Change in Corneal Endothelial Cells after Gonioscopy-Assisted Transluminal Trabeculotomy

PURPOSE: To examine the change in corneal endothelial cell density (ECD) after gonioscopy-assisted transluminal trabeculotomy (GATT) surgery alone or in combination with phacoemulsification (phaco).

METHODS: In this prospective monocentric comparative study, consecutive patients were enrolled with open angle glaucoma (OAG) and who had been treated with GATT or phaco + GATT, with complete endothelial cell data and at least 6 months of follow-up. Patients who underwent phaco surgery alone during the same period were recorded as the control group. The main outcomes were ECD changes.

RESULTS: The study included 64 OAG (40 eyes in the GATT and 24 eyes in the GATT + phaco groups) and 30 control eyes (phaco group). There was a significant decrease in mean ECD compared to baseline in the GATT, phaco + GATT, and phaco groups (p < 0.001 for all). At the end of follow-up, percent cumulative ECD reduction values were 6.89%, 14.47% and 10.32% in the GATT, phaco + GATT, and phaco groups, respectively (p = 0.01 for all groups). The ECD reduction in the phaco + GATT group (p = 0.02) and in the phaco group (p = 0.04) was significantly higher than in the GATT group. ECD reduction was similar in the phaco + GATT and phaco groups (p = 0.69).

CONCLUSIONS: A significant ECD loss was observed in 6 months period after GATT surgery compared to the baseline. The ECD reduction observed after GATT combined with phacoemulsification was greater than with GATT alone. There was no significant difference between phaco-GATT combined surgery and phaco alone.