The Systematic Review Of The Surgery Treatment For Primary Angle-Closure Glaucoma Coexisting Cataract

Objective:To make an evidence-based appraisal to the surgery treatment for primary angle-closure glaucoma (PACG) coexisting cataract, and to provide evidence-based therapies for the disease.Methods:The selection was based on the evidence-based requirements. Studies published in the English language were identified from PubMed, EMBASE, and the Cochrane Library (January2005to July2011), as well as studies published in Chinese from Chinese Bio-medicine Database and journals of Chinese Periodical Fulltext Database ((January2005to July2011), besides, retrospective retrieval and manual retrieval were also used. Randomized clinical trials (RCT), prospective controlled clinical trials, prospective uncontrolled clinical trials, and retrospective case series with more than50cases that evaluated treatments for primary angle-closure glaucoma coexisting cataract were included. Choosing the references According to the inclusion and exclusion criterion, the evidence qualities were classified and assessed by the grades of the evidence quality for the therapy articles, Ravman4.2provided by Cochrane was used for Meta Analysis. Select fixed or random model according to the literature results of heterogeneity test, Sensitivity analysis is done according to the standard literature. Main Outcome Measures included visual acuity, goniosynechia changes, intraocular pressure, success rate of controlling Intraocular pressure, progression in visual field loss, Thickness of retinal nerve fiber layer (RNFL), UBM, complications, postoperative anti-glaucoma medicines, and the secondary surgeries.Results:Ten articles in English and thirteen articles in Chinese were eligible, in which eleven were in grade Ⅰ～Ⅱ, seven were in grade Ⅲ, and five were in grade Ⅳ. The interventions include Laser peripheral iridectomy, surgical peripheral iridectomy, phacoemulsification, small incision non-phacoemulsification cataract extraction combined with intraocular lens implantation, phacoemulsification combined with goniosynechialysis, phacoemulsification combined with surgical peripheral iridectomy, combined phaco-trabeculectomy (with or without MMC), trabeculectomy(with or without MMC). There were four literatures compared phacoemulsification and combined phaco-trabeculectomy in the treatment of primary angle-closure glaucoma existing cataract. The Meta-analysis results showed that x2=0.76, I2=0%, P=0.04, There were statistically significant differences between the two groups in postoperative visual acuity, the phacoemulsification group had better visual acuity. Meanwhile, the Meta-analysis results showed that x2=0.45, I2=0%, P=0.62. There was no statistically significant difference between the two groups in postoperative Intraocular pressure (IOP). Whether to choose phacoemulsification or combine with other surgical therapies depended on the results of gonioscopy, visual field or UBM.Conclusions:1. The evidence-based medicine appraisal revealed that phacoemulsification compared with PhacoTrab+IOL, the former had statistical significance in postoperative visual acuity and no statistically significant differences in postoperative Intraocular pressure, according to Meta analysis of the fixed effect model. Phacoemulsification could be the choice as the surgery treatment for primary angle-closure glaucoma coexisting cataract. 2. The evidence-based medicine appraisal revealed that whether phacoe-mulsification combined with other surgery treatments, such as PhacoTrab+IOL, Phaco+SPI and Phaco-GSL, depending on the damage of visual function and results of UBM or Gonioscopy, but there were no systematic evidences of surgical indications.3. The evidence-based medicine appraisal revealed that randomized controlled trials of large sample and multi-center were needed. Meanwhile, the damage of optic nerve and long-term follow-up on postoperative intraocular pressure should be incorporated in the research.