{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T04:58:53Z","timestamp":1780894733511,"version":"3.54.1"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100013795","name":"Fujian Medical University","doi-asserted-by":"publisher","award":["Startup Fund for scientific research 2021QH1216, Startup Fund for scientific research 2024QH1289"],"award-info":[{"award-number":["Startup Fund for scientific research 2021QH1216, Startup Fund for scientific research 2024QH1289"]}],"id":[{"id":"10.13039\/501100013795","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Ophthalmol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>To evaluate the clinical outcomes of combined phacoemulsification and angle filtering procedures versus phacoemulsification alone in patients with primary glaucoma coexisting with cataracts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Randomized controlled trials comparing combined phacoemulsification and angle filtering procedures with phacoemulsification published before September 24, 2025, were identified through PubMed\/Medline, Embase, and Cochrane Library. Intraocular pressure (IOP), anti-glaucoma medications (AGMs), best-corrected visual acuity (BCVA), perimetry, and complications were analyzed in this meta-analysis. Subgroup analyses were conducted based on follow-up duration, angle status, use of mitomycin C (MMC), and surgical approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fourteen randomized controlled trials were pooled for analysis. Combined phacoemulsification and angle filtering procedures had a smaller effect on BCVA than phacoemulsification alone without MMC [mean difference (MD) = 0.07, confidence interval (CI): 0.01 to 0.13, I\n                      <jats:sup>2<\/jats:sup>\n                      = 49%, p = 0.03]. Combined phacoemulsification and angle filtering procedures were significantly more effective in reducing IOP (MD = \u22121.98, CI: \u22122.71 to \u22121.25, I\n                      <jats:sup>2<\/jats:sup>\n                      = 90%, p &amp;lt; 0.0001) and need of AGMs (MD = \u22120.69, CI: \u22120.87 to \u22120.52, I\n                      <jats:sup>2<\/jats:sup>\n                      = 73%, p &amp;lt; 0.0001) but associated with a significantly higher rate of complications [risk ratio (RR) = 2.66, CI: 1.82 to 3.89, I\n                      <jats:sup>2<\/jats:sup>\n                      = 13%, p &amp;lt; 0.00001].\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Combined phacoemulsification and angle filtering procedures are superior in reducing IOP and need for AGMs. In the subgroup without MMC use, combined angle filtering procedures were associated with a statistically significant difference in BCVA compared with phacoemulsification alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/inplasy.com\/inplasy-2026-5-0081\/<\/jats:ext-link>\n                      , identifier INPLASY202650081.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fopht.2026.1787044","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T04:22:54Z","timestamp":1780892574000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Combined phacoemulsification and angle filtering procedures versus phacoemulsification with clinical outcomes in primary glaucoma coexisting with cataracts: a meta-analysis of randomized controlled trials"],"prefix":"10.3389","volume":"6","author":[{"given":"Tangshou","family":"Xie","sequence":"first","affiliation":[{"name":"Nanping First Hospital Affiliated to Fujian Medical University","place":["Nanping, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenrong","family":"Rao","sequence":"additional","affiliation":[{"name":"Nanping First Hospital Affiliated to Fujian Medical University","place":["Nanping, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xi","family":"Liu","sequence":"additional","affiliation":[{"name":"Nanping Peoples\u2019 Hospital","place":["Nanping, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanyi","family":"Li","sequence":"additional","affiliation":[{"name":"Nanping First Hospital Affiliated to Fujian Medical University","place":["Nanping, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Zhu","sequence":"additional","affiliation":[{"name":"Nanping First Hospital Affiliated to Fujian Medical University","place":["Nanping, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,8]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.preteyeres.2018.01.003","article-title":"Cataract, phacoemulsification and intraocular pressure: Is the anterior segment anatomy the missing piece of the puzzle","volume":"64","author":"Masis Solano","year":"2018","journal-title":"Prog Retin Eye Res"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1097\/IJG.0000000000001345","article-title":"Mitomycin C-augmented phacotrabeculectomy versus phacoemulsification in primary angle-closure glaucoma: A randomized controlled study","volume":"29","author":"El Sayed","year":"2019","journal-title":"J Glaucoma"},{"key":"B3","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1186\/s12886-015-0074-3","article-title":"Small-incision phacotrabeculectomy versus phacoemulsification in refractory acute primary angle closure with cataract","volume":"29","author":"Hou","year":"2015","journal-title":"BMC Ophthalmol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0420.1998.760613.x","article-title":"A prospective study of combined phacoemulsification-trabeculectomy versus conventional phacoemulsification in cataract patients with coexisting open-angle glaucoma","volume":"76","author":"Storr-Paulsen","year":"1998","journal-title":"Acta Ophthalmol Scand"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2008.06.016","article-title":"Phacoemulsification versus combined phacotrabeculectomy in medically controlled chronic angle closure glaucoma with cataract","volume":"115","author":"Tham","year":"2008","journal-title":"Ophthalmology"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2008.12.054","article-title":"Phacoemulsification versus combined phacotrabeculectomy in medically uncontrolled chronic angle closure glaucoma with cataracts","volume":"116","author":"Tham","year":"2009","journal-title":"Ophthalmology"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.3109\/08820538.2014.880491","article-title":"Phaco-trabeculectomy in controlled, advanced, open-angle glaucoma and cataract: parallel, randomized clinical study of efficacy and safety","volume":"29","author":"Liaska","year":"2014","journal-title":"Semin Ophthalmol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.4103\/meajo.MEAJO_204_17","article-title":"Comparative clinical study of medically controlled nonsevere chronic primary angle-closure glaucoma with coexisting cataract surgically managed by phacoemulsification as against combined phacotrabeculectomy","volume":"25","author":"Chelerkar","year":"2018","journal-title":"Middle East Afr J Ophthalmol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/s0886-3350(13)80561-5","article-title":"Intraocular pressure response to combined phacoemulsification and trabeculotomy ab externo versus phacoemulsification alone in primary open-angle glaucoma","volume":"21","author":"Gimbel","year":"1995","journal-title":"J Cataract Refract Surg"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1007\/s10792-021-01997-6","article-title":"Phacoemulsification versus phacotrabeculectomy in medically controlled primary angle closure glaucoma with cataract in an Indian cohort: A randomized controlled trial","volume":"42","author":"Senthil","year":"2022","journal-title":"Int Ophthalmol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1007\/s00417-021-05213-0","article-title":"Twelve-month results of ab interno trabeculectomy with Kahook Dual Blade: an interventional, randomized, controlled clinical study","volume":"259","author":"Ventura-Abreu","year":"2021","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.3980\/j.issn.2222-3959.2015.04.18","article-title":"Angle parameter changes of phacoemulsification and combined phacotrabeculectomy for acute primary angle closure","volume":"8","author":"Li","year":"2015","journal-title":"Int J Ophthalmol"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1097\/IJG.0000000000001977","article-title":"Anterior chamber angle changes in primary angle-closure glaucoma following phacoemulsification versus phacotrabeculectomy: A prospective randomized clinical trial","volume":"31","author":"Ghadamzadeh","year":"2022","journal-title":"J Glaucoma"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1111\/aos.15733","article-title":"Phacoemulsification with gonioscopy-assisted transluminal trabeculotomy versus phacoemulsification alone in primary angle closure glaucoma: A randomized controlled study","volume":"102","author":"El Sayed","year":"2023","journal-title":"Acta Ophthalmol"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/j.ogla.2023.10.007","article-title":"Early outcomes of combined phacoemulsification and ab interno Tanito microhook trabeculotomy in open-angle glaucoma","volume":"7","author":"Maheshwari","year":"2024","journal-title":"Ophthalmol Glaucoma"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/s0002-9394(14)72258-5","article-title":"Comparison of a 3- and 6-mm incision in combined phacoemulsification and trabeculectomy","volume":"111","author":"Lyle","year":"1991","journal-title":"Am J Ophthalmol"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/s0002-9394(03)00792-x","article-title":"Optical coherence tomography to detect and manage retinal disease and glaucoma","volume":"137","author":"Jaffe","year":"2004","journal-title":"Am J Ophthalmol"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1097\/ICO.0b013e31812f6913","article-title":"Concept of functional visual acuity and its applications","volume":"26","author":"Kaido","year":"2007","journal-title":"Cornea"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1097\/IJG.0000000000001438","article-title":"Historical considerations and innovations in the perioperative use of mitomycin C for glaucoma filtration surgery and bleb revisions","volume":"29","author":"Grover","year":"2020","journal-title":"J Glaucoma"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD002897.pub2","article-title":"Intra-operative mitomycin C for glaucoma surgery","volume":"2005","author":"Wilkins","year":"2005","journal-title":"Cochrane Database Syst Rev"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1076\/soph.17.3.138.14792","article-title":"Avoiding complications in combined phacotrabeculectomy","volume":"17","author":"Gosiengfiao","year":"2002","journal-title":"Semin Ophthalmol"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2008.08.051","article-title":"Visual field progression in the Collaborative Initial Glaucoma Treatment Study: the impact of treatment and other baseline factors","volume":"116","author":"Musch","year":"2009","journal-title":"Ophthalmology"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1097\/IJG.0b013e31822e8e37","article-title":"Effect of cataract extraction on Visual Field Index in glaucoma","volume":"22","author":"Rao","year":"2013","journal-title":"J Glaucoma"}],"container-title":["Frontiers in Ophthalmology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fopht.2026.1787044\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T04:23:00Z","timestamp":1780892580000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fopht.2026.1787044\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,8]]},"references-count":23,"alternative-id":["10.3389\/fopht.2026.1787044"],"URL":"https:\/\/doi.org\/10.3389\/fopht.2026.1787044","relation":{},"ISSN":["2674-0826"],"issn-type":[{"value":"2674-0826","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,8]]},"article-number":"1787044"}}