Narendra L. Yudhisthira, Titiek Ernawati, Evelyn Komaratih, Nurwasis Nurwasis, Alivia R. Kusumowardani
Background Phacoemulsification combined with trabeculectomy (Phaco-Trab) is a standard procedure for the management of primary angle-closure glaucoma (PACG), but it carries complication risks. Phacoemulsification combined with goniosynechiolysis (Phaco-GSL) offers a potential alternative. Comparing their safety and efficacy is essential to determine the optimal intervention. Materials and methods A comprehensive literature search was conducted through PubMed, Scopus, and Google Scholar databases for the studies published between January 2000 and November 2024. Eligible studies were cohort studies or randomized controlled trials comparing Phaco-GSL with Phaco-Trab in adult PACG patients. The primary outcome measure was the intraocular pressure (IOP) reduction, while the secondary outcome measures included best-corrected visual acuity (BCVA), anterior chamber depth (ACD), and postoperative complications. The data were pooled and analyzed using random-effects models. Results Five studies with a total of 381 patients were included. The meta-analysis demonstrated no statistically significant differences between Phaco-GSL and Phaco-Trab regarding the IOP reduction at 1 month (mean difference −0.21, 95% CI: −0.84 to 0.41, P=0.067) and at 6 months (mean difference −0.61, 95% CI: −1.24 to 0.03, P=0.087), improvement in BCVA (mean difference 0.00, 95% CI: −0.10 to 0.10, P=0.99), and increase in the ACD (mean difference 0.02, 95% CI: −0.07 to 0.10, P=0.69). However, Phaco-GSL significantly reduced the postoperative complications compared to the Phaco-Trab procedure (odds ratio 0.33, 95% CI: 0.20 to 0.55, P<0.0001). Conclusion Phaco-GSL and Phaco-Trab showed comparable efficacy for reducing the IOP, enhancing the BCVA, and increasing the ACD in PACG patients. Nevertheless, Phaco-GSL had a significantly better safety profile, highlighting its potential as a preferred surgical option. Further randomized controlled trials with larger sample size and longer follow-up periods are necessary to confirm these findings. © 2026 Delta Journal of Ophthalmology.
Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; Department of Ophthalmology, Faculty of Medicine, Universitas Katolik Widya Mandala Surabaya, Surabaya, Indonesia; Department of Ophthalmology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; Department of Ophthalmology, Dr. Soetomo General Hospital, Surabaya, Indonesia