Department of Ophthalmology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia.
Indian J Ophthalmol. 2024 May 1;72(Suppl 3):S345-S353. doi: 10.4103/IJO.IJO_1322_23. Epub 2024 Mar 8.
Age is an important risk factor for both glaucoma and cataract. As global life expectancy continues to rise, the prevalence of concomitant open-angle glaucoma (OAG) and cataracts is increasing. Currently, there is a lack of definitive consensus on the optimal management approach for such individuals. Conventionally, trabeculectomy (Trab) in combination with phacoemulsification is the preferred method. Recent developments in microinvasive glaucoma surgery (MIGS), which offer similar results with fewer complications, provide a new possible approach to this condition. This study aimed to assess the current knowledge of combination surgery in patients with cataract and OAG to provide a comprehensive understanding and help its implementation in clinical settings. A comprehensive systematic search was conducted in May 2021 on five databases (MEDLINE, Embase, SCOPUS, Proquest, EBSCO, and Cochrane Library). The results were filtered for English and human studies but not publication year. All studies published up to May 2021 were reviewed. Newcastle-Ottawa Scale and PEDro scale were used to screen studies for risk of bias where appropriate. Four studies satisfied the inclusion criteria and were subsequently added in this review. Study designs consisted of one RCT and three descriptive studies. Appropriate assessment tools were used; these studies demonstrated moderate to good quality. Postoperative mean IOP, IOP reduction, and qualified success rates were comparable in the Phaco-MIGS (Phaco-endoscopic cyclophotocoagulation (ECP), Phaco-ab interno trabeculectomy (AIT)) and Phaco-Trab group. Severe complication was reported only in the latter. Phaco-MIGS (in particular, trabectome) shows excellent promise as an option for individuals with OAG and concomitant cataract; further research through RCT is required to validate these findings.
年龄是青光眼和白内障的重要危险因素。随着全球预期寿命的持续延长，开角型青光眼（OAG）和白内障同时发生的患病率正在上升。目前，对于此类患者，尚无明确的最佳治疗方法共识。传统上，小梁切除术（Trab）联合超声乳化术是首选方法。微创青光眼手术（MIGS）的最新进展提供了一种新的可能方法，其具有相似的结果，并发症更少。本研究旨在评估白内障合并 OAG 患者联合手术的最新知识，以提供全面的理解并帮助其在临床环境中实施。2021 年 5 月，在五个数据库（MEDLINE、Embase、SCOPUS、Proquest、EBSCO 和 Cochrane Library）中进行了全面的系统搜索。结果根据英语和人类研究进行了筛选，但不包括出版年份。审查了截至 2021 年 5 月发表的所有研究。在适当的情况下，使用纽卡斯尔-渥太华量表和 PEDro 量表筛选研究的偏倚风险。四项研究符合纳入标准，并随后纳入本综述。研究设计包括一项 RCT 和三项描述性研究。使用了适当的评估工具；这些研究的质量为中等至良好。在 Phaco-MIGS（Phaco-内窥镜睫状体光凝术（ECP）、Phaco-内路小梁切开术（AIT））和 Phaco-Trab 组中，术后平均眼压、眼压降低和合格成功率相当。仅在后一组中报告了严重并发症。Phaco-MIGS（特别是 trabectome）作为 OAG 和伴发性白内障患者的一种选择具有巨大的潜力；需要通过 RCT 进行进一步研究来验证这些发现。
