1. A presentation to: Meeting name Date
Combined surgery versus cataract surgery alone for eyes with cataract and glaucoma Mingjuan Lisa Zhang, Phenpan Hirunyachote, Henry Jampel Issue 7, 2015
A presentation to:
Meeting name
Date

2. Table of Contents 01 Background 02 Types of studies 03 Key results 04
Tables (Risk of Bias/Forest Plots) 05
Conclusions 06
Acknowledgements

3. 01: Background Glaucoma and cataract are leading causes of blindness
Glaucoma surgery may accelerate cataract progression
Cataract surgery alone may lower IOP, which leads to IOP control with co-existing glaucoma and cataract
Performing both surgeries at the same time may compromise success and increase risk of complications
The research question is:
Should you undergo combined glaucoma and cataract surgery OR cataract surgery alone?
Zhang et al, DOI: / CD pub3

4. 02: Types of studies Participants
9 randomized controlled trials (RCTs) with 655 participants (657 eyes) who had co-existing glaucoma and cataract
Interventions
Combined glaucoma surgery (any type) and cataract surgery (phacoemulsification)
VERSUS
Cataract surgery (phacoemulsification) alone
Zhang et al, DOI: / CD pub3

5. 03: Key results
“There is low quality evidence that combined cataract and glaucoma surgery may result in better IOP control at one year compared with cataract surgery alone”
Mean difference (MD) mmHg, 95% confidence interval (CI) to -0.64; 489 eyes
“The mean number of medications used postoperatively at one year was about one less in the combined surgery group than the cataract surgery alone group”
MD -0.69, 95% CI to -0.10; 301 eyes
Zhang et al, DOI: / CD pub3

6. 03: Key results (continued)
“Participants in the combined surgery group were about 50% less likely compared with the cataract surgery alone group to use one or more IOP-lowering medications one year postoperatively”
Risk ratio (RR) 0.47, 95% CI 0.28 to 0.80; 453 eyes
“The effect of combined surgery versus cataract surgery alone on the need for reoperation to control IOP at one year was uncertain”
RR 1.13, 95% CI 0.15 to 8.25; 382 eyes
“Also uncertain was whether eyes in the combined surgery group required more interventions for surgical complications than those in the cataract surgery alone group”
RR 1.06, 95% CI 0.34 to 3.35; 382 eyes
Zhang et al, DOI: / CD pub3

7. 03: Key results (continued)
“None of the studies reported the mean change in visual acuity or visual fields”
“No study reported any vision-related quality of life data or cost outcome”
“Due to the small number of events reported across studies and treatment groups, the difference between groups was uncertain for all reported adverse events”
Zhang et al, DOI: / CD pub3

8. 04: Tables
Zhang et al, DOI: / CD pub3

9. 04: Tables
Zhang et al, DOI: / CD pub3

10. 04: Tables
Zhang et al, DOI: / CD pub3

11. 05: Conclusions
“There is low quality evidence that combined cataract and glaucoma surgery may result in better IOP control at one year compared with cataract surgery alone”
“The evidence was uncertain in terms of complications from the surgeries”
“This Cochrane review has highlighted the lack of data regarding important measures of the patient experience, such as visual field tests, quality of life measurements, and economic outcomes after surgery, and long-term outcomes (five years or more)”
Zhang et al, DOI: / CD pub3

12. 06: Acknowledgements
Cochrane Eyes and Vision US Satellite, funded by the National Eye Institute, National Institutes of Health
Cochrane Eyes and Vision Editorial Base, funded by the UK National Health Service Research and Development Programme
Mingjuan Lisa Zhang, Phenpan Hirunyachote, Henry Jampel
Review citation
Zhang M, Hirunyachote P, Jampel H. Combined surgery versus cataract surgery alone for eyes with cataract and glaucoma. Cochrane Database of Systematic Reviews 2015, Issue 7. Art. No.: CD DOI: / CD pub3