Combining Cataract and Glaucoma Surgery Achieves 72.4 Percent Success, Suggests Study

While topical intraocular pressure–lowering medications represent traditional first-line therapy for primary open-angle glaucoma (POAG), poor adherence—as low as 20% due to cost and drop burden—accelerates visual field loss, prompting MIGS procedures like 360-degree gonioscopy-assisted transluminal trabeculotomy (GATT) and sectoral Kahook Dual Blade (KDB) goniotomy. Addressing conflicting research regarding whether circumferential trabeculotomy provides superior pressure control over sectoral excision, Dr. Dana Shannon and colleagues from the University of Chicago Medicine evaluated 6-month outcomes of phacoemulsification (phaco) combined with GATT versus KDB in a predominantly African American cohort.

Therefore, the 6-month retrospective study evaluated 87 eyes from 61 primary open-angle glaucoma patients undergoing phacoemulsification combined with either 360-degree gonioscopy-assisted transluminal trabeculotomy or Kahook Dual Blade goniotomy. Primary endpoints assessed surgical success—defined as a ≥20% intraocular pressure reduction or ≥1 medication reduction without reoperation—alongside secondary measures of target pressure control, drop independence, and safety.

Key clinical findings from the study include:

• Equivalent Surgical Success: The study demonstrated comparable 6-month success rates between phaco-GATT (72.4%) and phaco-KDB (60.3%) without statistical difference (p = 0.524).
• Greater Pressure Lowering: The investigation observed significantly larger net IOP lowering with phaco-GATT than phaco-KDB (3.3 vs. 1.2 mm Hg, p = 0.009), with 51.7% vs. 27.6% reaching ≥20% reduction (p = 0.048).
• Meaningful Drop Relief: The research revealed significant medication reductions for phaco-GATT (3.2 to 2.6 drops, p = 0.002) and phaco-KDB (2.6 to 2.1 drops, p < 0.001), with 42.5% dropping ≥1 drop and 18.4% achieving drop independence.
• Postoperative Hyphema Profile: The analysis reported transient hyphema as the main complication, occurring significantly more in phaco-GATT (44.8%) than phaco-KDB (18.9%, p = 0.022).
• Low Baseline Pressure Utility: The evaluation confirmed that in eyes with baseline IOP ≤15 mm Hg (64.4% of cohort), both procedures effectively reduced medication burden (48.2% reduced ≥1 drop) with equal efficacy (p = 0.445).

The results suggest that both phaco-GATT and phaco-KDB deliver similar 6-month surgical success (72.4% vs. 60.3%) and significant medication burden reduction (42.5% eliminating ≥1 medication) in primary open-angle glaucoma. Although 360-degree trabeculotomy produces greater net IOP lowering (3.3 vs. 1.2 mm Hg), it carries higher transient hyphema rates (44.8% vs. 18.9%), allowing surgeons to tailor procedure selection to patient risk profiles.

Thus, the study concludes clinicians can consider both 360-degree trabeculotomy and sectoral goniotomy as effective adjunctive options during cataract surgery, selecting the appropriate procedure based on individual glaucoma severity, target pressure goals, medication burden, and relative surgical risks.

Although constrained by its retrospective design, potential selection bias toward trabeculotomy in severe cases, and a 6-month follow-up timeline, this study underscores the necessity for prospective, long-term comparative trials across diverse populations to further refine clinical decision-making.

Reference

Shannon D, Qiu M, Gilbertson J, Parekh Z, Khabaz K, Amin P. Comparison of Outcomes at 6 Months between Sectoral Goniotomy and Gonioscopy-assisted Transluminal Trabeculotomy Combined with Cataract Surgery in Primary Open-angle Glaucoma. Journal of Current Glaucoma Practice. 2026;20(3):135–142.