Efficacy comparison of combined trabeculectomy with MMC and gonioscopy-assisted transluminal trabeculotomy.

Abstract

To compare the efficacy of gonioscopy-assisted transluminal trabeculotomy combined with cataract surgery (PGATT) and trabeculectomy combined with cataract surgery (PTRAB) in open-angle glaucoma patients. A multi-centered, retrospective, non-randomized study included 67 PGATT patients and 70 PTRAB patients. We compared preoperative intraocular pressure (IOP), best-corrected visual acuity (BCVA) compared with early and final IOP, medication numbers, and BCVA levels. Success was determined as IOP reduction > 20% from baseline, IOP between 5 and 21mmHg, preoperative IOP of higher than 21mmHg with medication and postoperative IOP of less than 21mmHg without medication for surgeries performed for intolerance to medication, postoperative IOP < 21mmHg as well as < 18mmHg separately without medications, and no need for further glaucoma surgery. Preoperative IOP values were 28.61 ± 6.02mmHg in PTRAB group and 23.99 ± 8.00mmHg in PGATT group (P < 0.0001). Early postoperative IOP values were found lower in PTRAB group as 12.19 ± 3.41mmHg and as 15.69 ± 4.67mmHg in PGATT group (P < 0.0001). Last follow-up IOP reading were lower in PGATT group (P = 0.009). IOP difference values were found higher both in early and last postoperative periods in PTRAB group (respectively, P < 0.0001, P = 0.018). Success rates were found higher in both at lower than 21 and 18mmHg levels in PGATT group (respectively, P = 0.014, P = 0.010). We found the PGATT combined procedure to be a well-tolerated, effective procedure that can lower IOP both early and late in the postoperative period with different rates of IOP success compared with the combined PTRAB procedure.