Frontiers in ophthalmology · 2026
Combined phacoemulsification and angle filtering procedures versus phacoemulsification with clinical outcomes in primary glaucoma coexisting with cataracts: a meta-analysis of randomized controlled trials.
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Xie Tangshou, Rao Wenrong, Liu Xi, Li Yuanyi, Zhu Jie
Аннотация
BACKGROUND: To evaluate the clinical outcomes of combined phacoemulsification and angle filtering procedures versus phacoemulsification alone in patients with primary glaucoma coexisting with cataracts.
METHODS: Randomized controlled trials comparing combined phacoemulsification and angle filtering procedures with phacoemulsification published before September 24, 2025, were identified through PubMed/Medline, Embase, and Cochrane Library. Intraocular pressure (IOP), anti-glaucoma medications (AGMs), best-corrected visual acuity (BCVA), perimetry, and complications were analyzed in this meta-analysis. Subgroup analyses were conducted based on follow-up duration, angle status, use of mitomycin C (MMC), and surgical approach.
RESULTS: Fourteen randomized controlled trials were pooled for analysis. Combined phacoemulsification and angle filtering procedures had a smaller effect on BCVA than phacoemulsification alone without MMC [mean difference (MD) = 0.07, confidence interval (CI): 0.01 to 0.13, I2 = 49%, p = 0.03]. Combined phacoemulsification and angle filtering procedures were significantly more effective in reducing IOP (MD = -1.98, CI: -2.71 to -1.25, I2 = 90%, p < 0.0001) and need of AGMs (MD = -0.69, CI: -0.87 to -0.52, I2 = 73%, p < 0.0001) but associated with a significantly higher rate of complications [risk ratio (RR) = 2.66, CI: 1.82 to 3.89, I2 = 13%, p < 0.00001].
CONCLUSIONS: Combined phacoemulsification and angle filtering procedures are superior in reducing IOP and need for AGMs. In the subgroup without MMC use, combined angle filtering procedures were associated with a statistically significant difference in BCVA compared with phacoemulsification alone.
SYSTEMATIC REVIEW REGISTRATION: https://inplasy.com/inplasy-2026-5-0081/, identifier INPLASY202650081.
METHODS: Randomized controlled trials comparing combined phacoemulsification and angle filtering procedures with phacoemulsification published before September 24, 2025, were identified through PubMed/Medline, Embase, and Cochrane Library. Intraocular pressure (IOP), anti-glaucoma medications (AGMs), best-corrected visual acuity (BCVA), perimetry, and complications were analyzed in this meta-analysis. Subgroup analyses were conducted based on follow-up duration, angle status, use of mitomycin C (MMC), and surgical approach.
RESULTS: Fourteen randomized controlled trials were pooled for analysis. Combined phacoemulsification and angle filtering procedures had a smaller effect on BCVA than phacoemulsification alone without MMC [mean difference (MD) = 0.07, confidence interval (CI): 0.01 to 0.13, I2 = 49%, p = 0.03]. Combined phacoemulsification and angle filtering procedures were significantly more effective in reducing IOP (MD = -1.98, CI: -2.71 to -1.25, I2 = 90%, p < 0.0001) and need of AGMs (MD = -0.69, CI: -0.87 to -0.52, I2 = 73%, p < 0.0001) but associated with a significantly higher rate of complications [risk ratio (RR) = 2.66, CI: 1.82 to 3.89, I2 = 13%, p < 0.00001].
CONCLUSIONS: Combined phacoemulsification and angle filtering procedures are superior in reducing IOP and need for AGMs. In the subgroup without MMC use, combined angle filtering procedures were associated with a statistically significant difference in BCVA compared with phacoemulsification alone.
SYSTEMATIC REVIEW REGISTRATION: https://inplasy.com/inplasy-2026-5-0081/, identifier INPLASY202650081.