Phacoemulsification with gonioscopy‐assisted transluminal trabeculotomy versus phacoemulsification alone in primary angle closure glaucoma: A randomized controlled study

Abstract Purpose To assess the safety and efficacy of combining phacoemulsification with gonioscopy‐assisted transluminal trabeculotomy (GATT) compared to phacoemulsification alone in the management of primary angle closure glaucoma (PACG). Methods Prospective, institutional study in which eyes requiring surgery for PACG were randomized to undergo phacoemulsification followed by GATT ( phaco‐GATT group ) or phacoemulsification alone. Success was defined as having a final IOP of 6–20 mmHg with no subsequent glaucoma surgery or vision‐threatening complications. Results Thirty‐six eyes underwent phaco‐GATT with 360° angle incision and 38 eyes underwent phacoemulsification alone. IOP and glaucoma medications were significantly lower in the phaco‐GATT group at 1, 3, 6, 9 and 12 months. The success rate in the phaco‐GATT group was 94.4% after 12.16 ± 2.03 months, with 75% of eyes being off medications compared to 86.8% after 12.47 ± 4.27 months in the phaco group , with 42.1% off medications. ( p = 0.008). Hyphema and fibrinous anterior chamber reaction were the most common complications in the phaco‐GATT group and resolved with conservative treatment or required YAG capsulotomy. Although this delayed visual rehabilitation in the phaco‐GATT group, it did not affect the final visual outcome with no significant difference in the final best‐corrected visual acuity between both groups ( p = 0.25). Conclusion Combining phacoemulsification with GATT in PACG yielded more favourable outcomes in terms of IOP, glaucoma medications and surgical success. Although the postoperative hyphema and fibrinous reaction may delay visual rehabilitation, GATT further lowers the IOP by breaking residual peripheral anterior synechiae and removing the dysfunctional trabeculum circumferentially, while avoiding the risks inherent in more invasive filtering procedures.