7w69
Authors: Adi Einan-Lifshitz* 1 , Assaf Greenbaum 1 , Sigal Zmujack-Yehiam 1 , Eran Pras 1 , Anat Maytal 1
1Ophthalmology,Shamir medical center,Zerifin,Israel
Purpose
To evaluate the effect of phacoemulsification on intraocular pressure (IOP) in glaucoma patients over 12- and 24-month follow-up periods.
Setting
A systematic review and meta-analysis.
Methods
Our protocol was registered in PROSPERO (CRD42024533437). We conducted a systematic search in PubMed, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science on December 7, 2023. We included randomized clinical trials (RCTs) with a sample size of at least 10 eyes and a 12-month minimum follow-up. Risk of bias assessment was performed using the Cochrane risk-of-bias tool for randomized trials (RoB 2). A random-effects model meta-analysis was used to determine the pooled effect size, and heterogeneity was assessed using Cochran’s Q and I² statistics. Publication bias was evaluated using, Egger's, Begg's tests, and trim-and-fill analysis.
Results
We included 41 RCTs with a total of at least 2,254 patients (2,315 eyes). The meta-analysis showed a significant reduction in IOP at the 6, 12, 24, and last follow-up periods in angle-closure glaucoma (ACG) and open-angle glaucoma (OAG) patients. In ACG, the pooled effect showed a percentage of IOP reduction (IOPR%) of 35.22% with a mean IOP reduction of -9.51 mmHg, p < 0.001 at 12 months, and an IOPR% of 27.47% with a mean reduction of -6.37 mmHg, p < 0.001 at 24 months. In OAG, the pooled effect showed an IOPR% of 18.94% with a significant absolute change of -4.35 mmHg, p < 0.001 at 12 months, and IOPR% of 16.95% with an absolute IOP change of -3.83 mmHg, p < 0.001 at 24 months. We found a low risk of publication bias.
Conclusions
Standalone phacoemulsification lowers IOP significantly in patients with glaucoma, especially ACG patients. High heterogeneity in some outcomes could limit our findings. Future research should focus on identifying patient-level factors that predict the degree of IOP lowering following phacoemulsification to guide surgical decision-making.