# Efficacy and safety of goniotomy and gonioscopy-assisted transluminal trabeculotomy for exfoliation glaucoma: a systematic review and single-arm meta-analysis

## TL;DR

This study reviews the effectiveness and safety of two surgical procedures for treating exfoliation glaucoma, finding that combining them with cataract surgery provides better long-term results.

## Contribution

The study provides a systematic review and meta-analysis of goniotomy and GATT for exfoliation glaucoma, highlighting the benefits of combining these procedures with phacoemulsification.

## Key findings

- GATT combined with phacoemulsification significantly reduced intraocular pressure and medication use at 1, 6, and 12 months.
- Goniotomy combined with phacoemulsification also reduced intraocular pressure and medication burden, though with less pronounced effects.
- Standalone GATT showed limited long-term intraocular pressure reduction, suggesting combined surgery is more effective for sustained control.

## Abstract

To assess the efficacy and safety of goniotomy (GT) and gonioscopy-assisted transluminal trabeculotomy (GATT) with or without phacoemulsification (PEI) for exfoliation glaucoma (XFG).

Searches were conducted in PubMed, Scopus, Embase, Ovid, and the Web of Science. Two independent reviewers performed study selection, data extraction, and quality assessment. The primary outcomes were the reduction in intraocular pressure (IOP) and the number of antiglaucoma medications (AGMs) at 1, 6, and 12 months postoperatively. Safety was assessed by the incidence of complications.

Fourteen studies involving 624 eyes were included. The GATT ± PEI group showed significant IOP reductions of 1.96 mmHg (p < 0.01), 2.17 mmHg (p < 0.001), and 2.07 mmHg (p < 0.001) at 1, 6, and 12 months, respectively, with corresponding AGM reductions of 3.28 (p < 0.001), 2.87 (p = 0.003), and 2.54 (p = 0.011). The GT + PEI group demonstrated IOP reductions of 1.95 (p < 0.001), 2.00 (p = 0.040), and 2.13 mmHg (p = 0.013), with AGM reductions of 1.07, 0.96, and 0.96 (all p < 0.001). For standalone procedures, GT significantly reduced AGMs at all timepoints (all p < 0.001) and IOP at 1 and 6 months (both p = 0.002), while standalone GATT significantly reduced IOP only at 1 month (2.39 mmHg, p < 0.001) and AGMs at 6 and 12 months (both p < 0.001). The most common complications were anterior chamber hemorrhage (47.6%) and IOP spike (17.0%).

This meta-analysis demonstrates that GT and GATT, particularly when combined with phacoemulsification, are safe and effective in reducing IOP and medication burden in patients with XFG. The evidence for sustained IOP lowering with standalone GATT remains limited, suggesting that combined surgery may offer more reliable long-term pressure control, especially for patients with concurrent cataract.

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420251072295, identifier CRD420251072295.