Meta‐Analysis of Phacoemulsification and Laser Peripheral Iridotomy in the Treatment of Primary Angle‐Closure Glaucoma

Abstract

Background. In this meta-analysis, we aimed to systematically compare the efficacy and safety of phacoemulsification and laser peripheral iridotomy (LPI) in the treatment of primary angle-closure glaucoma (PACG). Method. We searched PubMed, MEDLINE, EMBASE, the Cochrane Library, the Chinese Journal Full-text Database (CNKI), the Wanfang database, and the China Science and Technology Journal Database for randomized controlled trials (RCTs) of phacoemulsification and LPI in the treatment of PACG published up to September 30, 2022. Postoperative intraocular pressure (IOP), anterior chamber depth (ACD), complications, corneal endothelial cell count, and best-corrected visual acuity (BCVA) were compared. The effective quantity of measurement data was measured by the mean difference (MD) and 95% confidence interval (CI). The effect of counting data was measured by the odds ratio (OR). Result. A total of 1731 potential studies were identified, and after screening, 8 RCT studies were included. The results of the meta-analysis showed that, compared to the LPI group, the patients in the phacoemulsification group showed lower IOP six and twelve months after operation (MD-3.39, 95% CI −4.15∼−2.63, P < 0.00001 ; −2.29, −3.52∼−1.06, 0.0003). The ACD in the phacoemulsification group was significantly deeper than that in the LPI group (1.59, 1.10∼2.09, 0.00001). Meanwhile, the incidence of complications in the phacoemulsification group was lower than that in the LPI group (OR = 0.46, 0.29∼0.72, 0.0006). There was no statistically significant difference between the phacoemulsification group and the LPI group in corneal endothelial cell count and BCVA at 6 and 12 months after operation ( P = 0.38 ; 0.11; 0.81). Conclusion. Compared with LPI, phacoemulsification is safer and more effective in the treatment of PACG, especially in controlling IOP and minimizing postoperative complications.

Phacoemulsification versus Laser Peripheral Iridotomy for Treating Primary Angle Closure Glaucoma: A Systematic Review and Meta-Analysis

“… 7 The second systematic review did not assess several important outcomes such as the number of medications, visual field (VF) progression, central corneal thickness (CCT), peripheral anterior synechiae (PAS), and poor response to surgery. 8 …”

“…7 The second systematic review did not assess several important outcomes such as the number of medications, visual field (VF) progression, central corneal thickness (CCT), peripheral anterior synechiae (PAS), and poor response to surgery. 8 This systematic review aimed to compare the effectiveness of laser peripheral iridotomy to early lens extraction in the management of primary angle closure glaucoma (PACG), with respect to intraocular pressure (IOP), Shaffer gonioscopy grading, PAS, best-corrected visual acuity (BCVA), visual field (VF), central endothelial cell density (CECD), CCT, number of glaucoma medications, and poor response to treatment.…”