Efficacy and safety evaluation of phacoemulsification with intraocular lens implantation combined with goniotomy versus combined with trabeculectomy in advanced pseudoexfoliative glaucoma with cataract.

OBJECTIVE

To evaluate the efficacy and safety of phacoemulsification with intraocular lens implantation (PEI) combined with 120° goniotomy (GT) versus PEI combined with trabeculectomy (Trab) in advanced Pseudoexfoliative glaucoma (PXG) with cataracts.

METHODS

A retrospective study included 68 advanced PXG with cataract patients (68 eyes): 32 underwent PEI + GT and 36 underwent PEI + Trab. The visual acuity, intraocular pressure(IOP), the number of glaucoma medications, surgical success rate, complications, postoperative interventions, surgery duration, and quality of life (EQ-5D-5L) were recorded preoperatively and at 1, 3, 6, and 12 months postoperatively.

RESULTS

The PEI + GT group had a higher 1-month IOP than PEI + Trab (15.7 ± 1.7 vs. 13.9 ± 2.3 mmHg; P<0.05). Both groups experienced a significant reduction in the IOP and the number of medications used postoperatively (all P<0.05).The cumulative success rate and early complication incidence were comparable between the groups (P>0.05).PEI + GT demonstrated significantly lower rates of late complications and postoperative interventions, shorter operative time (16.8 ± 3.1 vs. 34.5 ± 5.5 min), and higher postoperative quality of life (EQ-5D-5L) compared to PEI + Trab (all P < 0.05).

CONCLUSION

Both PEI + GT and PEI + Trab effectively reduced IOP and glaucoma medication use in PXG patients with cataract. However, PEI + GT demonstrated shorter surgery duration, fewer late complications, reduced need for postoperative interventions, better surgery safety, and higher postoperative quality of life than PEI + Trab.