Phacoemulsification combined with bent ab interno needle goniectomy versus high-frequency deep sclerotomy: a comparative study of surgical outcomes in open-angle glaucoma

BACKGROUND: This study aims to compare intraocular pressure (IOP) reduction, surgical success, antiglaucoma medication (AGM) usage, complication profiles, and structural and functional outcomes between phacoemulsification combined with bent ab interno needle goniectomy (Phaco-BANG) and high-frequency deep sclerotomy (Phaco-HFDS) in patients with open-angle glaucoma (OAG), given the lack of direct head-to-head comparisons. METHODS: This retrospective comparative study included 70 eyes from 70 patients (35 per group). The primary outcome was the change in IOP from baseline to postoperative month 12. Secondary outcomes included surgical success rate, changes in AGM use, complications, and structural and functional parameters, such as retinal nerve fiber layer (RNFL) thickness, central macular thickness (CMT), and visual field mean deviation (MD). Surgical success was defined as a reduction in AGM without an increase in IOP, or an IOP of ≤21 mmHg with a ≥ 20% reduction from baseline. RESULTS: At 12 months, mean IOP decreased by -4.3 ± 5.2 mmHg in the Phaco-BANG group and -4.0 ± 4.3 mmHg in the Phaco-HFDS group. Both groups showed significant IOP reduction at all postoperative time points compared to baseline (p < 0.05), with no statistically significant differences between groups (p > 0.05). Surgical success (IOP ≤ 21 mmHg with ≥20% reduction and/or ≥1 medication reduction without IOP increase) was achieved in 80.0% and 77.1% of eyes in the Phaco-BANG and Phaco-HFDS groups, respectively, with similar Kaplan-Meier survival outcomes (all p > 0.05). AGM use was also significantly reduced in both groups, with no statistically significant differences between groups (p > 0.05). The mean reduction in AGM at 12 months was -2.1 ± 1.3 in the Phaco-BANG group and -1.4 ± 0.9 in the Phaco-HFDS group (p = 0.143). No statistically significant differences were observed between the groups regarding structural and functional outcomes. Early postoperative complications were more frequent in the Phaco-BANG group, primarily due to transient hyphema; however, no vision-threatening complications or need for additional glaucoma surgery occurred. CONCLUSIONS: Both Phaco-BANG and Phaco-HFDS were associated with reductions in IOP and AGM use at 12 months in patients with OAG. No statistically significant differences were observed between the two groups regarding IOP reduction, medication burden, surgical success rates, or structural and functional outcomes. Although transient hyphema was more common following Phaco-BANG, both procedures demonstrated favorable safety profiles.