Visual field outcomes after cataract surgery with or without microinvasive glaucoma surgery in open-angle glaucoma: a systematic review and meta-analysis of RCTs reporting visual field results

Purpose: To compare the benefits of combining microinvasive glaucoma surgery (MIGS) with cataract surgery (CS) for visual field (VF) preservation in patients with primary open-angle glaucoma (POAG) and coexisting cataracts. Methods: A systematic review and meta-analysis were conducted on randomised controlled trials (RCTs) comparing MIGS + CS to CS alone in POAG patients with cataracts that specifically reported visual field outcomes. Studies included were required to report VF outcomes with a follow-up of at least 12 months. Subanalysis focused on studies with 24-month follow-up durations, and consistent device used. Results: Three RCTs encompassing 857 eyes were included, with 523 eyes in the MIGS + CS group and 334 in the CS group. MIGS + CS was associated with a statistically significant reduced rate of VF deterioration in Mean Deviation (MD) at the 24-month follow-up compared to CS alone (SMD 0.29; p = 0.007), and a significant difference between groups in the rate of VF progression (MD 0.23 decibels (dB)/year; p = 0.00001). However, there was no difference in IOP reduction (MD -0.46 mmHg; p = 0.40). The MIGS + CS group showed a significant reduction in medication use (MD -0.36 medications; p < 0.00001). Conclusion: Among the MIGS devices studied (iStent and Hydrus), combining them with cataract surgery provided VF benefits in terms of rate of deterioration and decline, and reduced medication dependence. Standardised follow-up and reporting practices are essential for evaluating MIGS’s role in glaucoma management.