Visual field outcomes after cataract surgery with or without microinvasive glaucoma surgery in open-angle glaucoma: a systematic review and meta-analysis of RCTs reporting visual field results.

PURPOSE: To compare the benefits of combining microinvasive glaucoma surgery (MIGS) with cataract surgery (CS) for visual field (VF) preservation in patients with primary open-angle glaucoma (POAG) and coexisting cataracts.

METHODS

A systematic review and meta-analysis were conducted on randomised controlled trials (RCTs) comparing MIGS + CS to CS alone in POAG patients with cataracts that specifically reported visual field outcomes. Studies included were required to report VF outcomes with a follow-up of at least 12 months. Subanalysis focused on studies with 24-month follow-up durations, and consistent device used.

RESULTS

Three RCTs encompassing 857 eyes were included, with 523 eyes in the MIGS + CS group and 334 in the CS group. MIGS + CS was associated with a statistically significant reduced rate of VF deterioration in Mean Deviation (MD) at the 24-month follow-up compared to CS alone (SMD 0.29; p = 0.007), and a significant difference between groups in the rate of VF progression (MD 0.23 decibels (dB)/year; p = 0.00001). However, there was no difference in IOP reduction (MD -0.46 mmHg; p = 0.40). The MIGS + CS group showed a significant reduction in medication use (MD -0.36 medications; p < 0.00001).

CONCLUSION

Among the MIGS devices studied (iStent and Hydrus), combining them with cataract surgery provided VF benefits in terms of rate of deterioration and decline, and reduced medication dependence. Standardised follow-up and reporting practices are essential for evaluating MIGS's role in glaucoma management.