EFFICACY AND SAFETY OF GONIOSCOPY-ASSISTED TRANSLUMINAL TRABECULOTOMY COMBINED WITH PHACOEMULSIFICATION IN GLAUCOMA PATIENTS

To evaluate the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) combined with phacoemulsification in glaucoma patients

Retrospective study

Forty-six eyes of 46 glaucoma patients who underwent 20 phacoemulsification combined with GATT (phaco-GATT) and 26 phacoemulsification alone in a single center were retrospectively analyzed. Clinical examination results, operation notes and complications were recorded preoperatively and postoperatively. Preoperative and postoperative 3rd month anterior segment parameters and axial length (AL) data were recorded by optical biometry measurements. Prediction error (PE) in postoperative refraction was calculated by subtracting the expected refractive value of the implanted intraocular lens from the spherical equivalent (SE) at postoperative month 3. Refractive surprise (RS) was defined as values outside the ±0.5 diopter (D) range of the PE value.

The phaco-GATT group had lower best corrected visual acuity (BCVA) than the phacoemulsification group at postoperative week 1 (p<0.001), while there was no difference in BCVA between the groups after one month. At postoperative month 3, there was a significant decrease in intraocular pressure (IOP) in the phaco-GATT group (p<0.001), while the decrease in the phacoemulsification group was not significant. There were no significant changes in central corneal thickness (CCT) and AL in the phaco-GATT group, whereas there were statistically significant decreases in CCT and AL in the phacoemulsification group (p=0.031 and p<0.001, respectively). The incidence of RS was 8/20 (40%) in the phaco-GATT group and 10/26 (38.4%) in the phacoemulsification group. There was no significant difference in the distribution of RS between the two groups. When potential risk factors for the development of RS were analyzed, the addition of the GATT procedure to phacoemulsification surgery was not a significant variable in the development of RS.

Significant IOP reduction was observed after phaco-GATT and combined surgery is an effective method in patients with early to mid-stage glaucoma with high success rates. After phaco-GATT, the need for antiglaucomatous treatment is completely eliminated in the majority of cases and the number of drug molecules used is reduced in some cases, which shows that this technique is advantageous both in terms of eye health and quality of life and economically. The addition of the GATT procedure to phacoemulsification surgery does not cause a significant difference in the development of RS.