Gonioscopy-assisted transluminal trabeculotomy with phacoemulsification in high myopia versus non-high myopia with open-angle glaucoma—A comparative study

Purpose: To compare the safety and efficacy of gonioscopy-assisted transluminal trabeculotomy (GATT) combined with phacoemulsification in eyes with high myopia versus non-high myopia with open-angle glaucoma. Methods: This retrospective comparative study included 76 eyes with open-angle glaucoma. Eyes were stratified into high myopia (Group 1; axial length ≥26.5 mm, n = 36) and non-high myopia (Group 2; axial length <26.5 mm, n = 40). Baseline parameters including intraocular pressure (IOP), best-corrected visual acuity, and number of anti-glaucoma medications (AGMs) were compared at 2 weeks, 1 month, and 3, 6, and 12 months. Surgical success was defined as IOP ≤21, ≤18, or ≤15 mmHg with a ≥20%, ≥25%, or ≥30% reduction from baseline, respectively. Postoperative complications, secondary interventions, and surgical risk factors were analyzed. Results: The mean (SD) IOP (mmHg) decreased from 20.56 ± 4.71 to 13.32 ± 5.02 in Group 1 and 19.33 ± 4.15 to 12.94 ± 3.48 in Group 2 at 12 months, with no significant difference between groups ( P = 0.92). AGM reduced from 2.11 ± 0.89 to 0.36 ± 0.95 in Group 1 and 1.98 ± 0.89 to 0.06 ± 0.24 in Group 2 at 12 months ( P = 0.07). There was no significant difference in success rate between groups by all criteria at the end of 12 months ( P = 0.77, 0.54, 0.14). Transient hyphema and IOP spikes were common complications. Five eyes required anterior chamber wash (3 in Group 1, 2 in Group 2). Conclusion: GATT with phacoemulsification is a safe and effective procedure in high myopia with open-angle glaucoma, with comparable outcomes to non-high myopia eyes at 12 months.