Corneal Biomechanics and Aberrometry After Phacoemulsification Combined With Gonioscopy-Assisted Transluminal...

Combined Phaco+GATT surgery significantly alters corneal biomechanics and aberrometry, increasing deformability and affecting postoperative IOP interpretation in patients with POAG or PEXG.

To evaluate the changes in corneal biomechanical properties and corneal aberrometry following combined phacoemulsification and gonioscopy-assisted transluminal trabeculotomy (Phaco+GATT) in patients with primary open angle glaucoma (POAG) or pseudoexfoliative glaucoma (PEXG).

In this prospective comparative study, 28 eyes of 26 patients with visually significant cataracts and either POAG or PEXG underwent combined Phaco+GATT surgery. Corneal biomechanical parameters were assessed using the Corvis ST, and corneal aberrometry was evaluated using the Pentacam AXL, both preoperatively and 3 months postoperatively. Statistical analyses included paired t tests, Wilcoxon signed-rank tests, and linear regression modeling.

Significant postoperative reductions in Goldmann applanation tonometry intraocular pressure (IOP) and biomechanically corrected IOP were observed. Parameters such as A1 time, A2 velocity, SP-A1, and SSI significantly decreased, indicating increased corneal deformability. Conversely, deflection amplitude max, peak distance, and corneal biomechanical index (CBI) significantly increased. Higher-order aberrations (HOAs) from the corneal back also showed significant elevation. Regression analysis revealed that preoperative IOP was the most significant predictor of changes in several biomechanical parameters, while central corneal thickness (CCT) was significantly associated with changes in astigmatism.

assisted transluminal trabeculotomy was associated with measurable changes in corneal biomechanics and aberrometry at 3 months postoperatively. These changes may affect postoperative IOP interpretation, including the potential for IOP underestimation, and should be considered when evaluating visual and pressure outcomes. Longer-term studies are needed to determine the durability and clinical significance of these findings.