Does standalone phacoemulsification lower intraocular pressure in glaucomatous eyes? A systematic review and meta-analysis

We evaluated the effect of phacoemulsification on intraocular pressure (IOP) and the reduction of glaucoma medications in patients with glaucoma. Our protocol was registered in PROSPERO (CRD42024533437). We conducted a systematic search in PubMed, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science for randomized clinical trials (RCTs) with at least 10 eyes and a 12-month minimum follow-up. Risk of bias assessment was performed using the Cochrane risk-of-bias tool. A random-effects model meta-analysis was used, and heterogeneity was assessed using Cochran’s Q and I² statistics. We included 41 RCTs with a total of 2315 eyes in the phacoemulsification-alone group. In ACG patients, the pooled effect showed a percentage of IOP reduction (IOPR%) of 35.22% with a mean IOP reduction of −9.51 mmHg, p < 0.001 at 12 months, and an IOPR% of 27.47% with a mean reduction of −6.37 mmHg, p < 0.001 at 24 months. For OAG patients, the pooled effect showed an IOPR% of 18.94% with a significant absolute change of −4.35 mmHg, p < 0.001 at 12 months, and IOPR% of 16.95% with an absolute IOP change of −3.83 mmHg, p < 0.001 at 24 months. In ACG patients, medication use decreased by 67.13% at 12 months and 51.58% at 24 months (p < 0.001 for both), while in OAG patients, the reduction was 45.52% at 12 months and 50.19% at 24 months (p < 0.001). In conclusion, standalone phacoemulsification significantly lowers IOP and reduces the need for glaucoma medications in patients with glaucoma.