THE SUCCESS OF COMBINED PHACOEMULSIFICATION AND GONIOSCOPY-ASSISTED TRANSLUMINAL TRABECULOTOMY SURGERY AND ITS PROGNOSTIC FACTORS IN EYES WITH PSEUDOEXFOLIATIVE GLAUCOMA

Evaluation of the success of combined phacoemulsification and Gonioscopy-Assisted Transluminal Trabeculotomy (phaco-GATT) surgery and its prognostic factors in eyes with pseudoexfoliation glaucoma (PEXG).

A retrospective study conducted at a tertiary referral center

Nineteen patients with PEXG who underwent combined phacoemulsification and at least 180° GATT surgery at our hospital were included, with a minimum follow-up of 3 months. Patients had no prior glaucoma surgery or laser treatment and showed visible pseudoexfoliation material on examination. Surgical success was defined as postoperative IOP below 21 mmHg with or without medication. Kaplan-Meier survival analysis was used to compare surgical success rates.

The average patient age was 68 ± 8 years (range 55-85), with a mean follow-up of 4 months (range 3-15). Preoperative best-corrected visual acuity was 0.5 (0-2.7) LogMAR, and pre-op IOP was 22 (13-35) mmHg. Of the 19 patients, 14 underwent 360° GATT, while the remaining 5 had 180-270° GATT. Postoperative IOP was significantly reduced at 1 week [14 (7-23) mmHg], 1 month [13 (7-27) mmHg], 3 months [13 (10-19) mmHg], and at the last follow-up [13 (8-19) mmHg] compared to pre-op IOP (P<0.001). The average number of anti-glaucoma medications (AGM) also decreased postoperatively [3.2 ± 1.0 vs. 0.7 ± 1.1; P < 0.001]. Hyphema developed in 8 patients, with 1 requiring anterior chamber lavage. Hyphema cases had greater postoperative IOP reduction and AGM decrease (P=0.001 and P=0.026). Success without medication was 36.8%, and with medication, 63.2%. Significant correlations were observed between pre-op and post-op IOP changes (P<0.001, rho=0.8), hyphema and IOP change (P=0.001, rho=0.7), and hyphema and AGM reduction (P=0.02, rho=0.5). No correlation was found between glaucoma stage and surgical success (P>0.05).

Phaco-GATT surgery is a successful method in patients with PEXG. In eyes developing hyphema after Phaco-GATT surgery, the reduction in IOP may be more pronounced, and the need for antiglaucoma medications potentially reduced. Studies with larger patient populations and extended follow-up periods will provide further clarity on this topic.