Summary of findings for the main comparison. Combined surgery versus phacoemulsification alone for eyes with cataract and glaucoma.
| Combined surgery versus phacoemulsification alone for eyes with cataract and glaucoma | ||||||
| Patient or population: patients with eyes with cataract and glaucoma Settings: eye clinic Intervention: combined surgery (phacoemulsification and any type of glaucoma surgery) Comparison: phacoemulsification alone | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk: Cataract surgeryalone | Corresponding risk: Combined surgery | |||||
| Mean change in IOP Measured by Goldmann applanation Follow‐up: one year after surgery | The mean change in IOP at one year after surgery ranged across cataract surgery alone groups from 5.8 mmHg to 1.0 mmHg lower | The mean change in IOP at one year after surgery in the combined surgery groups was on average 1.62 mmHg lower than cataract surgery alone (95% CI 2.61 mmHg to 0.64 mmHg lower) | MD ‐1.62 mmHg (‐2.61 to ‐0.64) | 489 (6 studies) | ⊕⊕⊝⊝ low1,2,3 | No evidence for a difference in effect according to type of glaucoma surgery (trabeculectomy, iStent®, and trabeculotomy); Of 3 studies not included in meta‐analysis due to insufficient reporting of data or reporting data at other follow‐up times, two studies reported more reduction in IOP in the combined surgery group compared with the cataract surgery alone group and one study reported no difference between groups |
| Mean change in medications Measured by number of bottles Follow‐up: one year after surgery | The mean change in medication at one year ranged across cataract surgery alone groups from 1 bottle to 0.5 bottles fewer | The mean change in medication at one year in the combined surgery groups was on average 0.69 bottles fewer (95% CI 1.28 to 0.1 fewer) |
MD ‐0.69 bottles (‐1.28 to ‐0.10) |
301 (2 studies) | ⊕⊕⊝⊝ low1,2,3 | |
| Proportion using one or more medications at one year after surgery Number of participants Follow‐up: one year after surgery | Study population | RR 0.47 (0.28 to 0.80) | 453 (5 studies) | ⊕⊕⊝⊝ low1,2,3 | ||
| 592 per 1000 | 278 per 1000 (166 to 474) | |||||
| Proportion who received re‐operation to control IOP within one year Number of participants Follow‐up: one year after surgery | Study population | RR 1.13 (0.15 to 8.25) | 382 (4 studies) | ⊕⊕⊝⊝ low2,3,4 | ||
| 15 per 1000 | 17 per 1000 (2 to 124) | |||||
| Proportion who received intervention for surgical complications within one year Number of participants Follow‐up: one year after surgery | Study population | RR 1.06 (0.34 to 3.35) | 382 (4 studies) | ⊕⊕⊝⊝ low2,3,4 | ||
| 245 per 1000 | 260 per 1000 (83 to 821) | |||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
CI: confidence interval; IOP: intraocular pressure; MD: mean difference; RR: risk ratio
*The basis for the assumed risk is the mean cataract surgery alone group risk across studies. The corresponding risk (and its 95% CI) is based on the assumed risk in the cataract surgery alone group and the relative effect of the combined surgery (and its 95% CI).
1Substantial statistical heterogeneity. 2Risk of bias assessed as high or unclear among studies. 3Studies measuring outcome did not report sufficient information for meta‐analysis. 4Wide CI (imprecision) and crosses the line of appreciable benefit.