{"paper_id":"14156a0d-e995-43a3-a6e9-da6c3937ca3a","body_text":"Efficacy and Safety of 360º and 180º Gonioscopy-Assisted Transluminal Trabeculotomy in Combination with Phacoemulsification in Patients with Open-Angle Glaucoma: A Retrospective Case-Control Study. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Efficacy and Safety of 360º and 180º Gonioscopy-Assisted Transluminal Trabeculotomy in Combination with Phacoemulsification in Patients with Open-Angle Glaucoma: A Retrospective Case-Control Study. Ran Matlov Kormas, Eleanor Gafni Klepfish, Arie Marcovich, Rabea Kassem This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5377294/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 21 Nov, 2025 Read the published version in BMC Ophthalmology → Version 1 posted 12 You are reading this latest preprint version Abstract Purpose: To compare the efficacy and safety of 360º suture gonioscopy-assisted transluminal trabeculotomy (GATT) and 180º GATT (hemi-GATT) combined with cataract surgery in patients with open-angle glaucoma (OAG). Methods: This single-center retrospective study included patients with OAG treated by GATT or hemi-GATT combined with phacoemulsification with at least six months of follow-up. Outcome measures included change in intraocular pressure (IOP), best-corrected visual acuity (BCVA), and number of glaucoma medications (NGM) used. Success was defined as IOP<18 mmHg with complete reduction of NGM, or IOP<Pre-Op IOP with complete reduction of NGM, or more than 20% IOP reduction with the same or a smaller number of NGM. Results: Data from 35 patients (mean age=76 years) and 38 treated eyes were included in this study. The procedural success rate with GATT and hemi-GATT was 94% and 91%, respectively. Average IOP reduced from 17.0±4.8 to 12.9±2.7 mmHg in GATT (Δ=-4.2 mmHg, p =0.005) and from 17.8±4.9 to 13.8±3.12 mmHg in hemi-GATT (Δ=-4 mmHg, p =0.002) groups after six months. Average NGM was reduced from 3.5 to 0.3 medications in GATT (Δ=-3.2, p <0.0001) and from 2.5 to 0.5 medications in hemi-GATT (Δ=-2, p <0.0001) after six months. There were no serious adverse events in the two study groups. Conclusion: GATT and hemi-GATT with concomitant phacoemulsification cataract surgery are equally safe and effective procedures for decreasing IOP and NGM. Trabeculotomy glaucoma gonioscopy intraocular pressure safety efficacy Figures Figure 1 Figure 2 Figure 3 Key Message GATT and hemi-GATT are promising new surgical modalities for glaucoma, but their efficacy in conjunction with cataract surgery is yet to be assessed. We achieved a similarly high procedural success rate with GATT and hemi-GATT. Reductions in IOP, number of glaucoma medications, and best-corrected visual acuity were comparable with GATT and hemi-GATT. There were no serious adverse events in the two study groups. INTRODUCTION Glaucoma, a chronic progressive optic neuropathy, is the leading cause of irreversible blindness worldwide [1]. In 2019, nearly 7.5 million people globally were affected by glaucoma, with a higher disease burden in low sociodemographic index regions [2]. However, early diagnosis and treatment can prevent glaucoma-induced vision loss [1]. Reducing intraocular pressure (IOP), a crucial risk factor in glaucomatous optic neuropathy, is the primary treatment goal for slowing glaucoma progression [3]. While IOP reduction can be achieved non-invasively with eye drops, oral medication, and laser therapy [3], a subset of patients will require surgery at some point due to uncontrolled IOP driving disease progression. While traditional surgery carries risks and a high failure rate [4,5], micro-invasive glaucoma surgeries (MIGS) offer a minimally invasive, quicker, and safer alternative with rapid recovery time than trabeculectomy, the gold standard surgical approach for open-angle glaucoma (OAG) [6-8]. Among these, Gonioscopy-Assisted Transluminal Trabecolotomy (GATT), a conjunctiva-sparing procedure, is particularly attractive because of its potential to address the trabecular meshwork and Schlemm's canal, key components in the regulation of aqueous humor outflow [9]. Several studies have shown the efficacy of GATT in various glaucoma subtypes [10-12], producing successful reductions in IOP and the need for glaucoma medications [9,13,14] since it was first described by Grover et al. [13] in 2014 as a novel, ab interno MIGS approach to a 360° trabeculotomy. Moreover, GATT procedures are associated with fewer complications than trabeculectomy [15]. GATT minimizes post-operative complications related to bleb fibrosis, leakage, and infections as it is a non-bleb-forming procedure. Further, GATT can be performed as a standalone procedure or in combination with cataract surgery, allowing for greater treatment flexibility [16]. Numerous studies have indicated the safe combination of GATT with phacoemulsification, with some suggesting that cataract surgery itself may contribute to a slight reduction in IOP [17-19]. The exact mechanism behind this phenomenon remains unclear, although it has been demonstrated that outflow facilities improve in patients undergoing phacoemulsification [20]. Technical flexibility with GATT also allows it to be tailored to patients' needs. Suture-based GATT using a 6-0 or 5-0 polypropylene microfilament suture offers several advantages over the iTrack microcatheter (iTrack, Ellex, California) [6], as it does not require specialized equipment, is highly cost-effective, and preserves the option for more invasive glaucoma surgeries [21]. Similarly, a 180° GATT (or hemi-GATT) can produce similar reductions in IOP and the number of glaucoma medications (NGM) as 360° trabeculotomy while preserving the remaining 180° open for potential future intervention [22]. In addition, hemi-GATT is associated with a lower risk of post-operative hyphema with niveau formation than 360° GATT [22]. Although the efficacy of 360° GATT with ab interno canaloplasty (ABiC) in conjunction with phacoemulsification has been previously reported [16], the efficacy of 360° and 180° GATT in conjunction with cataract surgery is yet to be assessed. Therefore, this study aimed to compare the effectiveness and safety of GATT and hemi-GATT combined with cataract surgery in patients with OAG. METHODS Ethics This study complied with the Declaration of Helsinki and was approved by the Kaplan Medical Center Institutional Review Board (KMC-0160-23). The requirement for informed consent was waived as this study involves retrospective patient chart analyses. Study Participants Patients over 18 years with mild-to-moderate OAG who underwent a GATT or a hemi-GATT procedure combined with phacoemulsification and IOL implantation surgery with ≥ six months of follow-up data were included. Patients with advanced glaucoma or complicated cataract surgeries were excluded. Candidates for combined surgery were those with OAG who had (1) clinically significant cataracts that needed to be removed, (2) medically unstable glaucoma, or (3) issues with glaucoma medications, including intolerance or non-compliance. Data Collection Age, gender, type of glaucoma, IOP, BCVA, date of surgery, previous ocular surgery, the severity of glaucoma, and NGM were extracted to a standardized data collection sheet from the medical records of eligible patients treated at the Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel, between January 2021 and December 2022. Surgical Procedure A 2.4 mm clear corneal incision was made in the temporal quadrant through which an ophthalmic viscosurgical device (OVD) was injected into the anterior chamber, and three additional corneal paracenteses were made (superior, inferior, and nasal). The patient's head and microscope were tilted to provide visualization of the nasal iridocorneal angle. A 1–2 mm goniotomy was made with an Ocular Hill Open Access Surgical Gonio (Ocular Instruments Inc., WA, USA) through the main incision at the nasal angle using a 20-gauge microvitreoretinal blade. A 5–0 prolene suture was blunted using cautery and was directed toward the nasal angle via one of the paracenteses. A 25G microsurgical forceps (Kuhn 45 o Power Gripping, VitreQ, The Netherlands) was introduced through the main incision and used to grasp the blunted suture within the anterior chamber. The suture tip was inserted into the Schlemm canal at the nasal goniotomy incision and advanced through the canal circumferentially using microsurgical forceps. For GATT, the trabeculotomy was performed by pulling both ends of the suture after advancing the suture 360º. If it was impossible to canalize the 360º in the first attempt, a second attempt was performed through the same goniotomy to the opposite side to achieve as close to 360º trabeculotomy as possible. For hemi-GATT, the suture was advanced at least 180º before pulling the trailing end of the suture at the goniotomy through the main incision by the forceps, creating 180º trabeculotomy. Then, the eye was filled with OVD, capsulorhexis was created, and phacoemulsification was performed in a standard fashion with a foldable IOL implanted in the bag. OVD was left in the anterior chamber at the end of the surgery, filling approximately a quarter of the anterior chamber volume. The primary wound was hydrated to ensure a watertight seal, and the anterior chamber was filled with BSS to increase the IOP. Cefuroxime was injected into the anterior chamber for infection prophylaxis. All procedures were performed by one of two experienced surgeons (RYK, RMK). Post-operative Assessment Post-operative medications included topical ofloxacin 0.3% (4 times/day) for one week and topical dexamethasone 0.1% (4 times/day), which was tapered over four weeks. If the patient also had diabetes mellitus, topical diclofenac (4 times/day) was administered for four weeks. Patients were advised to use preservative-free artificial tears as needed. Patients were followed up one day, one week, one month, three months, and six months, during which post-operative IOP, number of glaucoma medications, BCVA, and any post-surgical complications were recorded. Outcome Measures The primary outcome measures included changes in IOP, BCVA, NGM, and the occurrence of adverse events. Success was defined as IOP <18 mmHg with complete reduction of medications, or IOP < Pre-Op IOP with complete reduction of medications, or more than 20% IOP reduction with the same/less NGM. Among adverse events, macro-hyphema was defined as significant measurable hyphema and IOP spike as an increase of 10 mmHg or ≥25%, whichever is smaller, compared to baseline preoperative IOP. Statistical Analysis Continuous variables were expressed as mean±standard deviation or range, and categorical variables as percentages. Paired t-tests were used to compare continuous variables within the same group. Between-group comparisons for continuous and categorical variables were performed using 2-sided t-tests and chi-square tests (Fisher exact test). Visual acuities were converted from Snellen to approximate logMAR [-1xlog (Snellen fraction)] for analysis. All statistical analyses were performed using Microsoft Excel® (Version 2308 Build 16.0.16731.20542). A p -value of <0.05 was used as the threshold for statistical significance. RESULTS Baseline Characteristics Medical charts of 35 patients and 38 treated eyes were included in this study. Most baseline variables, such as mean age (77.9±5.4 and 75.6±7.7), glaucoma severity (moderate), and preoperative IOP (17.0±4.7 and 17.8±4.9) were similar in the GATT and hemi-GATT groups ( Table 1 ): Half of the eyes were diagnosed with primary open-angle glaucoma, and the remaining 50% were diagnosed with pseudoexfoliation and steroid-induced secondary open-angle glaucomas in both groups. However, patients in the GATT group consumed more anti-glaucomatous medication ( p <0.005). Efficacy Procedural success was high with both GATT and hemi-GATT (94% and 91%, respectively). After six months, the average IOP was reduced by 4.2 mmHg ( p =0.005) and 4 mmHg ( p =0.002) in the two groups ( Figure 1 ). Similarly, the average NGM was reduced by 3.2 ( p <0.0001) and 2.0 ( p <0.0001) medications ( Figure 2 ) and BCVA from 0.67±0.5 to 0.34±0.34 ( p <0.05) and from 0.4±0.25 to 0.18±0.13 ( p <0.005) ( Figure 3 ) in the GATT and hemi-GATT groups respectively. The between-group differences at the six-month follow-up were not statistically significant in any outcomes. Safety None of the patients in either group developed irido-dialysis, choroidal effusion, endophthalmitis, loss of light perception, or sight-threatening complications. The most common post-operative complications were transient macro-hyphema (69% and 41%, p=0.09) followed by IOP spike within eight weeks (25% and 13.6%, p=0.4), intracapsular hematoma (18.7% and 9%, p=0.4), vitreous hemorrhage (6.2% and 13.6%, p=0.46), and toxic Anterior Syndrome (6.21% and 0.1%, p=0.7) in the GATT and the hemi-GATT groups. Macro-hyphema resolved spontaneously within one week postoperatively in all patients without further intervention. IOP spike occurred in the early post-operative period in both groups, and most cases were treated with tropical anti-glaucomatous medication and resolved within seven days. There was no need for further intervention to lower the pressure except for one patient who failed the surgery, was later diagnosed with malignant glaucoma, and further underwent a Yag laser posterior capsulotomy and hyaloidotomy. DISCUSSION This study aimed to compare the efficacy and safety of GATT and its modified counterpart, hemi-GATT, combined with phacoemulsification (phaco-GATT or phaco-hemiGATT, respectively) in managing mild to moderate OAG. We report similar significant IOP and NGM reduction in the two groups from baseline to the six-month follow-up. Significant improvements in BCVA were also noted postoperatively in the two groups, attributed to concomitant GATT with cataract extraction surgery. Finally, both surgeries are relatively safe; post-operative adverse effects were mostly non-vision-threatening, such as macro-hyphema and IOP spike. The results of this study are comparable with previous studies that evaluated the 360° GATT [17,23,24]. Moreover, Ruparelia et al. [25] recently demonstrated similar results for primary open-angle glaucoma patients who underwent inferior phaco-hemiGATT with a 37.9% reduction in IOP from baseline to 24-month follow-up. To our understanding, the higher percentage of IOP reduction might reflect the higher initial IOPs (21.9±5.8 mmHg) in their study, as the procedure's effect is known to plateau around the episcleral venous pressure. Furthermore, they did not record the NGM at baseline or during follow-up visits, which might render the results less comparable. In our study, the phaco-hemiGATT procedures were performed either inferiorly or superiorly. The decision was made randomly by the surgeon during the procedure. Factors that influenced the decision included the surgeon's judgment, their dominant hand, and the side of the operated eye. However, choosing inferior or superior hemi-GATT will unlikely affect the study outcomes. A recent study by Waldner et al. [26] reported no significant differences in operative success rates, complication rates, or effectiveness with superior versus inferior hemi-GATT. Although it would have been interesting to corroborate the findings of Waldner et al. [26], our relatively small sample size did not permit subgroup analysis of patients treated by the phaco-hemiGATT procedure. The theory that IOP reduction correlates with the degree of the incision during trabeculotomy ab interno was challenged in several studies in different types of MIGS such as trabeculotomy, Trabectome, KDB, Trab360, suture trabeculotomy ab extreno , and GATT [27-30]. For instance, Rosenquist et al. [27] showed that the 120° trabeculotomy resulted in close to 80% reduction in outflow resistance versus the 360° trabeculotomy in enucleated human eyes. This result emphasizes the non-linearity of aqueous humor outflow or IOP reduction with greater incision size. Further, Wecker et al. [28] demonstrated that the opening size of Trabectome surgery (53°±35°) did not correlate with IOP reduction at a follow-up point of 125±66 days. Similarly, Manabe et al. [29] showed that the extent of the incision in Schlemm's canal (275°±52.3°) in ab externo suture trabeculotomy did not correlate with IOP reduction at one year postoperatively. Additionally, similar IOP reduction was achieved with either KDB, which removes 90–120° of the trabecular meshwork, or 360° trabeculotomy using GATT or Trab360 (Sight Sciences, Menlo Park, CA, USA), although the nature of these two procedures is not identical, with the first considered an excisional procedure as opposed to the incisional nature of the latter [30]. Thus, the aforementioned findings and clinical observations indicate that incisions exceeding 120° might not yield additional IOP reduction in various MIGS procedures targeting the trabecular meshwork. An alternative explanation could be the pre-existing dysfunctionality of the distal outflow pathway before the surgical intervention. Previous studies have documented diverse morphological changes in the distal outflow pathway in eyes affected by glaucoma [31]. Furthermore, recent research indicates that the intraoperative detection of fluid waves in episcleral veins is associated with improved post-operative IOP reduction and/or reduced dependency on NGM [32-34]. This observation underscores the importance of a functional intrascleral drainage system distal to the trabeculotomy site, indicating its necessity for achieving both the optimal size of trabecular meshwork incisions and favorable outcomes in IOP reduction. The observed adverse effects of phaco-GATT or phaco-hemiGATT procedures in the current study are also consistent with those observed in prior studies. The primary complication with GATT and hemi-GATT in the study by Wan et al. [24] was hyphema, which typically resolved spontaneously. Nevertheless, we noted a numerically higher incidence of macro-hyphema and IOP spikes with phaco-GATT than with phaco-hemiGATT. Also, the rates of macro-hyphema in our two study arms (69% with phaco-GATT and 41% with phaco-hemiGATT) are slightly higher than the 30–40% incidence reported in prior studies with the 360° approach [10,35]. The lack of a precise definition of post-operative hyphema may be one of the reasons for this variation. Nonetheless, the incidence of IOP spikes within the eight-week post-operative period (25% and 13.6%, respectively) are consistent with previous studies that report IOP spikes in 17-44% of eyes after undergoing GATT or combined GATT procedures [24,36]. Limitations The inherent nature of retrospective designs introduces the possibility of selection bias and limits the researchers' control over data collection. Moreover, we relied on relatively small sample sizes, which may compromise the generalizability of the findings and did not allow a comparison of lower versus upper hemiGATT. Additionally, the short follow-up period could impact the study's ability to capture long-term trends or complications, thus warranting cautious interpretation of the results. Finally, significantly higher NGM and a numerically higher rate of systemic carbonic anhydrase treatment at baseline in phaco-GATT surgery group may be indicative of a more stubborn disease. At the same time, the preoperative pressure in the phaco-hemiGATT group was higher than in the phaco-GATT group. On the one hand, the reason for this may be the need for a lower target pressure in the former group, while another explanation is that the higher initial pressures mirrored the use of fewer NGM. Consequently, it is inevitable that these differences between the groups could have impacted the decision regarding the type of surgery opted for. While recognizing these limitations is crucial for a nuanced interpretation of our findings, the current study provides the foundation for future investigations with a more robust design, a diverse study population, and extended follow-up periods. CONCLUSION GATT and hemi-GATT are relatively recent additions to the surgical modalities for glaucoma surgeries; their long-term outcomes and potential for sustained efficacy remain crucial. In this study, similar clinical outcomes were achieved with phaco-hemiGATT and phaco-GATT in patients with mild-to-moderate OAG, challenging the instinctive notion that the more area treated, the more effect is produced. The possibility of future intervention with phaco-hemiGATT allows glaucoma control for a more extended period while delaying the need for higher profile bleb forming procedures such as trabeculectomy to a later stage. Declarations Acknowledgements Not applicable. Author contributions Ran Matlov Kormas and Eleanor Gafni Klepfish have contributed equally to the writing and statistical analysis. Eleanor Gafni Klepfish has contributed to collecting the data. Arie Marcovich has contributed as reviewers and editors of the manuscript. Rabea Kassem initiated the study and orchestrated every part of the study. All authors read and approved the final manuscript. Funding This manuscript did not receive any research funding. Data availability The data that support the findings of this study are available from the corresponding author. Ethical approval and consent to Participate This study complied with the Declaration of Helsinki and was approved by the Kaplan Medical Center Institutional Review Board (KMC-0160-23). The requirement for informed consent was waived as this study involves retrospective patient chart analyses. Consent for publication All authors read and approved the final manuscript. Competing Interests All the authors declare no financial or proprietary interest in any drug, device, or equipment mentioned in the submitted article. References Stein, JD; Khawaja, AP; Weizer, JS (2021) Glaucoma in Adults-Screening, Diagnosis, and Management: A Review. JAMA 325:164-174. https://doi.org/10.1001/jama.2020.21899. Lin, Y; Jiang, B; Cai, Y; Luo, W; Zhu, X; et al. (2023) The Global Burden of Glaucoma: Findings from the Global Burden of Disease 2019 Study and Predictions by Bayesian Age-Period-Cohort Analysis. J Clin Med 12. https://doi.org/10.3390/jcm12051828. Schuster, AK; Erb, C; Hoffmann, EM; Dietlein, T; Pfeiffer, N (2020) The Diagnosis and Treatment of Glaucoma. Dtsch Arztebl Int 117:225-234. https://doi.org/10.3238/arztebl.2020.0225. Rafuse, PE (2014) The optimal trabeculectomy: patient and procedure. Can J Ophthalmol 49:523-527. https://doi.org/10.1016/j.jcjo.2014.08.008. Mansouri, K; Guidotti, J; Rao, HL; Ouabas, A; D'Alessandro, E; et al. (2018) Prospective Evaluation of Standalone XEN Gel Implant and Combined Phacoemulsification-XEN Gel Implant Surgery: 1-Year Results. J Glaucoma 27:140-147. https://doi.org/10.1097/IJG.0000000000000858. Balas, M; Mathew, DJ (2023) Minimally Invasive Glaucoma Surgery: A Review of the Literature. Vision (Basel) 7. https://doi.org/10.3390/vision7030054. Birnbaum, FA; Neeson, C; Sola-Del Valle, D (2021) Microinvasive Glaucoma Surgery: An Evidence-Based Review. Semin Ophthalmol 36:772-786. https://doi.org/10.1080/08820538.2021.1903513. Schehlein, EM; Kaleem, MA; Swamy, R; Saeedi, OJ (2017) Microinvasive Glaucoma Surgery: An Evidence-Based Assessment. Expert Rev Ophthalmol 12:331-343. https://doi.org/10.1080/17469899.2017.1335597. Richter, GM; Coleman, AL (2016) Minimally invasive glaucoma surgery: current status and future prospects. Clin Ophthalmol 10:189-206. https://doi.org/10.2147/OPTH.S80490. Wang, Y; Wang, H; Han, Y; Shi, Y; Xin, C; et al. (2021) Outcomes of gonioscopy-assisted transluminal trabeculotomy in juvenile-onset primary open-angle glaucoma. Eye (Lond) 35:2848-2854. https://doi.org/10.1038/s41433-020-01320-0. Aktas, Z; Ucgul, AY; Ozdek, S; Boluk, CE (2021) Outcomes of Gonioscopy-assisted Transluminal Trabeculotomy in Vitrectomized Patients With Secondary Glaucoma After Silicone Oil Removal. J Glaucoma 30:e114-e118. https://doi.org/10.1097/IJG.0000000000001738. Sharkawi, E; Lindegger, DJ; Artes, PH; Lehmann-Clarke, L; El Wardani, M; et al. (2021) Outcomes of gonioscopy-assisted transluminal trabeculotomy in pseudoexfoliative glaucoma: 24-month follow-up. Br J Ophthalmol 105:977-982. https://doi.org/10.1136/bjophthalmol-2020-315954. Grover, DS; Smith, O; Fellman, RL; Godfrey, DG; Butler, MR; et al. (2015) Gonioscopy assisted transluminal trabeculotomy: an ab interno circumferential trabeculotomy for the treatment of primary congenital glaucoma and juvenile open angle glaucoma. Br J Ophthalmol 99:1092-1096. https://doi.org/10.1136/bjophthalmol-2014-306269. Al Habash, A; Nagshbandi, AA (2020) Quality of Life After Combined Cataract and Minimally Invasive Glaucoma Surgery in Glaucoma Patients. Clin Ophthalmol 14:3049-3056. https://doi.org/10.2147/OPTH.S276124. Fontana, L; De Maria, M; Caristia, A; Mastrofilippo, V; Braglia, L; et al. (2021) Comparison of Gonioscopy-assisted Transluminal Trabeculotomy Versus Trabeculectomy With Mitomycin C in Patients With Open-angle Glaucoma. J Glaucoma 30:101-108. https://doi.org/10.1097/IJG.0000000000001696. Al Habash, A; Alrushoud, M; Al Abdulsalam, O; Al Somali, AI; Aljindan, M; et al. (2020) Combined Gonioscopy-Assisted Transluminal Trabeculotomy (GATT) with Ab Interno Canaloplasty (ABiC) in Conjunction with Phacoemulsification: 12-Month Outcomes. Clin Ophthalmol 14:2491-2496. https://doi.org/10.2147/OPTH.S267303. Bozkurt, E; Yenihayat, F; Olgun, A; Yazici, AT; Sahbaz, I (2021) The efficacy of gonioscopy-assisted transluminal trabeculectomy combined with phacoemulsification. Int Ophthalmol 41:35-43. https://doi.org/10.1007/s10792-020-01550-x. Loayza-Gamboa, W; Martel-Ramirez, V; Inga-Condezo, V; Valderrama-Albino, V; Alvarado-Villacorta, R; et al. (2020) Outcomes of Combined Prolene Gonioscopy Assisted Transluminal Trabeculotomy with Phacoemulsification in Open-Angle Glaucoma. Clin Ophthalmol 14:3009-3016. https://doi.org/10.2147/OPTH.S272298. Issa, SA; Pacheco, J; Mahmood, U; Nolan, J; Beatty, S (2005) A novel index for predicting intraocular pressure reduction following cataract surgery. Br J Ophthalmol 89:543-546. https://doi.org/10.1136/bjo.2004.047662. Meyer, MA; Savitt, ML; Kopitas, E (1997) The effect of phacoemulsification on aqueous outflow facility. Ophthalmology 104:1221-1227. https://doi.org/10.1016/s0161-6420(97)30154-7. Velamala, IP; Bharathi, M (2023) Gonioscopy Assisted Transluminal Trabeculotomy:A Boon to Developing Nations-A Systematic Review. Semin Ophthalmol 38:178-182. https://doi.org/10.1080/08820538.2022.2094715. Sato, T; Kawaji, T (2021) 12-month randomised trial of 360 degrees and 180 degrees Schlemm's canal incisions in suture trabeculotomy ab interno for open-angle glaucoma. Br J Ophthalmol 105:1094-1098. https://doi.org/10.1136/bjophthalmol-2020-316624. Aktas, Z; Ucgul, AY; Bektas, C; Sahin Karamert, S (2019) Surgical Outcomes of Prolene Gonioscopy-assisted Transluminal Trabeculotomy in Patients With Moderate to Advanced Open-Angle Glaucoma. J Glaucoma 28:884-888. https://doi.org/10.1097/IJG.0000000000001331. Wan, Y; Cao, K; Wang, J; Sun, Y; Du, R; et al. (2023) Gonioscopy-assisted Transluminal Trabeculotomy (GATT) combined phacoemulsification surgery: Outcomes at a 2-year follow-up. Eye (Lond) 37:1258-1263. https://doi.org/10.1038/s41433-022-02087-2. Ruparelia, S; Wilson, D; Shoham-Hazon, N (2023) Hemi-GATT combined with phacoemulsification in patients with moderate-severe primary open-angle glaucoma: 2-year outcomes. Graefes Arch Clin Exp Ophthalmol 261:3257-3262. https://doi.org/10.1007/s00417-023-06166-2. Waldner, DM; Chaban, Y; Penny, MD; Al-Ani, A; Belkin, A; et al. (2023) Segmental Suture Gonioscopy-Assisted Transluminal Trabeculotomy: Comparison of Superior Versus Inferior Hemisphere Outcomes. J Glaucoma 32:396-406. https://doi.org/10.1097/IJG.0000000000002169. Rosenquist, R; Epstein, D; Melamed, S; Johnson, M; Grant, WM (1989) Outflow resistance of enucleated human eyes at two different perfusion pressures and different extents of trabeculotomy. Curr Eye Res 8:1233-1240. https://doi.org/10.3109/02713688909013902. Wecker, T; Anton, A; Neuburger, M; Jordan, JF; van Oterendorp, C (2017) Trabeculotomy opening size and IOP reduction after Trabectome(R) surgery. Graefes Arch Clin Exp Ophthalmol 255:1643-1650. https://doi.org/10.1007/s00417-017-3683-0. Manabe, SI; Sawaguchi, S; Hayashi, K (2017) The effect of the extent of the incision in the Schlemm canal on the surgical outcomes of suture trabeculotomy for open-angle glaucoma. Jpn J Ophthalmol 61:99-104. https://doi.org/10.1007/s10384-016-0487-4. Hirabayashi, MT; Lee, D; King, JT; Thomsen, S; An, JA (2019) Comparison Of Surgical Outcomes Of 360 degrees Circumferential Trabeculotomy Versus Sectoral Excisional Goniotomy With The Kahook Dual Blade At 6 Months. Clin Ophthalmol 13:2017-2024. https://doi.org/10.2147/OPTH.S208468. Hann, CR; Bentley, MD; Vercnocke, A; Ritman, EL; Fautsch, MP (2011) Imaging the aqueous humor outflow pathway in human eyes by three-dimensional micro-computed tomography (3D micro-CT). Exp Eye Res 92:104-111. https://doi.org/10.1016/j.exer.2010.12.010. Aktas, Z; Ozmen, MC; Atalay, HT; Ucgul, AY (2019) Evaluation of episcleral venous fluid wave during gonioscopy assisted transluminal trabeculotomy in patients with advanced glaucoma. Eye (Lond) 33:668-673. https://doi.org/10.1038/s41433-018-0254-5. Fellman, RL; Feuer, WJ; Grover, DS (2015) Episcleral Venous Fluid Wave Correlates with Trabectome Outcomes: Intraoperative Evaluation of the Trabecular Outflow Pathway. Ophthalmology 122:2385-2391 e2381. https://doi.org/10.1016/j.ophtha.2015.08.038. Fellman, RL; Grover, DS (2019) Episcleral Venous Fluid Wave in the Living Human Eye Adjacent to Microinvasive Glaucoma Surgery (MIGS) Supports Laboratory Research: Outflow is Limited Circumferentially, Conserved Distally, and Favored Inferonasally. J Glaucoma 28:139-145. https://doi.org/10.1097/IJG.0000000000001126. Guo, CY; Qi, XH; Qi, JM (2020) Systematic review and Meta-analysis of treating open angle glaucoma with gonioscopy-assisted transluminal trabeculotomy. Int J Ophthalmol 13:317-324. https://doi.org/10.18240/ijo.2020.02.17. Naftali Ben Haim, L; Yehezkeli, V; Abergel Hollander, E; Dar, N; Sharon, T; et al. (2024) Intraocular pressure spikes after gonioscopy-assisted transluminal trabeculotomy (GATT). Graefes Arch Clin Exp Ophthalmol 262:927-935. https://doi.org/10.1007/s00417-023-06265-0. Tables Table 1. Demographic characteristics of the participants with OAG who underwent a GATT, or a hemi-GATT procedure combined with phacoemulsification and IOL implantation surgery. Variables GATT Hemi-GATT p Number of eyes assessed n 16 22 - Mean age, years + SD 77.9 + 5.4 74.4 + 7.4 0.14 Male, n (%) 10 (69%) 10 (45%) 0.3 Type of glaucoma, n POAG 8 (50%) 11 (50%) 0.06 PXFG 7 (43.7%) 10 (45.4%) Steroid-induced 1 (6.3%) 1 (4.6%) Previous intraocular surgery, n 1 LPI (6.3%) 2 LPI (9%) 0.8 Severity of glaucoma Moderate Moderate 0.45 IOP, mmHg 17.0 + 4.8 17.8 + 4.9 0.7 NGM, mean 3.5 2.5 0.003 Oral carbonic anhydrase, n (%) 2 (12.6%) 1 (4.6%) 0.4 BCVA before surgery, LogMAR 0.7 + 0.5 0.4 + 0.25 0.07 *Data are presented as mean + SD or n (%); NGM = number of glaucoma medicine; POAG = primary open-angle glaucoma; PXF = pseudoexfoliation glaucoma; SD = standard deviation; LPI = laser peripheral iridotomy. Table 2 . Complications observed after surgery Complication GATT Number/ Percentage Hemi-GATT Number/ Percentage P Value Macro-Hyphema 11 (69%) 9 (41%) 0.09 IOP Spike within 8 weeks 4 (25%) 3 (13.6%) 0.4 Additional antiglaucoma procedure 0 1 YAG laser posterior capsulotomy and hyaloidotomy (4.5%) Choroidal effusion 0 0 Intracapsular hematoma 3 (18.7%) 2 (9%) 0.4 Vitreous hemorrhage 1 (6.2%) 3 (13.6%) 0.46 Endophthalmitis 0 0 Iridodialysis 0 0 Cyclodialysis 0 0 Toxic Anterior Syndrome (TASS) 1 (6.25%) 2 (0.1%) 0.7 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 21 Nov, 2025 Read the published version in BMC Ophthalmology → Version 1 posted Editorial decision: Revision requested 25 Apr, 2025 Reviews received at journal 23 Apr, 2025 Reviewers agreed at journal 23 Apr, 2025 Reviews received at journal 09 Apr, 2025 Reviewers agreed at journal 21 Mar, 2025 Reviewers agreed at journal 29 Jan, 2025 Reviewers agreed at journal 19 Dec, 2024 Reviewers invited by journal 18 Dec, 2024 Editor invited by journal 06 Nov, 2024 Editor assigned by journal 05 Nov, 2024 Submission checks completed at journal 05 Nov, 2024 First submitted to journal 02 Nov, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-5377294\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":378912480,\"identity\":\"46ca8ecb-af58-43e4-b99e-55a95878ed36\",\"order_by\":0,\"name\":\"Ran Matlov Kormas\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0UlEQVRIiWNgGAWjYJACxgYwxXwAxiJaC1sCyVp4DIjTYt5+9gDjjIp70fz9Z75J/NxhI8fAfvjoBnxaZM7kJTBuOFOcO+NG7jbJ3jNpxgw8aWk38GmRYMgxYHzYlpDbcIN3mwRv2+HEBgkeM/xa+N9AtMw/f+aZ5F+itEgAbdkI1LLhQA6bNHG2SABtmXEmIXfjjTRja9m2NGM2gn7hB9rSU5GQO+/84Yc337bZyPGzHz6GVwsQsP+AMlgkQCQbAeUogPkDKapHwSgYBaNg5AAAgXBLjhmqTJUAAAAASUVORK5CYII=\",\"orcid\":\"\",\"institution\":\"Kaplan Medical Center\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Ran\",\"middleName\":\"Matlov\",\"lastName\":\"Kormas\",\"suffix\":\"\"},{\"id\":378912481,\"identity\":\"9b97f67d-0539-4996-b6f1-b94d59852ea7\",\"order_by\":1,\"name\":\"Eleanor Gafni Klepfish\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Kaplan Medical Center\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Eleanor\",\"middleName\":\"Gafni\",\"lastName\":\"Klepfish\",\"suffix\":\"\"},{\"id\":378912482,\"identity\":\"72760f27-cfaf-4ca1-bdbd-6be05db14db3\",\"order_by\":2,\"name\":\"Arie Marcovich\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Kaplan Medical Center\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Arie\",\"middleName\":\"\",\"lastName\":\"Marcovich\",\"suffix\":\"\"},{\"id\":378912484,\"identity\":\"963925da-05c4-4287-84be-11120f795aaa\",\"order_by\":3,\"name\":\"Rabea Kassem\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Kaplan Medical Center\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Rabea\",\"middleName\":\"\",\"lastName\":\"Kassem\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2024-11-02 08:53:18\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-5377294/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-5377294/v1\",\"draftVersion\":[],\"editorialEvents\":[{\"content\":\"https://doi.org/10.1186/s12886-025-04348-6\",\"type\":\"published\",\"date\":\"2025-11-21T15:57:28+00:00\"}],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":70404202,\"identity\":\"fbf576a1-3bef-4f5d-bf2f-098dc0f3e0a1\",\"added_by\":\"auto\",\"created_at\":\"2024-12-02 22:59:26\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":43717,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e(A) Graphic representation of the significant IOP reduction during the study. (B). Average IOP reduction\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5377294/v1/c1755b7ecce291e073a63c2c.png\"},{\"id\":70404200,\"identity\":\"f078ff01-2c42-49dd-a639-57fcdd0b5dd0\",\"added_by\":\"auto\",\"created_at\":\"2024-12-02 22:59:26\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":40413,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e(A) Graphic representation of the significant medication reduction during the study. (B) Average medication reduction.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5377294/v1/375f51ee03d924fe0deef56c.png\"},{\"id\":70404201,\"identity\":\"47b8bfae-b91e-4bfd-a98d-eda737680b69\",\"added_by\":\"auto\",\"created_at\":\"2024-12-02 22:59:26\",\"extension\":\"png\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":32855,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eSignificant improvements in patient's BCVA after GATT and hemi-GATT.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"3.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5377294/v1/022b4581585601d9a6a72cbd.png\"},{\"id\":96650368,\"identity\":\"5547201d-5c00-4941-bba6-bcd8bf4f377b\",\"added_by\":\"auto\",\"created_at\":\"2025-11-24 16:11:35\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":963291,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5377294/v1/0ce0d801-b49c-4687-aae2-1aa4977fab6f.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Efficacy and Safety of 360º and 180º Gonioscopy-Assisted Transluminal Trabeculotomy in Combination with Phacoemulsification in Patients with Open-Angle Glaucoma: A Retrospective Case-Control Study.\",\"fulltext\":[{\"header\":\"Key Message\",\"content\":\"\\u003cul\\u003e\\n \\u003cli\\u003eGATT and hemi-GATT are promising new surgical modalities for glaucoma, but their efficacy in conjunction with cataract surgery is yet to be assessed.\\u003c/li\\u003e\\n \\u003cli\\u003eWe achieved a similarly high procedural success rate with GATT and hemi-GATT.\\u003c/li\\u003e\\n \\u003cli\\u003eReductions in IOP, number of glaucoma medications, and best-corrected visual acuity were comparable with GATT and hemi-GATT.\\u003c/li\\u003e\\n\\u003cli\\u003eThere were no serious adverse events in the two study groups.\\u003c/p\\u003e\\u003c/ul\\u003e\"},{\"header\":\"INTRODUCTION\",\"content\":\"\\u003cp\\u003eGlaucoma, a chronic progressive optic neuropathy, is the leading cause of irreversible blindness worldwide [1]. In 2019, nearly 7.5 million people globally were affected by glaucoma, with a higher disease burden in low sociodemographic index regions\\u0026nbsp;[2]. However, early diagnosis and treatment can prevent glaucoma-induced vision loss [1]. Reducing intraocular pressure (IOP), a crucial risk factor in glaucomatous optic neuropathy, is the primary treatment goal for slowing glaucoma progression [3]. While IOP reduction can be achieved non-invasively with eye drops, oral medication, and laser therapy [3], a subset of patients will require surgery at some point due to uncontrolled IOP driving disease progression.\\u003c/p\\u003e\\n\\u003cp\\u003eWhile traditional surgery carries risks and a high failure rate [4,5], micro-invasive glaucoma surgeries (MIGS) offer a minimally invasive, quicker, and safer alternative with rapid recovery time than trabeculectomy, the gold standard surgical approach for open-angle glaucoma (OAG) [6-8]. Among these, Gonioscopy-Assisted Transluminal Trabecolotomy (GATT), a conjunctiva-sparing procedure, is particularly attractive because of its potential to address the trabecular meshwork and Schlemm\\u0026apos;s canal, key components in the regulation of aqueous humor outflow [9]. Several studies have shown the efficacy of GATT in various glaucoma subtypes [10-12], producing successful reductions in IOP and the need for glaucoma medications [9,13,14] since it was first described by Grover et al. [13] in 2014 as a novel, \\u003cem\\u003eab interno\\u003c/em\\u003e MIGS approach to a 360\\u0026deg; trabeculotomy.\\u003c/p\\u003e\\n\\u003cp\\u003eMoreover, GATT procedures are associated with fewer complications than trabeculectomy [15]. GATT minimizes post-operative complications related to bleb fibrosis, leakage, and infections as it is a non-bleb-forming procedure. Further, GATT can be performed as a standalone procedure or in combination with cataract surgery, allowing for greater treatment flexibility [16]. Numerous studies have indicated the safe combination of GATT with phacoemulsification, with some suggesting that cataract surgery itself may contribute to a slight reduction in IOP [17-19]. The exact mechanism behind this phenomenon remains unclear, although it has been demonstrated that outflow facilities improve in patients undergoing phacoemulsification [20].\\u003c/p\\u003e\\n\\u003cp\\u003eTechnical flexibility with GATT also allows it to be tailored to patients\\u0026apos; needs. Suture-based GATT using a 6-0 or 5-0 polypropylene microfilament suture offers several advantages over the iTrack microcatheter (iTrack, Ellex, California) [6], as it does not require specialized equipment, is highly cost-effective, and preserves the option for more invasive glaucoma surgeries [21]. Similarly, a 180\\u0026deg; GATT (or hemi-GATT) can produce similar reductions in IOP and the number of glaucoma medications (NGM) as 360\\u0026deg; trabeculotomy while preserving the remaining 180\\u0026deg; open for potential future intervention [22]. In addition, hemi-GATT is associated with a lower risk of post-operative hyphema with niveau formation than 360\\u0026deg; GATT [22].\\u003c/p\\u003e\\n\\u003cp\\u003eAlthough the efficacy of\\u0026nbsp;360\\u0026deg; GATT with \\u003cem\\u003eab interno\\u003c/em\\u003e canaloplasty (ABiC) in conjunction with phacoemulsification has been previously reported [16], the efficacy of 360\\u0026deg; and 180\\u0026deg; GATT in conjunction with cataract surgery is yet to be assessed. Therefore, this study aimed to compare the effectiveness and safety of GATT and hemi-GATT combined with cataract surgery in patients with OAG.\\u003c/p\\u003e\"},{\"header\":\"METHODS\",\"content\":\"\\u003ch2\\u003eEthics\\u003c/h2\\u003e\\n\\u003cp\\u003eThis study complied with the Declaration of Helsinki and was approved by the Kaplan Medical Center Institutional Review Board (KMC-0160-23). The requirement for informed consent was waived as this study involves retrospective patient chart analyses.\\u003c/p\\u003e\\n\\u003ch2\\u003eStudy Participants\\u003c/h2\\u003e\\n\\u003cp\\u003ePatients over 18 years with mild-to-moderate OAG who underwent a GATT or a hemi-GATT procedure combined with phacoemulsification and IOL implantation surgery with \\u0026ge; six months of follow-up data were included. Patients with advanced glaucoma or complicated cataract surgeries were excluded.\\u003c/p\\u003e\\n\\u003cp\\u003eCandidates for combined surgery were those with OAG who had (1) clinically significant cataracts that needed to be removed, (2) medically unstable glaucoma, or (3) issues with glaucoma medications, including intolerance or non-compliance.\\u003c/p\\u003e\\n\\u003ch2\\u003eData Collection\\u003c/h2\\u003e\\n\\u003cp\\u003eAge, gender, type of glaucoma, IOP, BCVA, date of surgery, previous ocular surgery, the severity of glaucoma, and NGM were extracted to a standardized data collection sheet from the medical records of eligible patients treated at the Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel, between January 2021 and December 2022.\\u003c/p\\u003e\\n\\u003ch2\\u003eSurgical Procedure\\u003c/h2\\u003e\\n\\u003cp\\u003eA 2.4 mm clear corneal incision was made in the temporal quadrant through which an ophthalmic viscosurgical device (OVD) was injected into the anterior chamber, and three additional corneal paracenteses were made (superior, inferior, and nasal). The patient\\u0026apos;s head and microscope were tilted to provide visualization of the nasal iridocorneal angle. A 1\\u0026ndash;2 mm goniotomy was made with an Ocular Hill Open Access Surgical Gonio (Ocular Instruments Inc., WA, USA) through the main incision at the nasal angle using a 20-gauge microvitreoretinal blade. A 5\\u0026ndash;0 prolene suture was blunted using cautery and was directed toward the nasal angle via one of the paracenteses. A 25G microsurgical forceps (Kuhn 45\\u003csup\\u003eo\\u003c/sup\\u003e Power Gripping, VitreQ, The Netherlands) was introduced through the main incision and used to grasp the blunted suture within the anterior chamber. The suture tip was inserted into the Schlemm canal at the nasal goniotomy incision and advanced through the canal circumferentially using microsurgical forceps.\\u003c/p\\u003e\\n\\u003cp\\u003eFor GATT, the trabeculotomy was performed by pulling both ends of the suture after advancing the suture 360\\u0026ordm;. If it was impossible to canalize the 360\\u0026ordm; in the first attempt, a second attempt was performed through the same goniotomy to the opposite side to achieve as close to 360\\u0026ordm; trabeculotomy as possible. For hemi-GATT, the suture was advanced at least 180\\u0026ordm; before pulling the trailing end of the suture at the goniotomy through the main incision by the forceps, creating 180\\u0026ordm; trabeculotomy. Then, the eye was filled with OVD, capsulorhexis was created, and phacoemulsification was performed in a standard fashion with a foldable IOL implanted in the bag. OVD was left in the anterior chamber at the end of the surgery, filling approximately a quarter of the anterior chamber volume.\\u003c/p\\u003e\\n\\u003cp\\u003eThe primary wound was hydrated to ensure a watertight seal, and the anterior chamber was filled with BSS to increase the IOP. Cefuroxime was injected into the anterior chamber for infection prophylaxis. All procedures were performed by one of two experienced surgeons (RYK, RMK).\\u003c/p\\u003e\\n\\u003ch2\\u003ePost-operative Assessment\\u003c/h2\\u003e\\n\\u003cp\\u003ePost-operative medications included topical ofloxacin 0.3% (4 times/day) for one week and topical dexamethasone 0.1% (4 times/day), which was tapered over four weeks. If the patient also had diabetes mellitus, topical diclofenac (4 times/day) was administered for four weeks. Patients were advised to use preservative-free artificial tears as needed.\\u003c/p\\u003e\\n\\u003cp\\u003ePatients were followed up one day, one week, one month, three months, and six months, during which post-operative IOP, number of glaucoma medications, BCVA, and any post-surgical complications were recorded.\\u003c/p\\u003e\\n\\u003ch2\\u003eOutcome Measures\\u003c/h2\\u003e\\n\\u003cp\\u003eThe primary outcome measures included changes in IOP, BCVA, NGM, and the occurrence of adverse events. Success was defined as IOP \\u0026lt;18 mmHg with complete reduction of medications, or IOP \\u0026lt; Pre-Op IOP with complete reduction of medications, or more than 20% IOP reduction with the same/less NGM.\\u003c/p\\u003e\\n\\u003cp\\u003eAmong adverse events, macro-hyphema was defined as significant measurable hyphema and IOP spike as an increase of 10 mmHg or \\u0026ge;25%, whichever is smaller, compared to baseline preoperative IOP.\\u003c/p\\u003e\\n\\u003ch2\\u003eStatistical Analysis\\u003c/h2\\u003e\\n\\u003cp\\u003eContinuous variables were expressed as mean\\u0026plusmn;standard deviation or range, and categorical variables as percentages. Paired t-tests were used to compare continuous variables within the same group. Between-group comparisons for continuous and categorical variables were performed using 2-sided t-tests and chi-square tests (Fisher exact test). Visual acuities were converted from Snellen to approximate logMAR [-1xlog (Snellen fraction)] for analysis.\\u003c/p\\u003e\\n\\u003cp\\u003eAll statistical analyses were performed using Microsoft Excel\\u0026reg; (Version 2308 Build 16.0.16731.20542). A \\u003cem\\u003ep\\u003c/em\\u003e-value of \\u0026lt;0.05 was used as the threshold for statistical significance.\\u003c/p\\u003e\"},{\"header\":\"RESULTS\",\"content\":\"\\u003ch2\\u003eBaseline Characteristics\\u003c/h2\\u003e\\n\\u003cp\\u003eMedical charts of 35 patients and 38 treated eyes were included in this study. Most baseline variables, such as mean age (77.9\\u0026plusmn;5.4 and 75.6\\u0026plusmn;7.7), glaucoma severity (moderate), and preoperative IOP (17.0\\u0026plusmn;4.7 and 17.8\\u0026plusmn;4.9) were similar in the GATT and hemi-GATT groups (\\u003cstrong\\u003eTable 1\\u003c/strong\\u003e): Half of the eyes were diagnosed with primary open-angle glaucoma, and the remaining 50% were diagnosed with pseudoexfoliation and steroid-induced secondary open-angle glaucomas in both groups. However, patients in the GATT group consumed more anti-glaucomatous medication (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026lt;0.005).\\u003c/p\\u003e\\n\\u003ch2\\u003eEfficacy\\u003c/h2\\u003e\\n\\u003cp\\u003eProcedural success was high with both GATT and hemi-GATT (94% and 91%, respectively). After six months, the average IOP was reduced by 4.2 mmHg (\\u003cem\\u003ep\\u003c/em\\u003e=0.005) and 4 mmHg (\\u003cem\\u003ep\\u003c/em\\u003e=0.002) in the two groups (\\u003cstrong\\u003eFigure 1\\u003c/strong\\u003e). Similarly, the average NGM was reduced by 3.2 (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026lt;0.0001) and 2.0 (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026lt;0.0001) medications (\\u003cstrong\\u003eFigure 2\\u003c/strong\\u003e) and BCVA from 0.67\\u0026plusmn;0.5 to 0.34\\u0026plusmn;0.34 (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026lt;0.05) and from 0.4\\u0026plusmn;0.25 to 0.18\\u0026plusmn;0.13 (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026lt;0.005) (\\u003cstrong\\u003eFigure 3\\u003c/strong\\u003e) in the GATT and hemi-GATT groups respectively. The between-group differences at the six-month follow-up were not statistically significant in any outcomes.\\u003c/p\\u003e\\n\\u003ch2\\u003eSafety\\u003c/h2\\u003e\\n\\u003cp\\u003eNone of the patients in either group developed irido-dialysis, choroidal effusion, endophthalmitis, loss of light perception, or sight-threatening complications. The most common post-operative complications were transient macro-hyphema (69% and 41%, p=0.09) followed by IOP spike within eight weeks (25% and 13.6%, p=0.4), intracapsular hematoma (18.7% and 9%, p=0.4), vitreous hemorrhage (6.2% and 13.6%, p=0.46), and toxic Anterior Syndrome (6.21% and 0.1%, p=0.7) in the GATT and the hemi-GATT groups.\\u003c/p\\u003e\\n\\u003cp\\u003eMacro-hyphema resolved spontaneously within one week postoperatively in all patients without further intervention. IOP spike occurred in the early post-operative period in both groups, and most cases were treated with tropical anti-glaucomatous medication and resolved within seven days. There was no need for further intervention to lower the pressure except for one patient who failed the surgery, was later diagnosed with malignant glaucoma, and further underwent a Yag laser posterior capsulotomy and hyaloidotomy.\\u003c/p\\u003e\"},{\"header\":\"DISCUSSION\",\"content\":\"\\u003cp\\u003eThis study aimed to compare the efficacy and safety of GATT and its modified counterpart, hemi-GATT, combined with phacoemulsification (phaco-GATT or phaco-hemiGATT, respectively) in managing mild to moderate OAG. We report similar significant IOP and NGM reduction in the two groups from baseline to the six-month follow-up. Significant improvements in BCVA were also noted postoperatively in the two groups, attributed to concomitant GATT with cataract extraction surgery. Finally, both surgeries are relatively safe; post-operative adverse effects were mostly non-vision-threatening, such as macro-hyphema and IOP spike.\\u003c/p\\u003e\\n\\u003cp\\u003eThe results of this study are comparable with previous studies that evaluated the 360\\u0026deg; GATT [17,23,24]. Moreover, Ruparelia\\u003cem\\u003e\\u0026nbsp;et al.\\u003c/em\\u003e [25] recently demonstrated similar results for primary open-angle glaucoma patients who underwent inferior phaco-hemiGATT with a 37.9% reduction in IOP from baseline to 24-month follow-up. To our understanding, the higher percentage of IOP reduction might reflect the higher initial IOPs (21.9\\u0026plusmn;5.8 mmHg) in their study, as the procedure\\u0026apos;s effect is known to plateau around the episcleral venous pressure. Furthermore, they did not record the NGM at baseline or during follow-up visits, which might render the results less comparable.\\u003c/p\\u003e\\n\\u003cp\\u003eIn our study, the phaco-hemiGATT procedures were performed either inferiorly or superiorly. The decision was made randomly by the surgeon during the procedure. Factors that influenced the decision included the surgeon\\u0026apos;s judgment, their dominant hand, and the side of the operated eye. However, choosing inferior or superior hemi-GATT will unlikely affect the study outcomes. A recent study by Waldner\\u003cem\\u003e\\u0026nbsp;et al.\\u003c/em\\u003e [26] reported no significant differences in operative success rates, complication rates, or effectiveness with superior versus inferior hemi-GATT. Although it would have been interesting to corroborate the findings of Waldner et al. [26], our relatively small sample size did not permit subgroup analysis of patients treated by the phaco-hemiGATT procedure.\\u003c/p\\u003e\\n\\u003cp\\u003eThe theory that IOP reduction correlates with the degree of\\u003cspan dir=\\\"RTL\\\"\\u003e\\u0026nbsp;\\u003c/span\\u003ethe incision during trabeculotomy \\u003cem\\u003eab interno\\u003c/em\\u003e was challenged in several studies in different types of MIGS such as trabeculotomy, Trabectome, KDB, Trab360, suture trabeculotomy \\u003cem\\u003eab extreno\\u003c/em\\u003e, and GATT [27-30]. For instance, Rosenquist et al. [27] showed that the 120\\u0026deg; trabeculotomy resulted in close to 80% reduction in outflow resistance versus the 360\\u0026deg; trabeculotomy in enucleated human eyes. This result emphasizes the non-linearity of aqueous humor outflow or IOP reduction with greater incision size. Further, Wecker et al. [28] demonstrated that the opening size of Trabectome surgery (53\\u0026deg;\\u0026plusmn;35\\u0026deg;) did not correlate with IOP reduction at a follow-up point of 125\\u0026plusmn;66 days. Similarly, Manabe et al. [29] showed that the extent of the incision in Schlemm\\u0026apos;s canal (275\\u0026deg;\\u0026plusmn;52.3\\u0026deg;) in \\u003cem\\u003eab externo\\u003c/em\\u003e suture trabeculotomy did not correlate with IOP reduction at one year postoperatively. Additionally, similar IOP reduction was achieved with either KDB, which removes 90\\u0026ndash;120\\u0026deg; of the trabecular meshwork, or 360\\u0026deg; trabeculotomy using GATT or Trab360 (Sight Sciences, Menlo Park, CA, USA), although the nature of these two procedures is not identical, with the first considered an excisional procedure as opposed to the incisional nature of the latter [30].\\u003c/p\\u003e\\n\\u003cp\\u003eThus, the aforementioned findings and clinical observations indicate that incisions exceeding 120\\u0026deg; might not yield additional IOP reduction in various MIGS procedures targeting the trabecular meshwork. An alternative explanation could be the pre-existing dysfunctionality of the distal outflow pathway before the surgical intervention. Previous studies have documented diverse morphological changes in the distal outflow pathway in eyes affected by glaucoma [31]. Furthermore, recent research indicates that the intraoperative detection of fluid waves in episcleral veins is associated with improved post-operative IOP reduction and/or reduced dependency on NGM [32-34]. This observation underscores the importance of a functional intrascleral drainage system distal to the trabeculotomy site, indicating its necessity for achieving both the optimal size of trabecular meshwork incisions and favorable outcomes in IOP reduction.\\u003c/p\\u003e\\n\\u003cp\\u003eThe observed adverse effects of phaco-GATT or phaco-hemiGATT procedures in the current study are also consistent with those observed in prior studies. The primary complication with GATT and hemi-GATT in the study by Wan et al. [24] was hyphema, which typically resolved spontaneously. Nevertheless, we noted a numerically higher incidence of macro-hyphema and IOP spikes with phaco-GATT than with phaco-hemiGATT. Also, the rates of macro-hyphema in our two study arms (69% with phaco-GATT and 41% with phaco-hemiGATT) are slightly higher than the 30\\u0026ndash;40% incidence reported in prior studies with the 360\\u0026deg; approach [10,35]. The lack of a precise definition of post-operative hyphema may be one of the reasons for this variation. Nonetheless, the incidence of IOP spikes within the eight-week post-operative period (25% and 13.6%, respectively) are consistent with previous studies that report IOP spikes in 17-44% of eyes after undergoing GATT or combined GATT procedures [24,36].\\u003c/p\\u003e\\n\\u003ch2\\u003eLimitations\\u003c/h2\\u003e\\n\\u003cp\\u003eThe inherent nature of retrospective designs introduces the possibility of selection bias and limits the researchers\\u0026apos; control over data collection. Moreover, we relied on relatively small sample sizes, which may compromise the generalizability of the findings and did not allow a comparison of lower versus upper hemiGATT. Additionally, the short follow-up period could impact the study\\u0026apos;s ability to capture long-term trends or complications, thus warranting cautious interpretation of the results. Finally, significantly higher NGM and a numerically higher rate of systemic carbonic anhydrase treatment at baseline in phaco-GATT surgery group may be indicative of a more stubborn disease. At the same time, the preoperative pressure in the phaco-hemiGATT group was higher than in the phaco-GATT group. On the one hand, the reason for this may be the need for a lower target pressure in the former group, while another explanation is that the higher initial pressures mirrored the use of fewer NGM. Consequently, it is inevitable that these differences between the groups could have impacted the decision regarding the type of surgery opted for.\\u003c/p\\u003e\\n\\u003cp\\u003eWhile recognizing these limitations is crucial for a nuanced interpretation of our findings, the current study provides the foundation for future investigations with a more robust design, a diverse study population, and extended follow-up periods.\\u003c/p\\u003e\"},{\"header\":\"CONCLUSION\",\"content\":\"\\u003cp\\u003eGATT and hemi-GATT are relatively recent additions to the surgical modalities for glaucoma surgeries; their long-term outcomes and potential for sustained efficacy remain crucial. In this study, similar clinical outcomes were achieved with phaco-hemiGATT and phaco-GATT in patients with mild-to-moderate OAG, challenging the instinctive notion that the more area treated, the more effect is produced. The possibility of future intervention with phaco-hemiGATT allows glaucoma control for a more extended period while delaying the need for higher profile bleb forming procedures such as trabeculectomy to a later stage.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgements\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthor contributions\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eRan Matlov Kormas and Eleanor Gafni Klepfish have contributed equally to the writing and statistical analysis. Eleanor Gafni Klepfish has contributed to collecting the data. Arie Marcovich has contributed as reviewers and editors of the manuscript. Rabea Kassem initiated the study and orchestrated every part of the study. All authors read and approved the final manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis manuscript did not receive any research funding.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eData availability\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe data that support the findings of this study are available from the corresponding author.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eEthical approval and consent to Participate\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis study complied with the Declaration of Helsinki and was approved by the Kaplan Medical Center Institutional Review Board (KMC-0160-23). The requirement for informed consent was waived as this study involves retrospective patient chart analyses.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eAll authors read and approved the final manuscript.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u003cstrong\\u003eCompeting Interests\\u003c/strong\\u003e\\u003c/em\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAll the authors declare no financial or proprietary interest in any drug, device, or equipment mentioned in the submitted article.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n \\u003cli\\u003eStein, JD; Khawaja, AP; Weizer, JS (2021) Glaucoma in Adults-Screening, Diagnosis, and Management: A Review. JAMA 325:164-174. https://doi.org/10.1001/jama.2020.21899.\\u003c/li\\u003e\\n \\u003cli\\u003eLin, Y; Jiang, B; Cai, Y; Luo, W; Zhu, X; et al. (2023) The Global Burden of Glaucoma: Findings from the Global Burden of Disease 2019 Study and Predictions by Bayesian Age-Period-Cohort Analysis. J Clin Med 12. https://doi.org/10.3390/jcm12051828.\\u003c/li\\u003e\\n \\u003cli\\u003eSchuster, AK; Erb, C; Hoffmann, EM; Dietlein, T; Pfeiffer, N (2020) The Diagnosis and Treatment of Glaucoma. Dtsch Arztebl Int 117:225-234. https://doi.org/10.3238/arztebl.2020.0225.\\u003c/li\\u003e\\n \\u003cli\\u003eRafuse, PE (2014) The optimal trabeculectomy: patient and procedure. Can J Ophthalmol 49:523-527. https://doi.org/10.1016/j.jcjo.2014.08.008.\\u003c/li\\u003e\\n \\u003cli\\u003eMansouri, K; Guidotti, J; Rao, HL; Ouabas, A; D\\u0026apos;Alessandro, E; et al. (2018) Prospective Evaluation of Standalone XEN Gel Implant and Combined Phacoemulsification-XEN Gel Implant Surgery: 1-Year Results. J Glaucoma 27:140-147. https://doi.org/10.1097/IJG.0000000000000858.\\u003c/li\\u003e\\n \\u003cli\\u003eBalas, M; Mathew, DJ (2023) Minimally Invasive Glaucoma Surgery: A Review of the Literature. Vision (Basel) 7. https://doi.org/10.3390/vision7030054.\\u003c/li\\u003e\\n \\u003cli\\u003eBirnbaum, FA; Neeson, C; Sola-Del Valle, D (2021) Microinvasive Glaucoma Surgery: An Evidence-Based Review. Semin Ophthalmol 36:772-786. https://doi.org/10.1080/08820538.2021.1903513.\\u003c/li\\u003e\\n \\u003cli\\u003eSchehlein, EM; Kaleem, MA; Swamy, R; Saeedi, OJ (2017) Microinvasive Glaucoma Surgery: An Evidence-Based Assessment. Expert Rev Ophthalmol 12:331-343. https://doi.org/10.1080/17469899.2017.1335597.\\u003c/li\\u003e\\n \\u003cli\\u003eRichter, GM; Coleman, AL (2016) Minimally invasive glaucoma surgery: current status and future prospects. Clin Ophthalmol 10:189-206. https://doi.org/10.2147/OPTH.S80490.\\u003c/li\\u003e\\n \\u003cli\\u003eWang, Y; Wang, H; Han, Y; Shi, Y; Xin, C; et al. (2021) Outcomes of gonioscopy-assisted transluminal trabeculotomy in juvenile-onset primary open-angle glaucoma. Eye (Lond) 35:2848-2854. https://doi.org/10.1038/s41433-020-01320-0.\\u003c/li\\u003e\\n \\u003cli\\u003eAktas, Z; Ucgul, AY; Ozdek, S; Boluk, CE (2021) Outcomes of Gonioscopy-assisted Transluminal Trabeculotomy in Vitrectomized Patients With Secondary Glaucoma After Silicone Oil Removal. J Glaucoma 30:e114-e118. https://doi.org/10.1097/IJG.0000000000001738.\\u003c/li\\u003e\\n \\u003cli\\u003eSharkawi, E; Lindegger, DJ; Artes, PH; Lehmann-Clarke, L; El Wardani, M; et al. (2021) Outcomes of gonioscopy-assisted transluminal trabeculotomy in pseudoexfoliative glaucoma: 24-month follow-up. Br J Ophthalmol 105:977-982. https://doi.org/10.1136/bjophthalmol-2020-315954.\\u003c/li\\u003e\\n \\u003cli\\u003eGrover, DS; Smith, O; Fellman, RL; Godfrey, DG; Butler, MR; et al. (2015) Gonioscopy assisted transluminal trabeculotomy: an ab interno circumferential trabeculotomy for the treatment of primary congenital glaucoma and juvenile open angle glaucoma. Br J Ophthalmol 99:1092-1096. https://doi.org/10.1136/bjophthalmol-2014-306269.\\u003c/li\\u003e\\n \\u003cli\\u003eAl Habash, A; Nagshbandi, AA (2020) Quality of Life After Combined Cataract and Minimally Invasive Glaucoma Surgery in Glaucoma Patients. Clin Ophthalmol 14:3049-3056. https://doi.org/10.2147/OPTH.S276124.\\u003c/li\\u003e\\n \\u003cli\\u003eFontana, L; De Maria, M; Caristia, A; Mastrofilippo, V; Braglia, L; et al. (2021) Comparison of Gonioscopy-assisted Transluminal Trabeculotomy Versus Trabeculectomy With Mitomycin C in Patients With Open-angle Glaucoma. J Glaucoma 30:101-108. https://doi.org/10.1097/IJG.0000000000001696.\\u003c/li\\u003e\\n \\u003cli\\u003eAl Habash, A; Alrushoud, M; Al Abdulsalam, O; Al Somali, AI; Aljindan, M; et al. (2020) Combined Gonioscopy-Assisted Transluminal Trabeculotomy (GATT) with Ab Interno Canaloplasty (ABiC) in Conjunction with Phacoemulsification: 12-Month Outcomes. Clin Ophthalmol 14:2491-2496. https://doi.org/10.2147/OPTH.S267303.\\u003c/li\\u003e\\n \\u003cli\\u003eBozkurt, E; Yenihayat, F; Olgun, A; Yazici, AT; Sahbaz, I (2021) The efficacy of gonioscopy-assisted transluminal trabeculectomy combined with phacoemulsification. Int Ophthalmol 41:35-43. https://doi.org/10.1007/s10792-020-01550-x.\\u003c/li\\u003e\\n \\u003cli\\u003eLoayza-Gamboa, W; Martel-Ramirez, V; Inga-Condezo, V; Valderrama-Albino, V; Alvarado-Villacorta, R; et al. (2020) Outcomes of Combined Prolene Gonioscopy Assisted Transluminal Trabeculotomy with Phacoemulsification in Open-Angle Glaucoma. Clin Ophthalmol 14:3009-3016. https://doi.org/10.2147/OPTH.S272298.\\u003c/li\\u003e\\n \\u003cli\\u003eIssa, SA; Pacheco, J; Mahmood, U; Nolan, J; Beatty, S (2005) A novel index for predicting intraocular pressure reduction following cataract surgery. Br J Ophthalmol 89:543-546. https://doi.org/10.1136/bjo.2004.047662.\\u003c/li\\u003e\\n \\u003cli\\u003eMeyer, MA; Savitt, ML; Kopitas, E (1997) The effect of phacoemulsification on aqueous outflow facility. Ophthalmology 104:1221-1227. https://doi.org/10.1016/s0161-6420(97)30154-7.\\u003c/li\\u003e\\n \\u003cli\\u003eVelamala, IP; Bharathi, M (2023) Gonioscopy Assisted Transluminal Trabeculotomy:A Boon to Developing Nations-A Systematic Review. Semin Ophthalmol 38:178-182. https://doi.org/10.1080/08820538.2022.2094715.\\u003c/li\\u003e\\n \\u003cli\\u003eSato, T; Kawaji, T (2021) 12-month randomised trial of 360 degrees and 180 degrees Schlemm\\u0026apos;s canal incisions in suture trabeculotomy ab interno for open-angle glaucoma. Br J Ophthalmol 105:1094-1098. https://doi.org/10.1136/bjophthalmol-2020-316624.\\u003c/li\\u003e\\n \\u003cli\\u003eAktas, Z; Ucgul, AY; Bektas, C; Sahin Karamert, S (2019) Surgical Outcomes of Prolene Gonioscopy-assisted Transluminal Trabeculotomy in Patients With Moderate to Advanced Open-Angle Glaucoma. J Glaucoma 28:884-888. https://doi.org/10.1097/IJG.0000000000001331.\\u003c/li\\u003e\\n \\u003cli\\u003eWan, Y; Cao, K; Wang, J; Sun, Y; Du, R; et al. (2023) Gonioscopy-assisted Transluminal Trabeculotomy (GATT) combined phacoemulsification surgery: Outcomes at a 2-year follow-up. Eye (Lond) 37:1258-1263. https://doi.org/10.1038/s41433-022-02087-2.\\u003c/li\\u003e\\n \\u003cli\\u003eRuparelia, S; Wilson, D; Shoham-Hazon, N (2023) Hemi-GATT combined with phacoemulsification in patients with moderate-severe primary open-angle glaucoma: 2-year outcomes. Graefes Arch Clin Exp Ophthalmol 261:3257-3262. https://doi.org/10.1007/s00417-023-06166-2.\\u003c/li\\u003e\\n \\u003cli\\u003eWaldner, DM; Chaban, Y; Penny, MD; Al-Ani, A; Belkin, A; et al. (2023) Segmental Suture Gonioscopy-Assisted Transluminal Trabeculotomy: Comparison of Superior Versus Inferior Hemisphere Outcomes. J Glaucoma 32:396-406. https://doi.org/10.1097/IJG.0000000000002169.\\u003c/li\\u003e\\n \\u003cli\\u003eRosenquist, R; Epstein, D; Melamed, S; Johnson, M; Grant, WM (1989) Outflow resistance of enucleated human eyes at two different perfusion pressures and different extents of trabeculotomy. Curr Eye Res 8:1233-1240. https://doi.org/10.3109/02713688909013902.\\u003c/li\\u003e\\n \\u003cli\\u003eWecker, T; Anton, A; Neuburger, M; Jordan, JF; van Oterendorp, C (2017) Trabeculotomy opening size and IOP reduction after Trabectome(R) surgery. Graefes Arch Clin Exp Ophthalmol 255:1643-1650. https://doi.org/10.1007/s00417-017-3683-0.\\u003c/li\\u003e\\n \\u003cli\\u003eManabe, SI; Sawaguchi, S; Hayashi, K (2017) The effect of the extent of the incision in the Schlemm canal on the surgical outcomes of suture trabeculotomy for open-angle glaucoma. Jpn J Ophthalmol 61:99-104. https://doi.org/10.1007/s10384-016-0487-4.\\u003c/li\\u003e\\n \\u003cli\\u003eHirabayashi, MT; Lee, D; King, JT; Thomsen, S; An, JA (2019) Comparison Of Surgical Outcomes Of 360 degrees Circumferential Trabeculotomy Versus Sectoral Excisional Goniotomy With The Kahook Dual Blade At 6 Months. Clin Ophthalmol 13:2017-2024. https://doi.org/10.2147/OPTH.S208468.\\u003c/li\\u003e\\n \\u003cli\\u003eHann, CR; Bentley, MD; Vercnocke, A; Ritman, EL; Fautsch, MP (2011) Imaging the aqueous humor outflow pathway in human eyes by three-dimensional micro-computed tomography (3D micro-CT). Exp Eye Res 92:104-111. https://doi.org/10.1016/j.exer.2010.12.010.\\u003c/li\\u003e\\n \\u003cli\\u003eAktas, Z; Ozmen, MC; Atalay, HT; Ucgul, AY (2019) Evaluation of episcleral venous fluid wave during gonioscopy assisted transluminal trabeculotomy in patients with advanced glaucoma. Eye (Lond) 33:668-673. https://doi.org/10.1038/s41433-018-0254-5.\\u003c/li\\u003e\\n \\u003cli\\u003eFellman, RL; Feuer, WJ; Grover, DS (2015) Episcleral Venous Fluid Wave Correlates with Trabectome Outcomes: Intraoperative Evaluation of the Trabecular Outflow Pathway. Ophthalmology 122:2385-2391 e2381. https://doi.org/10.1016/j.ophtha.2015.08.038.\\u003c/li\\u003e\\n \\u003cli\\u003eFellman, RL; Grover, DS (2019) Episcleral Venous Fluid Wave in the Living Human Eye Adjacent to Microinvasive Glaucoma Surgery (MIGS) Supports Laboratory Research: Outflow is Limited Circumferentially, Conserved Distally, and Favored Inferonasally. J Glaucoma 28:139-145. https://doi.org/10.1097/IJG.0000000000001126.\\u003c/li\\u003e\\n \\u003cli\\u003eGuo, CY; Qi, XH; Qi, JM (2020) Systematic review and Meta-analysis of treating open angle glaucoma with gonioscopy-assisted transluminal trabeculotomy. Int J Ophthalmol 13:317-324. https://doi.org/10.18240/ijo.2020.02.17.\\u003c/li\\u003e\\n \\u003cli\\u003eNaftali Ben Haim, L; Yehezkeli, V; Abergel Hollander, E; Dar, N; Sharon, T; et al. (2024) Intraocular pressure spikes after gonioscopy-assisted transluminal trabeculotomy (GATT). Graefes Arch Clin Exp Ophthalmol 262:927-935. https://doi.org/10.1007/s00417-023-06265-0.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"},{\"header\":\"Tables\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eTable 1.\\u003c/strong\\u003e Demographic characteristics of the participants with OAG who underwent a GATT, or a hemi-GATT procedure combined with phacoemulsification and IOL implantation surgery.\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"100%\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 55%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eVariables\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eGATT\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHemi-GATT\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 10%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003ep\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 55%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNumber of eyes assessed \\u003cem\\u003en\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e16\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18%;\\\"\\u003e\\n \\u003cp\\u003e22\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 10%;\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 55%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMean age, \\u003cem\\u003eyears \\u003cu\\u003e+\\u003c/u\\u003e SD\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e77.9 \\u003cu\\u003e+\\u003c/u\\u003e 5.4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18%;\\\"\\u003e\\n \\u003cp\\u003e74.4 \\u003cu\\u003e+\\u003c/u\\u003e 7.4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 10%;\\\"\\u003e\\n \\u003cp\\u003e0.14\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 55%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMale, \\u003cem\\u003en (%)\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e10 (69%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18%;\\\"\\u003e\\n \\u003cp\\u003e10 (45%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 10%;\\\"\\u003e\\n \\u003cp\\u003e0.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"4\\\" style=\\\"width: 100%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eType of glaucoma, \\u003cem\\u003en\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 55%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003ePOAG\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e8 (50%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18%;\\\"\\u003e\\n \\u003cp\\u003e11 (50%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"3\\\" style=\\\"width: 10%;\\\"\\u003e\\n \\u003cp\\u003e0.06\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 55%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003ePXFG\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e7 (43.7%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18%;\\\"\\u003e\\n \\u003cp\\u003e10 (45.4%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 55%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eSteroid-induced\\u0026nbsp;\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e1 (6.3%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18%;\\\"\\u003e\\n \\u003cp\\u003e1 (4.6%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 55%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePrevious intraocular surgery, \\u003cem\\u003en\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e1 LPI (6.3%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18%;\\\"\\u003e\\n \\u003cp\\u003e2 LPI (9%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 10%;\\\"\\u003e\\n \\u003cp\\u003e0.8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 55%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eSeverity of glaucoma\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003eModerate\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18%;\\\"\\u003e\\n \\u003cp\\u003eModerate\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 10%;\\\"\\u003e\\n \\u003cp\\u003e0.45\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 55%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eIOP, \\u003cem\\u003emmHg\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e17.0 \\u003cu\\u003e+\\u003c/u\\u003e 4.8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18%;\\\"\\u003e\\n \\u003cp\\u003e17.8 \\u003cu\\u003e+\\u003c/u\\u003e 4.9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 10%;\\\"\\u003e\\n \\u003cp\\u003e0.7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 55%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNGM, mean\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e3.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18%;\\\"\\u003e\\n \\u003cp\\u003e2.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 10%;\\\"\\u003e\\n \\u003cp\\u003e0.003\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 55%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eOral carbonic anhydrase, \\u003cem\\u003en (%)\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e2 (12.6%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18%;\\\"\\u003e\\n \\u003cp\\u003e1 (4.6%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 10%;\\\"\\u003e\\n \\u003cp\\u003e0.4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 55%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eBCVA before surgery, \\u003cem\\u003eLogMAR\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e0.7 \\u003cu\\u003e+\\u003c/u\\u003e 0.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18%;\\\"\\u003e\\n \\u003cp\\u003e0.4 \\u003cu\\u003e+\\u003c/u\\u003e 0.25\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 10%;\\\"\\u003e\\n \\u003cp\\u003e0.07\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"4\\\" style=\\\"width: 100%;\\\"\\u003e\\n \\u003cp\\u003e*Data are presented as mean \\u003cu\\u003e+\\u003c/u\\u003e SD or n (%); NGM = number of glaucoma medicine; POAG = primary open-angle glaucoma; PXF = pseudoexfoliation glaucoma; SD = standard deviation; LPI = laser peripheral iridotomy.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 2\\u003c/strong\\u003e. Complications observed after surgery\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"586\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 217px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eComplication\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 142px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eGATT\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNumber/\\u003cspan dir=\\\"RTL\\\"\\u003e\\u003cbr\\u003e\\u0026nbsp;\\u003c/span\\u003ePercentage\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"3\\\" valign=\\\"top\\\" style=\\\"width: 151px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHemi-GATT\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNumber/\\u003cspan dir=\\\"RTL\\\"\\u003e\\u003cbr\\u003e\\u0026nbsp;\\u003c/span\\u003ePercentage\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eP Value\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 217px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMacro-Hyphema\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 151px;\\\"\\u003e\\n \\u003cp\\u003e11 (69%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 132px;\\\"\\u003e\\n \\u003cp\\u003e9 (41%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 53px;\\\"\\u003e\\n \\u003cp\\u003e0.09\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 32px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 217px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eIOP Spike within 8 weeks\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 151px;\\\"\\u003e\\n \\u003cp\\u003e4 (25%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 132px;\\\"\\u003e\\n \\u003cp\\u003e3 (13.6%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 53px;\\\"\\u003e\\n \\u003cp\\u003e0.4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 32px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 217px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eAdditional antiglaucoma\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eprocedure\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 151px;\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 132px;\\\"\\u003e\\n \\u003cp\\u003e1 YAG laser posterior capsulotomy and hyaloidotomy (4.5%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 53px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 32px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 217px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eChoroidal effusion\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 151px;\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 132px;\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 53px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 32px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 217px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eIntracapsular hematoma\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 151px;\\\"\\u003e\\n \\u003cp\\u003e3 (18.7%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 132px;\\\"\\u003e\\n \\u003cp\\u003e2 (9%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 53px;\\\"\\u003e\\n \\u003cp\\u003e0.4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 32px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 217px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eVitreous hemorrhage\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 151px;\\\"\\u003e\\n \\u003cp\\u003e1 (6.2%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 132px;\\\"\\u003e\\n \\u003cp\\u003e3 (13.6%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 53px;\\\"\\u003e\\n \\u003cp\\u003e0.46\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 32px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 217px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eEndophthalmitis\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 151px;\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 132px;\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 53px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 32px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 217px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eIridodialysis\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 151px;\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 132px;\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 53px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 32px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 217px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCyclodialysis\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 151px;\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 132px;\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 53px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 32px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 217px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eToxic Anterior Syndrome (TASS)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 151px;\\\"\\u003e\\n \\u003cp\\u003e1 (6.25%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 132px;\\\"\\u003e\\n \\u003cp\\u003e2 (0.1%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 53px;\\\"\\u003e\\n \\u003cp\\u003e0.7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 32px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-ophthalmology\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"boph\",\"sideBox\":\"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/boph\",\"title\":\"BMC Ophthalmology\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Trabeculotomy, glaucoma, gonioscopy, intraocular pressure, safety, efficacy\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-5377294/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-5377294/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cem\\u003ePurpose:\\u003c/em\\u003e To compare the efficacy and safety of 360º suture gonioscopy-assisted transluminal trabeculotomy (GATT) and 180º GATT (hemi-GATT) combined with cataract surgery in patients with open-angle glaucoma (OAG).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eMethods:\\u003c/em\\u003e This single-center retrospective study included patients with OAG treated by GATT or hemi-GATT combined with phacoemulsification with at least six months of follow-up. Outcome measures included change in intraocular pressure (IOP), best-corrected visual acuity (BCVA), and number of glaucoma medications (NGM) used. Success was defined as IOP\\u0026lt;18 mmHg with complete reduction of NGM, or IOP\\u0026lt;Pre-Op IOP with complete reduction of NGM, or more than 20% IOP reduction with the same or a smaller number of NGM.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eResults:\\u003c/em\\u003e Data from 35 patients (mean age=76 years) and 38 treated eyes were included in this study. The procedural success rate with GATT and hemi-GATT was 94% and 91%, respectively. Average IOP reduced from 17.0±4.8 to 12.9±2.7 mmHg in GATT (Δ=-4.2 mmHg, \\u003cem\\u003ep\\u003c/em\\u003e=0.005) and from 17.8±4.9 to 13.8±3.12 mmHg in hemi-GATT (Δ=-4 mmHg, \\u003cem\\u003ep\\u003c/em\\u003e=0.002) groups after six months. Average NGM was reduced from 3.5 to 0.3 medications in GATT (Δ=-3.2, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026lt;0.0001) and from 2.5 to 0.5 medications in hemi-GATT (Δ=-2, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026lt;0.0001) after six months. There were no serious adverse events in the two study groups.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eConclusion:\\u003c/em\\u003e GATT and hemi-GATT with concomitant phacoemulsification cataract surgery are equally safe and effective procedures for decreasing IOP and NGM.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Efficacy and Safety of 360º and 180º Gonioscopy-Assisted Transluminal Trabeculotomy in Combination with Phacoemulsification in Patients with Open-Angle Glaucoma: A Retrospective Case-Control Study.\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2024-12-02 22:59:22\",\"doi\":\"10.21203/rs.3.rs-5377294/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2025-04-25T05:55:24+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-04-23T15:40:54+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"139244924062287807875987737161749834349\",\"date\":\"2025-04-23T14:49:07+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-04-09T19:12:29+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"119699482948818105795016596879412465402\",\"date\":\"2025-03-21T15:07:42+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"185918297267440407319577799994845583681\",\"date\":\"2025-01-29T16:08:09+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"327364863832060158854049438798499000331\",\"date\":\"2024-12-19T10:22:31+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2024-12-18T11:53:40+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvited\",\"content\":\"\",\"date\":\"2024-11-06T11:02:30+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2024-11-05T12:57:23+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2024-11-05T12:56:15+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"BMC Ophthalmology\",\"date\":\"2024-11-02T08:49:54+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-ophthalmology\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"boph\",\"sideBox\":\"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/boph\",\"title\":\"BMC Ophthalmology\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"dcfe43b4-a8ea-4e18-9181-ec9b645bd329\",\"owner\":[],\"postedDate\":\"December 2nd, 2024\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"published-in-journal\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2025-11-24T16:06:43+00:00\",\"versionOfRecord\":{\"articleIdentity\":\"rs-5377294\",\"link\":\"https://doi.org/10.1186/s12886-025-04348-6\",\"journal\":{\"identity\":\"bmc-ophthalmology\",\"isVorOnly\":false,\"title\":\"BMC Ophthalmology\"},\"publishedOn\":\"2025-11-21 15:57:28\",\"publishedOnDateReadable\":\"November 21st, 2025\"},\"versionCreatedAt\":\"2024-12-02 22:59:22\",\"video\":\"\",\"vorDoi\":\"10.1186/s12886-025-04348-6\",\"vorDoiUrl\":\"https://doi.org/10.1186/s12886-025-04348-6\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-5377294\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-5377294\",\"identity\":\"rs-5377294\",\"version\":[\"v1\"]},\"buildId\":\"qtupq5eGEP_6zYnWcrvyt\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}