Combined trabecular micro-bypass and goniotomy improves glaucoma treatment outcomes

The addition of goniotomy to trabecular micro-bypass (TMB) surgery, when performed alongside phacoemulsification, shows significant promise in improving the efficacy of glaucoma treatment for patients with open-angle glaucoma (OAG), according to a study presented at AAO 2023.

The study demonstrates that while both procedures effectively lower intraocular pressure (IOP), the combined approach resulted in a higher percentage of patients achieving a 20% or greater reduction in IOP compared to TMB surgery alone. In addition, the study found that the combined procedure was safe and well-tolerated, with no severe adverse events reported.

The study involved a prospective, nonrandomized, unmasked, 2-surgeon trial, and included patients who underwent phacoemulsification and TMB surgery (iStent inject W; Glaukos), either with or without concurrent goniotomy (iAccess Precision Blade; Glaukos).

The trial enrolled 94 patients, totaling 153 eyes, with 48 eyes in the group that received phacoemulsification and TMB alone (Group A), and 104 eyes in the group that received phacoemulsification, TMB, and concurrent goniotomy (Group B). The mean baseline intraocular pressure (IOP) for Group A was 14.88 ± 4.08 mmHg, while Group B had a mean baseline IOP of 14.53 ± 3.64 mmHg.

After 6 months, Group A and Group B exhibited significant reductions in IOP, with measurements of 13.04 mmHg and 12.19 mmHg, respectively (P < 0.05). Notably, 34.8% of patients in Group A achieved an IOP reduction of 20% or greater, compared to 44.7% in Group B.

Reference

Hu DJ, et al. Efficacy of Combined Trabecular Micro-Bypass and Goniotomy in Patients With OAG. Presented at: AAO 2023.