OUTCOMES AND COMPARİSON OF COMBİNED PHACOEMULSİFİCATİON AND GATT İN MİLD-TO-MODERATE VS. ADVANCED PSEUDOEXFOLİATİVE GLAUCOMA

Our aim was to evaluate the outcomes of combined phacoemulsification and gonioscopy-assisted transluminal trabeculotomy (phaco-GATT) in eyes with mild-to-moderate-stage (Group 1) and advanced-stage (Group 2) pseudoexfoliative(PEX) glaucoma, and to compare the surgical success rates between these groups.

Tertiary Eye Care Center, Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Türkiye

This retrospective study at Kartal Dr. Lütfi Kırdar City Hospital included 56 eyes of 56 patients with pseudoexfoliative glaucoma and cataract who underwent phaco-GATT with ≥180° trabeculotomy. Glaucoma staging was based on structural and functional assessment. IOP, number of antiglaucomatous medications (AGM), and BCVA (logMAR) were recorded preoperatively and at 1 week, 1, 3, and 6 months postoperatively. Surgical success was defined as ≥20% IOP reduction or IOP ≤18 mmHg, either without medications (complete success, S) or with medications (qualified success, QS).

Group 1 included 26 eyes; Group 2, 30 eyes. Mean age was 70.2 ± 7.9 and 73.0 ± 8.3 years, with 17 and 19 male patients, respectively. Preoperative IOP was 18.96 ± 5.63 mmHg in Group 1 and 23.30 ± 9.10 mmHg in Group 2 (p = 0.06). Postoperative IOP decreased significantly in both groups at all follow-ups (p < 0.001), reaching 11.62 ± 2.11 mmHg and 12.43 ± 3.09 mmHg at 6 months (p = 0.37). Mean AGM decreased from 3.00 ± 1.02 and 3.30 ± 0.79 preoperatively to 0.12 ± 0.32 and 0.17 ± 0.37 at 6 months (p<0.001). BCVA improved significantly in both groups (p < 0.001), with greater improvement in Group 1 (p = 0.001). At 6 months, S was achieved in 88.5% and 80.0%, QS in 11.5% and 13.3%, and failure in 0% and 6.7% of Group 1 and 2, respectively (p = 0.38). No serious complications occurred. No serious complications occurred. Postoperative hyphema was observed in 73.1% and 66.7% of eyes (p=0.60). Among those with hyphema, no intervention was required in 68.4% and 75% of cases, while anterior chamber washout was performed in 31.6% and 25% of cases (p=0.64).IOP change from baseline was strongly correlated with preoperative IOP (rho = 0.920, p < 0.001),and preoperative IOP was negatively correlated with RNFL thickness (rho = -0.289, p = 0.031). No other significant correlations were observed.

Phaco-GATT is a surgical procedure that effectively lowers IOP and significantly reduces the need for AGM in eyes with cataract and pseudoexfoliative glaucoma. Visual improvement is greater in eyes with mild-to-moderate pseudoexfoliative glaucoma compared to those with advanced disease. Overall, the surgery is largely safe, with transient hyphema being the most common self-resolving complication.