GATT-Phaco Combo Reduces IOP By Over One-Third, Study Finds

GATT is emerging as a minimally invasive glaucoma surgery, showing promising outcomes with minimal vision-threatening complications in various types of glaucoma. Photo: Richter G, Coleman AL. Clin Ophthalmol. Jan. 28, 2016. Click image to enlarge. Gonioscopy-assisted transluminal trabeculotomy (GATT) provides a minimally invasive, effective alternative to traditional glaucoma surgeries, with stable visual outcomes and a manageable reoperation rate, supporting its role in advanced glaucoma management. There is little literature about the outcomes of GATT in primary angle-closure glaucoma (PACG), so researchers based in India prospectively evaluated surgical outcomes of GATT combined with phacoemulsification in primary open-angle glaucoma (POAG) and PACG. The team determined that the combination was safe and effective with similar surgical outcomes in terms of intraocular pressure (IOP) and glaucoma medication reduction at 12-month follow-up. The IOP reduction percentage was 38.4%, with 93.3% of patients remaining medication-free in the POAG group; in PACG, it was 35.4% and 91.8%, respectively.This prospective, interventional study, which was published in Journal of Glaucoma, included 180 eyes (90 POAG, 90 PACG) of 180 patients with uncontrolled glaucoma. All patients underwent 360º GATT combined with phacoemulsification. Three criteria for success were established:  IOP Reduction (%)IOP Post-surgeryCriteria 120%21mm HgCriteria 225%18mm HgCriteria 330%15mm Hg “The patients in our study had relatively advanced glaucoma in the POAG group and moderate to advanced glaucoma in the PACG group, based on Humphrey visual field mean deviation, yet were using a lower mean number of antiglaucoma medications,” the study authors wrote in their paper. “This likely reflects the presentation pattern in our population, where many patients present unmedicated with advanced glaucoma, as is commonly observed in India. Although these patients often show an initial response to medical therapy, they typically proceed to surgical intervention relatively early.”The mean IOP and glaucoma medications decreased from 20.97mm Hg with 1.66 medications and 21.02mm Hg with 1.87 meds to 12.60mm Hg with 0.09 meds and 13.10mm Hg with 0.11 meds in the POAG and PACG groups, respectively, with no significant difference between them.There was a 38.4% and 35.4% IOP reduction found at the end of 12 months in the POAG (93.3% meds-free) and the PACG (91.8% meds-free) groups, respectively. Success rate was 91.1% in POAG and 85.2% in the PACG group with criteria 1, with no significant difference between groups by all three criteria.Higher baseline IOP was found to have a reduced likelihood of failure in both groups. The researchers found that 14 patients (six POAG, eight PACG) had IOP spikes, 63 (25 POAG, 38 PACG) micro-hyphemas and 40 (16 POAG, 24 PACG) macro-hyphemas. Also, 10 patients (four POAG, six PACG) required anterior chamber wash.The PACG group experienced a higher rate of postoperative bleeding-related events, which were self-limiting. Microhyphemas or transient hyphemas were commonly seen postoperatively in both open-angle and angle-closure following GATT, which usually resolved within two weeks. Patients with IOP spikes were given steroid-sparing agents, along with glaucoma medications, and on the next subsequent visit, IOP was normalized.The limitations of the study included a shorter duration of follow-up, as well as not documenting peripheral anterior synechiae during follow-up and the lack of a phaco-control group limits the ability to isolate the effect of GATT in the PACG group. In addition, postoperative visual field assessment was not performed, and the study included only Indian eyes; this may limit the generalizability of the results to other populations.Click here for the journal source. Maheshwari D, Nagdev NG, Pillai MR, et al. Phacoemulsification combined with 360° gonioscopy-assisted transluminal trabeculotomy: prospective 12-month outcomes in primary open-angle and primary angle-closure glaucoma. J Glaucoma. June 23, 2026. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.