GATT-First Surgical Sequence Reduces Complications in Combined Phacoemulsification-GATT Surgery for Glaucoma

This study highlights the importance of surgical sequencing in combined procedures, suggesting that the GATT-first sequence is safer and more reliable, especially for less experienced surgeons.

To evaluate the impact of the surgical sequence in combined phacoemulsification (PHACO) and gonioscopy-assisted transluminal trabeculotomy (GATT) on intraocular pressure (IOP), medication use, glaucoma progression, and complication rates in patients with moderate-to-severe open angle glaucoma and cataract.

This retrospective comparative study included 73 eyes of 73 patients who underwent combined PHACO and GATT surgery. Patients were divided into 2 groups based on the surgical sequence: PHACO performed first (group 1, n=37) or GATT performed initially (group 2, n=36). IOP, anti-glaucoma medication use, retinal nerve fiber layer (RNFL) thickness, and intraoperative and postoperative complications were evaluated over 12 months.

Preoperative IOP decreased from 26.6±7.9 mm Hg-10.9±2.8 mm Hg and from 28±6.3 mm Hg-12.8±2.8 mm Hg in group 1 and group 2 ( P <0.001 in both groups), respectively, at 12 months. The number of anti-glaucoma medications decreased from 2.83±0.5 to 1.22±0.8, and from 2.47±0.7 to 1.17±0.7 in groups 1 and 2, respectively. No significant differences in IOP or medication reduction were observed between the 2 groups. Complication-free outcomes were significantly higher in group 2 (63.8%) compared with group 1 (13.5%) ( P <0.001). Both groups achieved 100% surgical success.

The surgical sequence in combined PHACO-GATT does not affect IOP reduction or the number of medications but significantly impacts complication rates. Performing GATT first minimizes intraoperative complications and increases the rate of complication-free outcomes, making it a safer approach for combined surgeries, especially for beginners.