Gonioscopy-assisted transluminal trabeculotomy versus trabeculectomy with phacoemulsification in primary open angle glaucoma – One-year outcomes

PURPOSE: To assess the safety and efficacy of gonioscopy-assisted transluminal trabeculotomy (GATT) with phacoemulsification in primary open-angle glaucoma (POAG). METHODS: In this prospective, nonrandomized, comparative study, patients with POAG underwent either phaco-GATT (Group A, n = 75) or phacotrabeculectomy (Group B, n = 77) and were followed up for one year. Changes in intraocular pressure (IOP), antiglaucoma medications (AGMs), complications, and success rates over one year were compared. Success rate was described under two criteria: 1: IOP between 6 and 21 mmHg and a decrease of >20% from the baseline; 2: IOP between 6 and 18 mmHg and a decrease of >25% from the baseline. RESULTS: Mean IOP decreased by 25.1%, from 17.93 ± 4.29 mmHg to 13.00 ± 3.18 mmHg (P < 0.001) in Group A (n = 70) and by 28% from 17.81 ± 4.52 mmHg to 12.16 ± 3.28 mmHg (P < 0.001) in Group B (n = 74) at one year. AGM reduced from 1.03 ± 0.43 to 0.09 ± 0.29 in Group A (P < 0.001) and from 1.04 ± 0.41 to 0.16 ± 0.37 in Group B (P < 0.001), with no significant difference between the groups (P = 0.24). 91.4% of patients in Group A and 85.1% in Group B were free of medications. The cumulative one-year success was 68% and 63.6% by Criteria 1 (P = 0.52) and 60% and 50.7% by Criteria 2 (P = 0.23) in Groups A and B, respectively, with no significant difference between the groups. Sixteen patients in Group A had microhyphema, seven had macrohyphema, and two patients underwent anterior chamber (AC) wash. Four patients in Group B had hypotony, one required conjunctival resuturing, and one required AC reformation. CONCLUSION: Phaco-GATT demonstrated comparable intraocular pressure reduction, medication independence, and surgical success rates to phacotrabeculectomy at one year, with minimal complications.