Phacoemulsification Combined With 360 Degrees Gonioscopy-Assisted Transluminal Trabeculotomy: Prospective 12-Month...

This study concludes that combined gonioscopy-assisted transluminal trabeculotomy-phacoemulsification has similar efficacy in terms of intraocular pressure and antiglaucoma medication reduction in primary open angle and primary angle closure glaucoma at 12-month follow-up.

To evaluate the safety and efficacy of combined phacoemulsification with gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with primary open angle glaucoma (POAG) and primary angle closure glaucoma (PACG).

A prospective, interventional study included 180 eyes (90 POAG, 90 PACG) of 180 patients with uncontrolled glaucoma. All patients underwent 360-degree GATT combined with phacoemulsification. Outcome measures included changes in intraocular pressure (IOP), antiglaucoma medication (AGM), and best-corrected visual acuity (BCVA). Success was defined as at least 20%/25%/30% IOP reduction from baseline and IOP ≤21/18/15 mm Hg (criteria 1, 2, and 3). In addition, risk factors for surgical failure were analyzed.

The mean (SD) IOP and AGMs decreased from 20.97±4.23 mm Hg with 1.66±0.80 AGMs and 21.02±6.13 mm Hg with 1.87±0.93 AGMs to 12.60±2.72 mm Hg with 0.09±0.36 AGMs, and 13.10±3.39 with 0.11±0.39 AGMs in the POAG and PACG groups, respectively, with no significant difference between them ( P =0.685, 0.940). A total of 38.4% and 35.4% IOP reductions were found at the end of 12 months in POAG (93.3% meds-free) and PACG (91.8% meds-free), respectively. Success rate was 91.1% in the POAG and 85.2% in the PACG group with criteria 1, with no significant difference between groups by all 3 criteria. Higher baseline IOP was found to have a reduced likelihood of failure ( P <0.001) in both groups. A total of 14 patients (6 POAG, 8 PACG) had IOP spikes, 63 (25 POAG, 38 PACG) microhyphemas, and 40 (16 POAG, 24 PACG) macrohyphemas. Ten (4 POAG, 6 PACG) patients required an anterior chamber wash.

Combined GATT with phacoemulsification is safe and effective with similar surgical outcomes in primary open angle and primary angle closure glaucoma.