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GATT-First Surgical Sequence Reduces Complications in Combined Phacoemulsification-GATT Surgery for Glaucoma
Erdem Yüksel1, Zübeyir Yozgat2, Berire Şeyma Durmuş Ece2
1Department of Ophthalmology, Gazi University, School of Medicine, Ankara.
Journal of Glaucoma
|July 1, 2026
Summary
Performing gonioscopy-assisted transluminal trabeculotomy (GATT) before phacoemulsification (PHACO) in combined surgeries significantly reduces complications. This GATT-first approach offers a safer and more reliable option, particularly for surgeons new to combined procedures.
Area of Science:
- Ophthalmology
- Surgical Innovation
- Glaucoma Management
Background:
- Combined phacoemulsification (PHACO) and gonioscopy-assisted transluminal trabeculotomy (GATT) are used for patients with moderate-to-severe open-angle glaucoma and cataracts.
- The optimal surgical sequence for combined PHACO-GATT procedures remains under investigation.
Purpose of the Study:
- To evaluate the impact of surgical sequence in combined PHACO-GATT on intraocular pressure (IOP), medication use, glaucoma progression, and complication rates.
- To compare outcomes between performing PHACO first versus GATT first.
Main Methods:
- A retrospective comparative study of 73 patients undergoing combined PHACO-GATT.
- Patients were divided into two groups: PHACO-first (n=37) and GATT-first (n=36).
- Evaluated IOP, medication use, RNFL thickness, and complications over 12 months.
Main Results:
- Both sequences effectively reduced IOP and medication use significantly (P<0.001).
- No significant differences in IOP or medication reduction were observed between groups.
- The GATT-first group showed a significantly higher rate of complication-free outcomes (63.8%) compared to the PHACO-first group (13.5%) (P<0.001).
Conclusions:
- Surgical sequence in combined PHACO-GATT does not influence IOP or medication reduction.
- Performing GATT first significantly reduces intraoperative complications and improves complication-free outcomes.
- The GATT-first approach is recommended as a safer strategy for combined surgeries, especially for less experienced surgeons.
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