Comparison Of Clinical Outcomes Of Gonioscopy-Assisted Transluminal Trabeculotomy Combined With Phacoemulsification In Primary Open-Angle Glaucoma And Pseudoexfoliation Glaucoma: A 48-Month Follow-Up

To report the outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) combined with phacoemulsification in eyes with primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG).

This study was conducted at a single ophthalmology center specializing in glaucoma and cataract surgery. All procedures were performed by experienced glaucoma surgeons, and patient data were retrospectively analyzed over a 48-month follow-up period.

This single-center, retrospective, comparative case series included 41 patients with PXG and 34 patients with POAG who underwent GATT in combination with cataract extraction. The primary outcome was overall surgical success at the end of a 48-month follow-up. Surgical success was defined as an intraocular pressure (IOP) reduction of >30% from baseline, an IOP between 6 and 18 mmHg, and no requirement for additional glaucoma surgery. Secondary outcomes included changes in IOP and antiglaucoma medication use, complications observed during the study.

Age, sex, cup-to-disc ratio, mean deviation, and retinal nerve fiber layer thickness did not differ significantly between groups (p > 0.05 for all). The overall surgical success rate at 48 months was significantly higher in PXG (92.7%) than in POAG (76.5%) (p = 0.04). Postoperative IOP and the number of antiglaucoma medications decreased significantly at all time points (6, 12, 18, 24, 36, and 48 months) in both groups (p < 0.05 for all). The percentage reduction in IOP from baseline was comparable between groups (PXG: 47.18 ± 12.78%, POAG: 41.50 ± 13.75%, p = 0.24) at 48 months. No significant differences were observed in postoperative hyphema (p = 0.34) or IOP spikes (p = 0.62).

GATT combined with phacoemulsification is an effective and safe procedure for patients with PXG and POAG. Our findings indicate that this approach is more effective in PXG than in POAG over long-term follow-up.