Combined phacoemulsification and angle filtering reduce intraocular pressure and medication needs in glaucoma patients

BackgroundTo evaluate the clinical outcomes of combined phacoemulsification and angle filtering procedures versus phacoemulsification alone in patients with primary glaucoma coexisting with cataracts.MethodsRandomized 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.ResultsFourteen 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, I2 = 49%, p = 0.03]. Combined phacoemulsification and angle filtering procedures were significantly more effective in reducing IOP (MD = −1.98, CI: −2.71 to −1.25, I2 = 90%, p < 0.0001) and need of AGMs (MD = −0.69, CI: −0.87 to −0.52, I2 = 73%, p < 0.0001) but associated with a significantly higher rate of complications [risk ratio (RR) = 2.66, CI: 1.82 to 3.89, I2 = 13%, p < 0.00001].ConclusionsCombined 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.Systematic review registrationhttps://inplasy.com/inplasy-2026-5-0081/, identifier INPLASY202650081.