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G. A. Gdih, D. Yuen, P. Yan, L. Sheng, Y.-P. Jin, Y. M. Buys; Meta Analysis of One Versus Two-Site Phaco-Trabeculectomy. Invest. Ophthalmol. Vis. Sci. 2010;51(13):613.
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The last systematic review of one- vs two-site phacotrabeculectomy included 5 prospective and 1 retrospective study and concluded there was weak evidence that two-site phacotrabeculectomy provides 1-2 mmHg lower IOP than one-site surgery. Since this review there have been further publications on this topic stimulating this meta-analysis.
This study was conducted according to the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement. RCTs comparing one- versus two-site phacotrabeculectomy were searched up to the end of August 2009 using MEDLINE and the Cochrane Registry with the keyword phacotrabeculectomy. Inclusion criteria were prospective RCTs, minimum 12 months follow-up and English language. Two reviewers independently reviewed each article using standardized data collection sheets. Any discrepancies were resolved by consensus. Quality of the trials was assessed using the Cochrane collaboration’s tool of assessing risk of bias. The main outcome measure was IOP and secondary outcomes included glaucoma medications, visual acuity, complications and surgical time. The pooled reduction for each variable at each time point was computed if study results were homogeneious as indicated by the heterogeneity test.
The initial search yielded 167 articles. The abstracts were reviewed and 18 articles with potentially relevant trials were reviewed in entirety. 6 were excluded and the remaining 12 included in the meta-analysis. There was no significant difference in the amount of IOP reduction between one- and two-site phacotrabeculectomy. The IOP decrease from baseline in mmHg (95% CI) was: 7.85 (6.76-8.92) vs 5.83 (4.72-6.94) at one month; 8.03 (7.38-8.67) vs 7.03 (6.35-7.71) at 3 months; 7.78 (7.14-8.42) vs 6.75 (6.04-7.46) at 6 months; 6.44 (5.47-7.41) vs 6.68 (5.56-7.81) at 12 months; 7.17 (6.45-7.89) vs 6.56 (5.77-7.35) at 24 months and 7.76 (7.02-8.49) vs 7.14 (6.36-7.92) at 36 months for one- vs two-site respectively. There was no significant difference in glaucoma medications or VA.
This meta-analysis of 12 RCTs comparing one- versus two-site phacotrabeculectomy found no significant difference in reduction of IOP, glaucoma medications, and change in visual acuity from baseline. There was however a tendency for a greater IOP reduction for one-site surgery.
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