Comparison of surgical outcomes of suture gonioscopy-assisted transluminal trabeculotomy versus excisional goniotomy with Kahook dual blade at 12 months

PURPOSE: To compare safety and efficacy of gonioscopy-assisted transluminal trabeculotomy (GATT) versus Kahook dual blade (KDB) with phacoemulsification in eyes with primary open angle glaucoma. METHODS: This retrospective comparative study included 122 eyes-61 in GATT-Phaco group (Group 1) and 61 in KDB-Phaco group (Group 2). Baseline parameters including intraocular pressure (IOP), best-corrected visual acuity, and number of anti-glaucoma medications (AGMs) were compared across visits at 2 weeks and 1, 3, 6, and 12 months. Surgical success was defined as IOP ≤21/≤18/≤15 mmHg with >20%/25%/30% reduction from baseline (Criteria 1,2,3). Postoperative complications, secondary interventions, and surgical risk factors were analyzed. RESULTS: The mean (SD) IOP (mmHg) decreased from 21.15 ± 3.76 to 13.20 ± 3.21 in Group 1 and 22.90 ± 4.05 to 14.44 ± 5.01 in group 2 at 12 months, with no significant difference between groups (P = 0.100). AGM reduced from 1.64 ± 0.84 to 0.08 ± 0.28 and 1.67 ± 0.77 to 0.08 ± 0.38 in groups 1 and 2, respectively, at 12 months (P > 0.99). By criteria 1, 2, and 3, the overall success was 85.3%, 78.7%, and 60.7% in Group 1 and 86.9%, 83.6%, and 70.5% in Group 2, respectively. Micro hyphemas were observed in 28 patients (20 in group 1, 8 in group 2), macro hyphemas in 4 patients of group 1 (2 requiring AC wash) and transient IOP spikes in 6 patients (4 in group 1, 2 in group 2). CONCLUSION: Both GATT and KDB achieved significant reductions in intraocular pressure and anti-glaucoma medication use at 12 months, with KDB demonstrating equivalent efficacy to 360° suture trabeculotomy.