Meta-analysis of 1- versus 2-Site Phacotrabeculectomy.
OBJECTIVE
Comparison of efficacy of intraocular pressure (IOP) reduction between 1- versus 2-site phacotrabeculectomy.


CONCLUSIONS
The last systematic review concluded that there was weak evidence to suggest that 2-site phacotrabeculectomy provides 1- to 2-mmHg lower IOP than 1-site surgery. Since this study, there have been further publications on this topic, stimulating this meta-analysis.


METHODS
Randomized controlled trials comparing 1- versus 2-site phacotrabeculectomy were searched through August 2009 using MEDLINE and the Cochrane Registry with the keyword phacotrabeculectomy. Inclusion criteria were prospective randomized controlled trials, a minimum of 12 months of follow-up, and English language. Quality of the trials was assessed using Cochrane collaboration's tool of assessing risk of bias. The main outcome measure was IOP, and secondary outcomes included number of glaucoma medications, visual acuity, complications, and surgical time.


RESULTS
Ten articles were included. There was no statistically significant difference in the amount of IOP reduction between 1- and 2-site phacotrabeculectomy. The pooled IOP decreases from baseline (95% confidence interval) were: 7.85 mmHg (6.76-8.92 mmHg) versus 5.83 mmHg (4.72-6.94 mmHg) at 1 month; 8.03 mmHg (7.38-8.67 mmHg) versus 7.03 mmHg (6.35-7.71) at 3 months; 7.78 (7.14-8.42) versus 6.75 (6.04-7.46) at 6 months; 6.44 (5.47-7.41 mmHg) versus 6.68 mmHg (5.56-7.81 mmHg) at 12 months; 7.17 mmHg (6.45-7.89 mmHg) versus 6.56 mmHg (5.77-7.35 mmHg) at 24 months; and 7.76 mmHg (7.02-8.49 mmHg) versus 7.14 mmHg (6.36-7.92 mmHg) at 36 months for 1- versus 2-site phacotrabeculectomy, respectively. There was no significant difference in the reduction in glaucoma medications or change in visual acuity at any time point.


CONCLUSIONS
There is no significant difference in IOP reduction between 1- and 2-site phacotrabeculectomy.
Gdih
Gdih A
GA
Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada.
Yuen
Darana
D
Yan
Peng
P
Sheng
Li
L
Jin
Ya-Ping
YP
Buys
Yvonne M
YM
D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage; D002386:Cataract / Q000150:complications / Q000628:therapy; D016208:Databases, Factual; D005260:Female; D005901:Glaucoma / Q000150:complications / Q000601:surgery; D006801:Humans; D007429:Intraocular Pressure; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification / Q000379:methods*; D011183:Postoperative Complications; D016032:Randomized Controlled Trials as Topic; D014065:Tonometry, Ocular; D014130:Trabeculectomy / Q000379:methods*; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology
D000959:Antihypertensive Agents