Low Versus High Intraoperative Intraocular Pressure During Phacoemulsification Cataract Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
5 affiliations
- 1Department of Biochemistry and Molecular Medicine, College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
- 2Ministry of Health, Kuwait City 13001, Kuwait
- 3Kuwait Institute for Medical Specializations, Kuwait City 12050, Kuwait
- 4Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
- 5College of Medicine and Medical Sciences, Arabian Gulf University, Manama 26671, Bahrain
Abstract
Objective: To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing low versus high intraoperative intraocular pressure (IOP) during phacoemulsification. Methods: PubMed, Scopus, Web of Science (WoS), and CENTRAL were searched from inception through 6 July 2026, followed by a supplementary manual search conducted before data extraction on 5 August 2026, to identify any additional eligible studies. RCTs comparing low-IOP versus high-IOP strategies during phacoemulsification were included. Outcomes were categorized as intraoperative, postoperative, and safety outcomes. Data were pooled as mean differences (MDs) or risk ratios (RRs) with corresponding 95% confidence intervals (CIs) using random-effects models. Results: Twelve RCTs comprising 1051 eyes were included. Cumulative dissipated energy was comparable between low- and high-IOP strategies (MD −0.12, 95% CI −0.45 to 0.20; p = 0.42). No significant between-group differences were observed in endothelial cell density, best-corrected visual acuity, central corneal thickness, or postoperative IOP across the reported follow-up periods (all p > 0.05). Intraoperative pain, aspiration time, total case time, fluid usage, and safety outcomes were also comparable between groups. Low-IOP phacoemulsification was associated with a modest increase in total ultrasound time (MD 1.53 s, 95% CI 0.03 to 3.03; p = 0.047). Conclusions: Low-IOP phacoemulsification provides intraoperative, postoperative, and safety outcomes broadly comparable to high-IOP strategies. Despite a statistically significant but clinically negligible increase in ultrasound time of approximately 1.5 s in favor of low-IOP, no significant differences were observed in cumulative dissipated energy, endothelial cell density, best-corrected visual acuity, central corneal thickness, postoperative IOP, or safety outcomes. However, these findings should not be interpreted as definitive evidence of equivalence or non-inferiority between the two strategies.
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BibTeX
@article{abuzaid2026versus,
title = {{Low Versus High Intraoperative Intraocular Pressure During Phacoemulsification Cataract Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials}},
author = {Ahmed Abu-Zaid and Omar A. Alnajar and Rashed A. Alasoosi and Fawaz Almutairi and Abdullah M. Alazemi and Latifah Alyaqout and Mariam Mohammad Alkandari and Farah R. Alqussair and Abdulaziz S. Alasfar and Omar Almutairi and Maryam S. AlAmrani and Abdullah J. Alrashed and Abdullah M. Alharran},
journal = {Journal of Clinical Medicine},
year = {2026},
month = nov,
doi = {10.3390/jcm15218557},
url = {https://www.mdpi.com/2077-0383/15/21/8557},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Low Versus High Intraoperative Intraocular Pressure During Phacoemulsification Cataract Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
AU - Ahmed Abu-Zaid
AU - Omar A. Alnajar
AU - Rashed A. Alasoosi
AU - Fawaz Almutairi
AU - Abdullah M. Alazemi
AU - Latifah Alyaqout
AU - Mariam Mohammad Alkandari
AU - Farah R. Alqussair
AU - Abdulaziz S. Alasfar
AU - Omar Almutairi
AU - Maryam S. AlAmrani
AU - Abdullah J. Alrashed
AU - Abdullah M. Alharran
PY - 2026
DA - 2026/11/03
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218557
UR - https://www.mdpi.com/2077-0383/15/21/8557
AB - Objective: To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing low versus high intraoperative intraocular pressure (IOP) during phacoemulsification. Methods: PubMed, Scopus, Web of Science (WoS), and CENTRAL were searched from inception through 6 July 2026, followed by a supplementary manual search conducted before data extraction on 5 August 2026, to identify any additional eligible studies. RCTs comparing low-IOP versus high-IOP strategies during phacoemulsification were included. Outcomes were categorized as intraoperative, postoperative, and safety outcomes. Data were pooled as mean differences (MDs) or risk ratios (RRs) with corresponding 95% confidence intervals (CIs) using random-effects models. Results: Twelve RCTs comprising 1051 eyes were included. Cumulative dissipated energy was comparable between low- and high-IOP strategies (MD −0.12, 95% CI −0.45 to 0.20; p = 0.42). No significant between-group differences were observed in endothelial cell density, best-corrected visual acuity, central corneal thickness, or postoperative IOP across the reported follow-up periods (all p > 0.05). Intraoperative pain, aspiration time, total case time, fluid usage, and safety outcomes were also comparable between groups. Low-IOP phacoemulsification was associated with a modest increase in total ultrasound time (MD 1.53 s, 95% CI 0.03 to 3.03; p = 0.047). Conclusions: Low-IOP phacoemulsification provides intraoperative, postoperative, and safety outcomes broadly comparable to high-IOP strategies. Despite a statistically significant but clinically negligible increase in ultrasound time of approximately 1.5 s in favor of low-IOP, no significant differences were observed in cumulative dissipated energy, endothelial cell density, best-corrected visual acuity, central corneal thickness, postoperative IOP, or safety outcomes. However, these findings should not be interpreted as definitive evidence of equivalence or non-inferiority between the two strategies.
SN - 2077-0383
ER -