Does Lens Status Matter In Gatt? Phakic Vs Pseudophakic Outcomes

The present study aims to evaluate the impact of lens status on clinical outcomes following 360-degree Gonioscopy-Assisted Transluminal Trabeculotomy (GATT) by comparing phakic and pseudophakic eyes.The primary objective is to evaluate the influence of lens status on intraocular pressure (IOP) reduction and the number of glaucoma medications through 6 and 12 months of follow-up. 

Tertiary-care university hospital glaucoma service in Turkey (retrospective, single-center, single-surgeon cohort; surgeries, 2022-2025)

This retrospective comparative cohort study included 91 eyes (62 phakic, 29 pseudophakic) undergoing standalone 360° gonioscopy-assisted transluminal trabeculotomy (GATT)at a tertiary center, all performed by a single surgeon. Prior surgeries (except uncomplicated cataract surgery in pseudophakics) were excluded.Collected variables included demographics,glaucoma subtype,visual acuity,CCT,RNFL thickness,visual field MD, preoperative IOP and medication count,postoperative IOP and medication count at 0,1,6 and 12 months,and need for additional glaucoma surgery. STATA version 18 was used for t-test comparisons and age-adjusted ANCOVA compared 6- and 12-month outcomes by lens status.

In 91 eyes undergoing 360°GATT, pseudophakic eyes were older than phakic eyes (70.31±1.11 vs 53.19±17.07) and had lower baseline decimal VA (0.50±0.30 vs 0.64±0.32; p=0.06). Baseline CCT/RNFL/VF-MD and preoperative IOP were comparable (p>0.05) and additional surgery need were similar (11.3% vs 10.3%). IOP decreased in both groups with no between-group difference at 6 or 12 months (p=0.34 and p=0.75) ANCOVA confirmed no age-adjusted difference at 6 months (F(1,82)=0.92, p=0.34; Δ=0.85 mmHg). Baseline medication counts were comparable (p=0.45) but phakic eyes required fewer drops at 6 and 12 months (p=0.03 and p=0.001) ANCOVA showed a significant lens-status effect on medication burden independent of age (F(1,47)=11.21, p=0.0016; age p=0.77).

Following 360° GATT in 91 eyes,pseudophakic patients were older and had slightly lower baseline VA,while baseline CCT,RNFL,VF-MD,preoperative IOP were comparable,indicating similar disease severity.Both groups achieved similar IOP reduction at 6 and 12 months and had comparable rates of additional glaucoma surgery.Pseudophakic eyes required more glaucoma medications at both 6 and 12 months. Crucially, age-adjusted ANCOVA confirmed no independent effect of lens status on IOP at 6 or 12 months,but remained an independent predictor of medication burden. Despite similar baseline medication use,phakic eyes required significantly fewer drops during follow-up after adjusting for age,suggesting lens status affects postoperative drop dependence.