GATT-First Surgical Sequence Reduces Complications in Combined Phacoemulsification–GATT Surgery for Glaucoma
Journal of Glaucoma, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Basım Tarihi: 2026
- Doi Numarası: 10.1097/ijg.0000000000002743
- Dergi Adı: Journal of Glaucoma
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, EMBASE, MEDLINE
- Anahtar Kelimeler: anti-glaucoma medication, combined surgery, gonioscopy-assisted transluminal trabeculotomy, intraocular pressure, open-angle glaucoma, phacoemulsification, surgical complications
- Gazi Üniversitesi Adresli: Evet
Özet
Précis: – This study highlights the importance of surgical sequencing in combined procedures, suggesting that the GATT-first sequence is safer and more reliable, especially for less experienced surgeons. Purpose: – To evaluate the impact of the surgical sequence in combined phacoemulsification (PHACO) and gonioscopy-assisted transluminal trabeculotomy (GATT) on intraocular pressure (IOP), medication use, glaucoma progression, and complication rates in patients with moderate-to-severe open-angle glaucoma and cataract. Methods: – This retrospective comparative study included 73 eyes of 73 patients who underwent combined PHACO and GATT surgery. Patients were divided into two groups based on the surgical sequence: PHACO performed first (Group 1, n=37) or GATT performed initially (Group 2, n=36). IOP, anti-glaucoma medications use, retinal nerve fiber layer (RNFL) thickness, and intraoperative and postoperative complications were evaluated over 12 months. Results: – Preoperative IOP decreased from 26.6±7.9 mmHg to 10.9±2.8 mmHg and from 28±6.3 mmHg to 12.8±2.8 mmHg in Group 1 and Group 2 (P<0.001 in both groups), respectively, at 12 months. The number of anti-glaucoma medications reduced from 2.83± 0.5 to 1.22± 0.8, and from 2.47± 0.7 to 1.17± 0.7 in Group 1 and Group 2, respectively. No significant differences in IOP or medication reduction were observed between the two groups. Complication-free outcomes were significantly higher in Group 2 (63.8%) compared to Group 1 (13.5%) (P<0.001). Both groups achieved 100% surgical success. Conclusions: – The surgical sequence in combined PHACO-GATT does not affect IOP reduction or medication number but significantly impacts complication rates. Performing GATT first minimizes intraoperative complications and results in a higher rate of complication-free outcomes, suggesting it as a safer approach for combined surgeries, especially for beginners.