- Design
- Prospective, non-randomised comparative study
- Population
- 152 eyes with primary open-angle glaucoma (75 phaco-GATT, 77 phacotrabeculectomy)
- Primary outcome
- IOP, medications and success at 1 year
- Effect
- IOP 17.9→13.0 vs 17.8→12.2 mmHg; success 60% vs 50.7% (P = .23)
This prospective, non-randomised comparative study from India followed 152 eyes with primary open-angle glaucoma: 75 had phacoemulsification with gonioscopy-assisted transluminal trabeculotomy (GATT) and 77 had phacotrabeculectomy.
At one year, pressure fell from about 18 to 13 mmHg after phaco-GATT (25%) and to 12 mmHg after phacotrabeculectomy (28%). Most patients in both groups were off drops (91% and 85%), and success rates were similar by both definitions used (for the stricter: 60% vs 51%, P = .23). The complications differed in kind: hyphaema after GATT (16 micro, 7 macro, 2 washouts) and hypotony after trabeculectomy (4 cases, with one resuture and one chamber reformation).
For patients with moderate pressures and cataract, phaco-GATT is a bleb-free option with comparable one-year results. Baseline pressures were modest, follow-up is short, and groups were not randomised, so this does not show equivalence for advanced disease or low target pressures where trabeculectomy remains the reference.
- Consider phaco-GATT as a bleb-free option for open-angle glaucoma with cataract and moderate target pressures.
- Warn GATT patients that early hyphaema is common and usually clears.
- Keep phacotrabeculectomy for advanced disease or very low target pressures.
- Review gonioscopy carefully before GATT; an open angle is required.
Why it matters
It gives Indian glaucoma surgeons local comparative data on a procedure that avoids bleb-related risks.
Don't overread it
This was non-randomised with one-year follow-up; it does not establish equivalence with trabeculectomy.
The statistics, in plain English
Similar success rates with P values of .23 and .52 mean no difference was detected, not that the procedures are proven equal. Without randomisation, surgeons may have chosen GATT for milder cases.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for ophthalmology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free