OBJECTIVES :

The group of chronic optic neuropathies, characterized by degeneration of the optic nerve, are called glaucoma. An increase in intraocular pressure (IOP) can lead to blindness, requiring inhibition of glaucoma progression. A review of the evidence is required to determine the best therapy to reduce IOP for patients with glaucoma and cataract.

We conducted a systematic literature review of the international studies, on the various surgical methods included, in combination with phacoemulsification, in order to study the efficacy of each of these alternatives.

METHODS :

The review was performed on the PubMed and Cochrane Library databases using the following search terms: "iStent inject", "phacoemulsification", "viscocanalostomy", "trabeculectomy", "sclerectomy", phacoviscocanalostomy", "phacotrabeculectomy", "phacosclerectomy", "second-generation trabecular micro-bypass stents", "glaucoma" and "cataract". The inclusion criteria were: comparative studies, patients with glaucoma and cataract, initial IOP < 21 mmHg, studies evaluating change in IOP pre and post-surgery and/or % of patients with IOP < 21 mmHg, studies using 1 stent per eye and publications in English or Spanish. Studies where phacoemulsification was not considered as adjunctive surgery were excluded. No temporal restriction was used.

RESULTS

250 studies were identified. Fifty-one duplicate studies were excluded and finally 191 publications were excluded as they did not meet the inclusion criteria. Finally, 8 studies were selected; these correspond to 3 studies on the use of iStent inject®, 1 article comparing phaco-viscochanalostomy versus phaco-trabeculectomy, 2 publications studying phaco-trabeculectomy versus phacoemulsification and 2 studies on phaco-esclerotomy versus phaco-trabeculectomy.

CONCLUSIONS :

There is no conclusive evidence that phaco-viscochanalostomy, phaco-trabeculectomy or phaco-esclerotomy are statistically superior to phacoemulsification. On the other hand, iStent inject® in combination with phacoemulsification presents statistically significant differences against phacoemulsification.