Combined phacoemulsification and angle filtering procedures versus phacoemulsification with clinical outcomes in primary glaucoma coexisting with cataracts: a meta-analysis of randomized controlled trials.

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.