Phacoemulsification with gonioscopy-assisted transluminal trabeculotomy versus phacoemulsification alone in primary...

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Surgical Innovation

Background:

• Primary angle closure glaucoma (PACG) poses a significant risk to vision due to elevated intraocular pressure (IOP).
• Current management often involves medication or invasive procedures, with varying efficacy and risk profiles.
• Phacoemulsification is a common cataract surgery, but its effect on PACG IOP is limited.

Purpose of the Study:

• To evaluate the safety and effectiveness of combining phacoemulsification with gonioscopy-assisted transluminal trabeculotomy (GATT).
• To compare the outcomes of phaco-GATT versus phacoemulsification alone in managing PACG.
• To assess key metrics including IOP, medication use, and surgical success rates.

Main Methods:

• A prospective, randomized institutional study was conducted.
• Patients with PACG requiring surgery were assigned to either phaco-GATT or phacoemulsification alone.
• Surgical success was defined by a target IOP range (6-20 mmHg) and absence of further glaucoma surgery or vision-threatening complications.

Main Results:

• The phaco-GATT group (36 eyes) demonstrated significantly lower IOP and reduced glaucoma medication requirements at all follow-up points (1-12 months) compared to the phacoemulsification-alone group (38 eyes).
• The phaco-GATT group achieved a 94.4% success rate, with 75% of patients off medication, versus 86.8% success and 42.1% off medication in the phacoemulsification group.
• Postoperative hyphema and anterior chamber reaction were more common in the phaco-GATT group, potentially delaying visual recovery but not impacting final visual acuity.

Conclusions:

• Phacoemulsification combined with GATT provides superior outcomes for PACG management, including lower IOP, reduced medication dependency, and enhanced surgical success.
• GATT effectively lowers IOP by addressing peripheral anterior synechiae and dysfunctional trabecular meshwork.
• While transient complications like hyphema may occur, the phaco-GATT procedure offers a safer alternative to more invasive glaucoma surgeries.