The comparative efficacy and safety of one-site versus two-site phacotrabeculectomy: an updated systematic review and meta-analysis.

PURPOSE: To compare the efficacy and safety of one-site versus two-site phacotrabeculectomy in the management of concurrent cataract and glaucoma through an updated systematic review and meta-analysis of randomized controlled trials.

METHODS

Systematic searches were conducted across seven electronic databases through February 2025. Only randomized controlled trials comparing one-site versus two-site phacotrabeculectomy were included. Primary outcome was intraocular pressure (IOP) reduction. Secondary outcomes included anti-glaucoma medication (AGM) use, visual acuity, endothelial cell loss, and complications. Meta-regression analyzed the effects of mitomycin C (MMC) usage, age, and follow-up duration on outcomes.

RESULTS

Sixteen randomized controlled trials (1087 eyes) were included. Both techniques achieved comparable IOP reduction at most timepoints. Although two-site surgery demonstrated a trend toward greater IOP reduction at select intervals (e.g., day one and 18 months), these differences were not statistically significant. AGM requirements were similar between groups at 12 months (mean difference: 0.05; 95% CI - 0.16, 0.27). Visual outcomes were comparable, though influenced by age (p = 0.004) and MMC use (p = 0.025). Endothelial cell loss was initially greater with two-site surgery but stabilized over time. Complication rates, including hyphema (OR: 0.99; 95% CI: 0.56, 1.76) and bleb-related complications (OR: 1.09; 95% CI 0.55, 2.16), were similar between groups.

CONCLUSIONS

One-site and two-site phacotrabeculectomy demonstrate comparable efficacy and safety profiles. While two-site surgery shows a trend toward greater IOP reduction, the differences are not clinically significant. Surgical approach should be individualized based on patient characteristics, surgeon experience, and specific surgical goals rather than assumed superiority of either technique.