The Impact Of Phaco-Gatt On Corneal Endothelial Integrity

This study aimed to evaluate and compare the impact of phacoemulsification (Phaco) and combined phacoemulsification with gonioscopy-assisted transluminal trabeculotomy (Phaco-GATT) on corneal endothelial morphology. The focus was to assess endothelial cell density (ECD), central corneal thickness (CCT), corneal volume (CV), coefficient of variation (CV) of cell size, and hexagonal cell percentage in patients with similar lens opacity grades and matched baseline characteristics.

A prospective clinical study (April–December 2024) on 100 eyes (73 patients) with similar cataract grades, comparing Phaco-GATT (50 eyes) vs. Phaco (50 eyes). All surgeries were performed by one surgeon using Stellaris® phaco equipment, with endothelial assessments via Topcon SP specular microscope at pre-op, 1 month, and 6 months post-op.

A prospective study was conducted between April 2024 and December 2024 with strict inclusion criteria, including patients with similar cataract grades. A total of 100 eyes from 73 patients were included (50 Phaco-GATT, 50 Phaco). All surgeries were performed by the same surgeon using Stellaris® phacoemulsification equipment and the Topcon SP specular microscope for endothelial assessment. The lens opacity was graded similarly in both groups. Measurements were taken preoperatively and at 1 and 6 months postoperatively to assess CCT, ECD, corneal volume, CV, and hexagonal cell percentage

Preoperative CCT was 547 ± 38 μm for Phaco-GATT and 551 ± 29 μm for Phaco (p=0.9811). At 6 months, there was no significant difference in CCT between groups (Phaco-GATT: 552 ± 32 μm, Phaco: 559 ± 31 μm; p=0.0741). Preoperative ECD was similar between groups (Phaco-GATT: 2408 ± 362 cells/mm²; Phaco: 2421 ± 304 cells/mm²; p=0.8501), with comparable reductions at 6 months (Phaco-GATT: -15.7%; Phaco: -16.5%; p=0.3071). No significant differences were observed in the coefficient of variation (p=0.6211) or hexagonal cell percentage (p=0.6581) at 6 months.

Both Phaco and Phaco-GATT led to comparable endothelial morphological changes, with no significant differences in corneal thickness, volume, or endothelial cell integrity. These findings suggest that adding GATT to phacoemulsification does not significantly impact corneal endothelial health, supporting its safety in combined cataract and glaucoma surgery.