Angle-Based Migs Combined With Phacoemulsification: Long-Term Comparative Efficacy And Safety Of Gatt Versus Bang

To compare the long-term intraocular pressure (IOP) reduction and safety profile of combined phacoemulsification with gonioscopy-assisted transluminal trabeculotomy (Phaco-GATT) versus phacoemulsification with bent ab interno needle goniotomy (Phaco-BANG) in patients with visually significant cataract and medically uncontrolled open-angle glaucoma.

Retrospective comparative study conducted at Benghazi Teaching Eye Hospital, Libya, a tertiary referral center for glaucoma and cataract surgery.

This retrospective study included 72 eyes of 86 patients who underwent combined cataract and glaucoma surgery between June 2024 and January 2026. Eyes were assigned to Phaco-GATT (38 eyes) or Phaco-BANG (34 eyes). Standard phacoemulsification was followed by trabeculotomy using a 6-0 prolene suture (GATT) or 90° needle goniotomy (BANG). IOP was measured preoperatively and up to 36 months postoperatively. Surgical success was defined as IOP ≤21 mmHg with ≥20% reduction without additional glaucoma surgery; complete success required no medications.

Baseline IOP was similar between groups (~31 mmHg). At 3 years, IOP decreased to 15.0±4.2 mmHg after Phaco-GATT and 17.8±5.1 mmHg after Phaco-BANG (p=0.038). Complete success was achieved in 79.0% and 60.1% of eyes, respectively, while medication use decreased significantly in both groups, with greater reduction after Phaco-GATT (p=0.044). Transient hyphema was the most common complication. Early surgical failure and reoperation were more frequent after Phaco-BANG, and no sight-threatening complications occurred.

Combined phacoemulsification with GATT provides greater and more sustained long-term IOP reduction compared with Phaco-BANG. The broader trabecular intervention achieved with GATT likely enhances aqueous outflow more effectively, resulting in higher medication-free success and reduced need for further glaucoma surgery. Both procedures demonstrated favorable safety profiles with predominantly mild and self-limited complications. These findings support Phaco-GATT as a preferred angle-based MIGS option when durable pressure reduction is desired in patients undergoing combined cataract and glaucoma surgery.