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Phacoemulsification Combined With 360° Gonioscopy-Assisted Transluminal Trabeculotomy: Prospective 12-Month Outcomes
Devendra Maheshwari1, Nimrita Gyanchand Nagdev1, Madhavi Ramanatha Pillai1
1Department of Glaucoma, Aravind Eye Hospital & PG Institute of Ophthalmology, Tirunelveli.
Precis:
This study concludes that combined gonioscopy assisted transluminal trabeculotomy-phacoemulsification have similar efficacy in terms of intraocular pressure and antiglaucoma medication reduction in primary open angle and primary angle closure glaucoma at 12 months follow-up.
Purpose:
To evaluate 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).
Patients And Methods:
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). Additionally, risk factors for surgical failure were analysed.
Results:
The mean (SD) IOP and AGMs decreased from 20.97±4.23 mmHg with 1.66±0.80 AGMs and 21.02±6.13 mmHg with 1.87±0.93 AGMs to 12.60±2.72 mmHg with 0.09±0.36 AGMs, and 13.10±3.39 with 0.11±0.39 AGMs in POAG and PACG group respectively with no significant difference between them (P=0.685, P=0.940). 38.4% and 35.4% IOP reduction 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 POAG and 85.2% in the PACG group with criteria 1, with no significant difference between groups by all three criteria. Higher baseline IOP were found to have a reduced likelihood of failure (P<0.001) in both groups.14 patients (6 POAG, 8PACG) had IOP spikes, 63 (25 POAG,38 PACG) micro-hyphemas and 40 (16POAG, 24PACG) macro-hyphemas.10 (4POAG, 6PACG) patients required anterior chamber wash.
Conclusion:
Combined GATT with phacoemulsification is safe and effective with similar surgical outcomes in primary open-angle and primary angle closure glaucoma.
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