Outcomes of Minimally Invasive Glaucoma Surgery (MIGS) in Glaucoma Patients With Coexisting Cataract: A Systematic Review and Meta-Analysis.

Glaucoma and cataracts frequently occur together in elderly populations, demanding combined surgical therapeutic strategies. Therefore, this study aimed to assess the clinical outcomes of minimally invasive glaucoma surgery (MIGS) in patients with coexisting open-angle glaucoma (OAG) and cataracts by adopting a meta-analysis research approach. The current meta-analysis followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines in selecting and screening the studies. A computer-based search of the PubMed, EMBASE, and Cochrane Library databases was carried out using the last search up to November 2024. The quality of the studies included in this review was evaluated by methodological quality using the Joanna Briggs Institute (JBI) checklist while the risk bias of the included randomized controlled trials (RCTs) was assessed using Cochrane Library tools. All statistical analyses were performed using Review Manager (RevMan) version 5.4.0 (The Cochrane Collaboration). Seven studies (five cohort studies and two RCTs) involving 669 eyes of 651 patients were included. Pooled analysis showed that MIGS combined with cataract surgery significantly reduced intraocular pressure (IOP) compared to cataract surgery alone (mean difference: 1.58 mmHg, 95% CI: 0.30 to 2.87, p<0.00001). Additionally, MIGS decreased postoperative medication use (mean difference: -0.79, 95% CI: -1.28 to -0.30, p<0.0001). However, significant heterogeneity was observed (I=85-100%), likely due to variations in study designs, patient characteristics, and surgical techniques. These findings indicate that MIGS is a reasonable approach to decreasing IOP and reducing glaucoma medications in patients with cataracts and OAG. Due to the small size of the incision, it might be useful for individuals who are older and would still like to get the surgery done but with minimum surgery required. However, the durability and safety of several MIGS procedures have not been consistently determined by different techniques and long-term assessments of MIGS need to be evaluated.