The Efficacy and Safety of Canaloplasty Vs Trabeculectomy Either Standalone or Combined with Cataract Surgery: An Updated Meta-Analysis

Abstract To compare the efficacy and safety between trabeculectomy (TE) and canaloplasty (CP) either as standalone or combined with phacoemulsification (PTE and PCP). Nine databases were searched for studies reporting efficacy and safety of TE/PTE and CP/PCP. Efficacy endpoints included postoperative intraocular pressure (IOP), complete, and qualified success, while safety endpoints included failure, revision surgery, and complications. STATA was used to pool the crude mean difference (MD) or log odds ratio (logOR) for continuous and categorical outcomes, respectively. Fourteen studies were included. TE/PTE was associated with lower IOP when compared to CP/PCP [MD=-2.55; 95%CI=-3.30: -1.80, I2 = 61.43%]. Similarly, TE/PTE was associated with significantly higher odds of complete [logOR = 1.20; 95%CI = 0.79:1.61, I2 = 7.41] and qualified success [logOR = 0.64; 95%CI = 0.16:1.13, I2 = 0%] when compared to CP/PCP, respectively. Although no significant differences in failure and revision surgery were noted between TE/PTE and CP/PCP, in the TE subgroup, a significant reduction in failure was observed as compared to CP [logOR=-0.82; 95%CI=-1.61: -0.04, I2 = 28.18%]. TE/PTE was associated with higher odds for hypotony and choroidal detachment and lower odds for Descemet’s membrane detachment and hyphema. TE/PTE has superiority over CP/PCP regarding IOP control and revision surgery rates. However, the certainty of these findings is low to very low.