- Design
- Prospective, non-randomised comparative study
- Population
- 152 patients with primary open-angle glaucoma and cataract in India
- Primary outcome
- Pressure reduction, medication use and success at one year
- Effect
- Success 68% vs 63.6% (criterion 1, p=0.52); 60% vs 50.7% (criterion 2, p=0.23)
This prospective, non-randomised study from India compared phacoemulsification combined with gonioscopy-assisted transluminal trabeculotomy (phaco-GATT, 75 patients) against phacotrabeculectomy (77 patients) in primary open-angle glaucoma, followed for one year.
Pressure fell by 25% after phaco-GATT (17.9 to 13.0 mmHg) and 28% after phacotrabeculectomy (17.8 to 12.2 mmHg). Drop use fell to near zero in both, with 91% and 85% medication-free. Cumulative success was 68% versus 64% by a 21 mmHg criterion and 60% versus 51% by an 18 mmHg criterion, neither significantly different. Hyphaema was common after GATT (16 micro and 7 macro, two needing washout); hypotony occurred in four after phacotrabeculectomy.
GATT avoids a bleb and its lifelong risks, which matters for patients who may not return for follow-up. But groups were not randomised, baseline pressures were modest, and one year is short for comparing glaucoma operations. For patients with mild to moderate disease who do not need a very low target pressure, phaco-GATT is a reasonable option to discuss.
- Consider phaco-GATT as a bleb-free option for open-angle glaucoma with cataract when a very low target pressure is not needed.
- Warn patients that hyphaema is common early after GATT and usually clears.
- Prefer trabeculectomy where target pressures in the low teens are essential for advanced disease.
- Plan longer follow-up, since one-year outcomes may not predict durability.
Why it matters
A bleb-free operation with similar one-year results could suit patients for whom lifelong bleb care is impractical.
Don't overread it
A non-randomised one-year comparison does not show the two operations are equivalent in the long term.
The statistics, in plain English
The success rates differ by a few percentage points with p-values of 0.23 and 0.52, so the study found no meaningful difference. Without randomisation, surgeons may have chosen GATT for different patients, and a study of this size could miss a real difference of about 10 percentage points.
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