Phacoemulsification combined with trabecular meshwork-Schlemm canal-based minimally invasive glaucoma surgery in primary angle-closure glaucoma: a systematic review and meta-analysis.

Background: To summarize the efficacy and safety of the phacoemulsification with intraocular lens implantation (PEI) ± goniosynechialysis (GSL) + trabecular meshwork-Schlemm canal (TM-SC)-based minimally invasive glaucoma surgery (MIGS) in primary angle-closure glaucoma (PACG).

Methods: A comprehensive literature search was conducted across seven electronic databases: PubMed, ScienceDirect, The Cochrane Library, Scopus, Embase, Ovid MEDLINE, and Web of Science. Studies focused on TM-SC-based MIGS with PEI for PACG were included in this review. The efficacy was assessed by the reduction in intraocular pressure (IOP) values and the decrease in the number of anti-glaucoma medications (AGMs), while safety was evaluated by incidence of complications.

Results: Out of 5158 studies initially identified, this meta-analysis included 12 articles with a total of 633 eyes with PACG. At 12 months postoperatively, PEI ± GSL + TM-SC-based MIGS yielded an IOP decrease of 10.25 mmHg (95% CI: 7.06 to 13.43), PEI ± GSL + goniotomy yielded an IOP decrease of 13.10 mmHg (95% CI: 7.59 to 18.62), PEI ± GSL + gonioscopy-assisted transluminal trabeculotomy yielded an IOP decrease of 11.54 mmHg (95% CI: 7.18 to 15.90), and PEI ± GSL + trabecular micro-bypass stent yielded an IOP decrease of 3.94 mmHg (95% CI: 2.58 to 5.30). The most common complications were hyphema (16.3%) and IOP spike (7.4%). Specifically, the iStent group had the lowest incidence of each complication.

Conclusions: PEI ± GSL + TM-SC-based MIGS is effective in reducing IOP and medication burden while maintaining a favorable safety profile in PACG. More randomized controlled trials are required to support this therapeutic recommendation.

Registration: This meta-analysis was registered on PROSPERO (registration number: CRD42024583864).