Bidiwala Saad, Jabarkhyl Dost, Bidiwala Kaim
General Medicine, Royal Free National Health Service (NHS) Foundation Trust, London, GBR.
General Medicine, Luton and Dunstable University Hospital, London, GBR.
Cureus. 2025 Jan 6;17(1):e77007. doi: 10.7759/cureus.77007. eCollection 2025 Jan.
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.
青光眼和白内障在老年人群中经常同时出现，需要联合手术治疗策略。因此，本研究旨在采用荟萃分析研究方法，评估微创青光眼手术（MIGS）在合并开角型青光眼（OAG）和白内障患者中的临床疗效。本次荟萃分析在选择和筛选研究时遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南。使用截至2024年11月的最新搜索结果，对PubMed、EMBASE和Cochrane图书馆数据库进行了基于计算机的检索。本综述纳入的研究质量采用乔安娜·布里格斯研究所（JBI）清单通过方法学质量进行评估，而纳入的随机对照试验（RCT）的风险偏倚则使用Cochrane图书馆工具进行评估。所有统计分析均使用Review Manager（RevMan）5.4.0版（Cochrane协作网）进行。纳入了7项研究（5项队列研究和2项RCT），涉及651例患者的669只眼。汇总分析表明，与单纯白内障手术相比，MIGS联合白内障手术显著降低了眼压（平均差值：1.58 mmHg，95%CI：0.30至2.87，p<0.00001）。此外，MIGS减少了术后药物使用（平均差值：-0.79，95%CI：-1.28至-0.30，p<0.0001）。然而，观察到显著的异质性（I=85-100%），可能是由于研究设计、患者特征和手术技术的差异。这些发现表明，MIGS是降低白内障和OAG患者眼压及减少青光眼药物使用的合理方法。由于切口小，对于年龄较大且仍希望进行手术但所需手术最少的个体可能有用。然而，几种MIGS手术的耐久性和安全性尚未通过不同技术得到一致确定，需要对MIGS进行长期评估。
