Search Results (56)

Background/Objectives: To investigate the non-inferiority of preservative-free (PF) tafluprost eye drops (Taflotan sine^®) compared to latanoprost eye drops (Xalatan^®) in reducing mean 24 h intraocular pressure (IOP) on the second day of a diurnal IOP measurement. Methods: In this retrospective monocentric cohort study, patients suffering from primary open-angle glaucoma, ocular hypertension, normal tension glaucoma, pigment dispersion glaucoma, or pseudoexfoliation glaucoma who had undergone inpatient diurnal IOP measurement were included. Patients of cohort 1 used latanoprost eye drops as monotherapy; patients of cohort 2 used preservative-free tafluprost eye drops. Data from 7 January 2005 to 9 July 2019, inclusive, were analyzed. Results: Ninety-three eyes were included (n = 59 latanoprost group, n = 34 PF tafluprost group). Mean 24 h IOP on day 2 was 14.1 mmHg (SD 2.3) in the latanoprost group and 14.5 mmHg (SD 3.4) in the PF tafluprost group. The non-inferiority of PF tafluprost eye drops to latanoprost eye drops in efficacy on mean 24 h IOP could not be confirmed (95% CI −1.5, ∞, p = 0.235). The average difference in mean IOP at the individual measurement times between both cohorts was 0.24 mmHg (SD 0.17) on day 1 and 0.44 mmHg (SD 0.6) on day 2. The non-inferiority of PF tafluprost compared to latanoprost regarding fluctuation range could not be demonstrated for both days. Conclusions: The data suggests slight inferiority of PF tafluprost to latanoprost eye drops. There were similar mean 24 h IOP values in both cohorts. PF tafluprost eye drops remain a useful treatment option as long as the patient’s individual target pressure is achieved. Furthermore, according to the literature, it is also a treatment option for patients with symptoms of ocular surface disease and other side effects affecting the ocular surface while receiving preservative-containing topical therapy. Full article

Background and Objectives: This study aims to comparatively evaluate the outcomes of glaucoma surgeries performed by a single surgeon during the non-pandemic period (2019, 2021, and the first quarter of 2022) versus the pandemic year (2020). The analysis focuses on key surgical outcomes, including intraocular pressure (IOP) reduction, intraoperative and postoperative complications, surgical success and failure rates, and their broader clinical implications. Materials and Methods: Out of a total of 66 patients admitted between November 2019 and March 2022, 45 met the inclusion and exclusion criteria and were enrolled in the study. All patients underwent glaucoma surgery conducted by the same surgeon employing a standardized technique (trabeculectomy ± iridectomy ± mitomycin C). The evaluated clinical parameters included preoperative and postoperative IOP values (with specific assessment on the first postoperative day), early and late intraoperative and postoperative complications, as well as postoperative success and failure rates. Results: The majority of glaucoma cases—particularly those of primary open-angle glaucoma—were recorded in 2021 and 2022, in contrast to 2019 and 2020, when pseudoexfoliative and secondary closed-angle glaucomas predominated. Over the observation period, retrobulbar anesthesia was more frequently utilized in 2019. Statistical analysis indicated that the surgical failure rate was not significantly influenced by the presence of complications, patient age, associated comorbidities, or the specific surgical variant performed. Conclusions: The conduct of glaucoma surgery during the pandemic period was marked by substantial operational and clinical constraints when compared to non-pandemic years, primarily as a consequence of decreased patient accessibility and the reprioritization of healthcare resources, despite the acknowledged emergency status of these procedures. Nonetheless, the overall incidence of early intraoperative and postoperative complications remained minimal, with transient intraocular hypotony emerging as the predominant adverse event, observed in ten cases. Across all study cohorts, more than 80% of patients achieved qualified surgical success, while only 18% exhibited surgical failure, underscoring the robustness of standardized operative protocols under variable healthcare conditions. Consistent with the directives of the American Academy of Ophthalmology (AAO) and the European Glaucoma Society (EGS), glaucoma must be regarded as a genuine ophthalmic emergency necessitating prompt surgical intervention when intraocular pressure cannot be adequately managed through pharmacological or laser-based therapies. The current findings reinforce the imperative of timely glaucoma surgery, irrespective of pandemic or non-pandemic circumstances, as a critical measure for averting irreversible optic nerve damage, mitigating functional visual loss, and sustaining long-term ocular integrity. Full article

Background/Objectives: Early postoperative hypotony and complications like choroidal detachment can occur after Preserflo MicroShunt (MS) implantation in patients with pseudoexfoliation glaucoma (PEXG). To prevent these risks, outflow from the microshunt tube can be reduced by implementing a nylon stent. This study aims to evaluate the impact of intraluminal stenting of the MS during the first four months after surgery. Methods: This retrospective study of 43 eyes investigated the incidence of intraocular hypotony in PEXG patients undergoing MS implantation with (n = 23) or without (n = 20) intraluminal stenting using a 10.0 nylon suture. The follow-up period was four months after surgery. Results: Our results demonstrated that intraluminal stenting significantly reduced the incidence of postoperative complications related to hypotony. Notably, no cases of choroidal detachment occurred in the nylon-stenting group (nsMS) compared to 30% (6 eyes) in the MS-only group (p = 0.0064). The hypotony rates between the nsMS (21.74%, 5 eyes) and the MS-only group (40%, 8 eyes) did not significantly differ (p = 0.3184). Both groups experienced significant reductions in intraocular pressure (p < 0.001) and a decrease in the number of antiglaucomatous medications (p < 0.001) up to four months after surgery. Conclusions: The use of an intraluminal stent (10.0 nylon suture) during MS implantation may be a promising strategy to reduce the risk of hypotony-related complications, particularly choroidal detachment, in patients with PEXG. Full article

Background/Objectives: This study aimed to evaluate estimated pulse wave velocity (ePWV) in different glaucoma types. Methods: This was observational, cross-sectional, non-interventional study conducted on 127 primary open-angle glaucoma (POAG) patients, 59 primary angle-closure glaucoma (PACG) patients, 34 pseudoexfoliative glaucoma (PEX) patients, and 55 normotensive glaucoma (NTG) patients (total of 275 glaucoma patients). The control group (CG, 92 patients) consisted of patients with cataract. ePWV was calculated by the formula that was recommended by the Reference Values for Arterial Stiffness Collaboration from data on age and mean arterial blood pressure. The obtained results were processed by applying methods of descriptive (arithmetical mean, standard deviation) and analytical statistics, and comparisons of tested variables were performed using ANOVA. A p value less than 0.05 was considered statistically significant. Results: Statistically significant differences were found between patients with POAG and the CG (p value 0.042), and between those with NTG and the CG (p value 0.001). There was a statistically significant difference in ePWV values when comparing all tested patients with glaucoma and the control group (p = 0.001). Conclusions: Estimated pulse wave velocity may be a helpful tool in future risk assessment models for glaucoma. Full article

Background/Objectives: Heart rate variability (HRV) is a marker of autonomic nervous system function, based on fluctuations in heartbeat intervals. Although several studies have investigated the association between frequency-domain HRV parameters and glaucoma, evidence based on large sample sizes remains limited. Therefore, the present study aimed to examine the relationship between frequency-domain HRV parameters and glaucoma subtypes, including primary open-angle glaucoma (PG) and exfoliation glaucoma (EG), using a larger sample size. Methods: Participants with primary open-angle glaucoma (PG), exfoliation glaucoma (EG), or no ocular disease other than cataract (controls) were recruited at Shimane University between June 2023 and July 2024. Frequency-domain HRV parameters (total power [TP], very-low-frequency [VLF], low-frequency [LF], high-frequency [HF], and LF/HF) were measured using a sphygmograph (TAS9 Pulse Analyzer Plus View). Group comparisons were conducted using unpaired t-tests, Fisher’s exact tests, and Tukey’s HSD test. Multivariate analyses were performed to identify factors associated with each HRV parameter. Results: A total of 809 participants were analyzed, including 522 with PG, 191 with EG, and 96 controls. The EG group showed significantly lower values across all frequency-domain HRV parameters compared to the PG group, and significantly lower LnLF values than the control group (p = 0.012). Multivariate analyses revealed that no significant associations were found between HRV measures and the presence of glaucoma or pseudoexfoliation material (PEM) deposition. Older age was significantly associated with lower values across all HRV parameters. Conclusions: In elderly glaucoma patients, age-related alterations in frequency-domain HRV parameters have been observed. Full article

Background/Objectives: This study aims to evaluate the long-term efficacy and safety of ab interno techniques using minimally invasive glaucoma surgery (MIGS), specifically XEN gel stent implantation, by evaluating its 2-year outcomes in patients with primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG). Methods: This retrospective single-center study consecutively included 31 eyes of 31 patients with POAG or PXG who underwent XEN gel stent implantation. Patients were followed for 24 months, with assessments at multiple time points. Success was defined as achieving an IOP of less than 14 mmHg and a reduction of more than 20% from preoperative IOP without additional glaucoma surgery. Bleb morphology was evaluated using anterior segment optical coherence tomography (AS-OCT) and slit-lamp photographs. Postoperative interventions and complications were also recorded. Results: At 24 months, complete success and qualified success rates were 35.5% (11/31) and 51.6% (16/31), respectively. There was no difference in surgical success rates at 2 years based on the tip location (intraconjunctiva, intratenon, and uviform) on the 1st postoperative day. Patients with high sparse wall on AS-OCT imaging or avascular bleb morphology via slit-lamp photography at 6 months postoperatively had higher complete success rates at 2 years than those without (p = 0.007, p = 0.009, respectively). Patients with avascular bleb types at 6 months postoperatively had higher qualified success rates at 2 years compared with the vascular types (p = 0.038). Needling was performed in 32.3% of eyes, with secondary surgical procedures required in 16.1% of eyes. The most common adverse event was hypotony, occurring in 67.7% of eyes on the 1st postoperative day but resolving within 6 months. Conclusions: The ab interno XEN gel stent is an effective and minimally invasive option for managing POAG and PXG, with long-term success predicted by the AS-OCT assessment of bleb morphology at 6 months. Proactive postoperative management, emphasizing early intervention and monitoring, is crucial for maintaining optimal outcomes. Full article

Purpose: To investigate the role of the kynurenine pathway (KP) in ocular diseases by evaluating the activity of key enzymes—kynurenine aminotransferase (KAT) and kynurenine monooxygenase (KMO)—and the 3-hydroxykynurenine to kynurenic acid (3-HK/KYNA) ratio in relation to cataract severity, diabetes, glaucoma, and pseudoexfoliation syndrome (PEXS). Methods: Tryptophan metabolite levels were measured in patients undergoing cataract surgery and stratified by SPONCS grading and comorbid conditions. KAT and KMO activities were estimated using metabolite ratios (KYNA/KYN and 3-HK/KYN, respectively). Statistical analyses included Kruskal–Wallis tests with post hoc comparisons and Mann–Whitney U tests. Results: KAT activity declined significantly with increasing SPONCS grade (p = 0.014), suggesting a progressive loss of KYNA production and antioxidative capacity in advanced cataracts. Diabetic patients exhibited higher KMO activity (p = 0.039) and elevated 3-HK/KYNA ratios (p = 0.013), indicating a metabolic shift toward oxidative stress and neurotoxicity. Similarly, glaucoma patients had significantly increased KMO activity (p = 0.032), consistent with enhanced 3-HK-mediated retinal ganglion cell damage. In contrast, PEXS showed no significant alterations in KP markers. Conclusions: The kynurenine pathway is differentially modulated in ocular diseases. A decline in KAT activity correlates with cataract severity, while upregulation of KMO is prominent in diabetes and glaucoma, revealing disease-specific metabolic dysregulation. Targeting KMO to reduce toxic metabolite accumulation or enhancing KYNA synthesis may offer novel therapeutic avenues. These findings also support the potential of KP metabolites as biomarkers for disease monitoring and progression. Full article

Background: Systemic arterial stiffness and atherosclerosis have been increasingly recognized as potential contributors to the pathogenesis of glaucoma. Several studies have reported associations between glaucoma and various surrogate markers of vascular stiffness. However, despite the growing interest in the vascular components of glaucoma, no previous studies have specifically explored the relationship between the indices derived from acceleration plethysmography (APG) and glaucoma. This study seeks to address this gap by investigating the potential association between APG parameters and the presence of glaucoma. Methods: The subjects were 701 patients (mean age 68.6 years, 54% male) with open-angle glaucoma (primary open-angle glaucoma [POAG] or exfoliation glaucoma [EXG]), and 94 control subjects (mean age 60.1 years, 57% male) who had no eye diseases other than cataracts. The subjects were all cases in which APG was measured using a sphygmograph (TAS9 Pulse Analyzer Plus View; YKC Corp., Tokyo, Japan). The amplitude of waveform types (a, b, c, d, and e-waves) and derived vascular types (A, B, and C) of the accelerated pulse wave components were statistically compared between the cases and controls. Results: The accelerated pulse wave components (mean ± standard deviation) of the control and glaucoma groups were a-wave 785 ± 99 and 776 ± 93 (p = 0.40), b-wave −522 ± 161 and −491 ± 143 (p = 0.050), c-wave −142 ± 108 and −156 ± 105 (p = 0.24), d-wave −288 ± 144 and −322 ± 122 (p = 0.014), and e-wave 103 ± 79 and 90 ± 58 (p = 0.059), with differences between the groups being observed in the b and d-waves. For derived vascular types, compared with the controls and POAG, patients with EXG had a lower frequency of Type A and a higher frequency of Type C than the other groups (p = 0.044). Multivariate analysis showed that factors significantly associated with vascular type included age (p < 0.0001), sex (p < 0.0001), diastolic blood pressure (p = 0.021), and pulse rate (p < 0.0001), while BMI, systolic blood pressure, history of hypertension, history of diabetes, presence or absence of glaucoma, and presence or absence of pseudoexfoliation material were not significant. Conclusions: This is the first study to investigate the relationship between APG and glaucoma with a large sample size. In elderly glaucoma patients, particularly those with EXG, systemic vascular changes are often present. APG parameters may reflect vascular alterations in glaucoma. Full article

Objective: This study aimed to investigate the structural, vascular, and biochemical alterations in patients with pseudoexfoliation syndrome (PES) and pseudoexfoliative glaucoma (PXG) and to evaluate the associations between serum biomarkers, the retinal nerve fiber layer (RNFL), choroidal thickness (CT), and vessel density (VD) in these groups. Methods: All subjects underwent spectral-domain optical coherence tomography (SD-OCT) and OCT angiography (OCTA) to assess RNFL thickness, CT, and VD. Serum levels of inflammatory and oxidative stress biomarkers—including malondialdehyde (MDA), glutathione (GSH), interleukin-6 (IL-6), nitric oxide (NO), inducible NO synthase (iNOS), galectin-3, and SCUBE-1—were analyzed, and regression and ROC curve analyses were performed to evaluate predictive value and diagnostic performance. Results: A total of 80 patients were included and are listed as follows: 25 controls, 30 with PES, and 25 with PXG. There were no significant differences among groups in terms of age or gender. RNFL thickness, CT, and VD were significantly reduced in the PXG group compared to the PES and control groups (p < 0.001). PXG patients showed the most pronounced reductions in both peripapillary and macular CT, as well as superficial and deep VD. Serum iNOS, SCUBE-1, galectin-3, and MDA levels were significantly elevated in PXG, while GSH levels were lower (p < 0.001); NO levels showed no significant differences. In the PES and PXG groups, several ocular parameters correlated significantly with serum biomarkers, particularly iNOS, MDA, and GSH. Regression analysis in PXG patients identified iNOS and MDA as significant predictors of RNFL thickness and VD. ROC analysis demonstrated that MDA and GSH exhibited the highest diagnostic accuracy among the tested biomarkers for distinguishing PXG patients from controls. Conclusions: PXG is associated with significant structural, vascular, and biochemical alterations, including reduced RNFL thickness, choroidal thinning, and decreased VD. Altered serum levels of MDA and GSH were significantly associated with these ocular changes and demonstrated the highest diagnostic accuracy among the biomarkers evaluated. These findings support their potential utility as non-invasive biomarkers for distinguishing PXG from PES and healthy controls and for monitoring disease progression. Full article

This study aimed to determine the microRNA (miRNA) profile extracted from exosomes in plasma samples in pseudoexfoliation (PEX) glaucoma patients compared to controls. A blood sample (10 mL) was obtained after acquiring written informed consent. Exosome was extracted from each plasma sample using an Exoquick-TC kit. RNA sequencing was performed for each exosome sample. A bioinformatics study was conducted for miRNA-related pathways and targets. A total of 14 Korean subjects (7 with PEX glaucoma; 7 age-matched controls) were involved in the final study. In exosomes of PEX glaucoma participants, 330 mature miRNAs were detected. Among these, three miRNAs were significantly upregulated, including hsa-miR-92b-5p (fold change: 24.68), hsa-miR-744-5p (fold change: 2.49), and hsa-miR-148b-3p (fold change: 3.96). Sixty-six miRNAs were significantly downregulated in PEX glaucoma patients compared to the controls (all p < 0.05). These significantly altered miRNAs (both upregulated and downregulated) were associated with the gene ontology (GO) category of neurogenesis (9.41%), which accounted for the largest proportion. The expression of exosomal microRNAs in plasma was significantly different between PEX glaucoma patients and the controls. This suggests their possible roles in the pathogenic mechanism and a good diagnostic marker for PEX glaucoma. Full article

Background/Objectives: To evaluate the long-term efficacy and safety of canaloplasty and phacocanaloplasty in patients with primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PEXG). Methods: This retrospective observational study included 85 patients with POAG and PEXG who underwent canaloplasty (group 1) or phacocanaloplasty (group 2). Every patient had complete medical records over a 10-year follow-up period. The primary endpoints were the pressure-lowering and drug-sparing effects. The secondary endpoints were intra- and postoperative complications as well as the need for additional surgical interventions. Results: In group 1, the mean baseline intraocular pressure (IOP) of 22.1 ± 0.9 mmHg was reduced to 15.3 ± 0.5 mmHg, 15.7 ± 0.5 mmHg, and 15.9 ± 0.7 mmHg at 1, 5, and 10 years, respectively. The mean medication use decreased from 2.4 ± 1.0 before surgery to 0.1 ± 0.5, 0.8 ± 1.1, and 1.4 ± 1.3 at 1,5, and 10 years, respectively. In group 2, IOP was reduced from 20.4 ± 1.5 to 15.6 ± 1.0, 14.3 ± 0.8, and 14.2 ± 1.2 at 1, 5, and 10 years, respectively. The mean medication use dropped from 2.4 ± 1 to 0.3 ± 0.9, 0.9 ± 1.4, and 0.8 ± 1.1 at 1,5, and 10 years, respectively. Goniopuncture was performed postoperatively in nine cases (13.9%) within the initial 3 months due to IOP spikes (POAG n = 6, PEXG n = 3). Patients with PEXG had a significantly higher likelihood of requiring re-operation (HR = 5.11, HR = 5.11, 95% CI 1.05–24.74, p = 0.043). No serious complications were observed. Conclusions: Canaloplasty is a safe and effective procedure for lowering IOP in eyes with POAG and PEXG, achieving approximately a 30% reduction in IOP. PEXG patients are likelier to have IOP spikes in the late postoperative period therefore careful monitoring and management is required. Full article

Background and Objectives: Is it possible to predict the course of disease in patients with pseudoexfoliation based on blood examination? Materials and Methods: This retrospective study included 800 patients recruited for cataract surgery in the Clinic of Ophthalmology, University Clinical Centre Kragujevac, Serbia. The patients were divided into four groups: pseudoexfoliation syndrome early stage group (n = 200 patients), pseudoexfoliation syndrome late stage group (n = 200 patients), pseudoexfoliation glaucoma group (n = 200 patients) and the control group (n = 200 patients). During the preoperative process, some blood examination must be performed. We retrospectively used the results for the blood cell counts that we obtained from the patients. We recorded the neutrophil, lymphocyte, platelet, monocyte and leucocyte numbers, as well as the lipid profile, and simply calculated the ratio of their values, which we considered through different stages of the disease. Results: Our results indicated that there were no significant differences between all the groups examined in terms of leucocyte, neutrophil and lymphocyte count, but we recorded significant differences in the monocyte and platelet count. It was interesting that the monocyte count increased in the late stage of pseudoexfoliation syndrome and pseudoexfoliation glaucoma, in comparison with the control group and patients with early stage pseudoexfoliation syndrome. The lipid profile analysis indicated only increased values of LDL in patients with pseudoexfoliation (syndrome/glaucoma) in comparison with the control group. Conclusions: Monocytes are the main source of various cytokines, so our results support the proinflammatory theory of pseudoexfoliation development. Monocytes are the main cells in chronic inflammation, which leads to pseudoexfoliation syndrome. Platelets play an important role in the differentiation and activation of monocytes, as well as in the process of chronic inflammation and fibrosis, which are significant for pseudoexfoliation material production. A disturbed lipid profile in patients with pseudoexfoliation is expected, as they are at higher risk for cardiovascular and cerebrovascular diseases. Full article

The aim of this study is to present interesting images of a clinical case of asymmetrical bilateral ciliary body cysts associated with pseudoexfoliative syndrome (PEX), leading to unilateral reverse pupillary block and subsequent secondary angle-closure glaucoma in a 64-year-old patient who presented with vision loss and redness, revealing angle-closure glaucoma in the left eye. Slit lamp examination showed an asymmetrical iris configuration between the eyes, with a normal appearance in the right eye and an inverted “volcano-shape” iris appearance, corresponding to reverse pupillary block, with pseudoexfoliation in the left eye. Multimodal imaging confirmed the presence of bilateral ciliary body cysts, which were unexpectedly identified in the right eye. The patient’s secondary angle-closure glaucoma in the left eye was likely due to anterior displacement of the iris from these cysts. Following an inadequate response to topical and systemic treatments, the patient underwent trabeculectomy in the left eye, successfully stabilizing the intraocular pressure (IOP) and leading to the resolution of the reverse pupillary block. This case underscores the importance of thorough ocular examination and multimodal imaging in diagnosing complex clinical presentations like secondary angle-closure glaucoma stemming from the combination of ciliary body cysts’ pressure towards the angle, the pseudoexfoliative material component, and the reverse pupillary block configuration. All of the findings provided critical diagnostic clues leading to the identification of the underlying pathology. Full article

Background and Objectives: The search for less invasive and more effective methods in the surgical treatment of glaucoma continues. For advanced glaucoma, all surgical options carry a high risk of complications and vision loss. The aim of this study was to evaluate the outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) surgery in advanced glaucoma. Materials and Methods: In this retrospective study, advanced open-angle glaucoma (OAG) patients were followed up on the 1st day, 1st week, and 1st month, then monthly for 6 months and then every 3 months after GATT surgery. Outcomes at 6 and 24 months were analyzed to evaluate early and long-term surgical success. Surgical success was defined as a ≥20% intraocular pressure (IOP) reduction from baseline, final IOP ≤21 mmHg, and no need for additional glaucoma surgery. Pre- and postoperative measurements included IOP, retinal nerve fiber layer (RNFL) thickness by optical coherence tomography (OCT), peripapillary vessel density (VD) via optical coherence tomography angiography, and visual field (VF) tests. Results: Among 44 advanced glaucoma patients (61.4% pseudoexfoliative glaucoma), surgical success was 81.8% at 6 months and 76.5% at 24 months. Mean IOP decreased from 26.9 ± 10.4 mmHg preoperatively to 13.8 ± 8.3 mmHg at 3 months (40.36% reduction, p < 0.001) and 13.9 ± 4.0 mmHg at final follow-up (42.12% reduction, p < 0.001). Disease progression was absent in 66% of patients. BCVA initially declined (0.61 ± 0.36 to 0.41 ± 0.33 logMAR at 3 months, p = 0.011) but returned to baseline (0.59 ± 0.35 logMAR at final follow-up, p = 1.00). Glaucoma medications decreased by 66.2%, and peripapillary VD remained stable (p > 0.05). The most common complication was mild hyphema (34.1%), which resolved without intervention; only one patient (2.3%) experienced vision-threatening complications (wipe-out phenomenon in degenerative myopia). Conclusions: GATT is a safe and effective alternative to trabeculectomy for advanced glaucoma, achieving significant IOP reduction with stable VD and low rates of serious complications. This study provides novel insights by offering long-term (24-month) follow-up data, evaluating peripapillary VD stability, and specifically assessing GATT outcomes in an advanced glaucoma cohort. However, caution is advised in patients with additional ocular pathologies. Full article

Background/Objectives: The aim of this paper was to evaluate the two-year outcomes of phacoemulsification combined with gonioscopy-assisted transluminal trabeculotomy (PHACO-GATT) versus standalone GATT in terms of efficacy, safety, and surgical success. Methods: This retrospective, comparative study included 64 eyes of 64 patients with moderate-to-severe open-angle glaucoma: 35 patients (54.7%) with primary open-angle glaucoma (POAG) and 29 patients (45.3%) with pseudoexfoliative glaucoma (PEG). Group 1 (n = 38) underwent PHACO-GATT, and Group 2 (n = 26) underwent standalone GATT. Data, including intraocular pressure (IOP), the number of anti-glaucomatous medications, and complications, were analyzed preoperatively and postoperatively (1st, 3rd, 6th, 12th, and 24th months). Surgical success was defined as achieving a ≥ 20% IOP reduction or IOP ≤ 21 mmHg with or without medications. Results: The mean age was 74.4 ± 7.2 years in Group 1 and 70.8 ± 7.3 years in Group 2. Both groups achieved significant IOP reductions at the 24-month follow-up: Group 1 from 28.6 ± 6.3 mmHg to 12.7 ± 2.4 mmHg, and Group 2 from 27 ± 4.8 mmHg to 13 ± 1.7 mmHg (both p < 0.001). BCVA in Group 1 improved significantly from 0.77 ± 0.29 logMAR to 0.28 ± 0.13 logMAR at 24 months (p < 0.001), while in Group 2, it remained stable at 0.46 ± 0.19 logMAR at baseline and 0.47 ± 0.19 logMAR at 24 months (p > 0.05). The mean number of anti-glaucoma medications decreased significantly in both groups (p < 0.001) without significant intergroup differences (p > 0.05). Complication-free rates were 68.4% in Group 1 and 69.2% in Group 2 (p = 0.899). Surgical success rates were comparable between groups at 12 (100% in both groups) and 24 months (94.7% in Group 1, 96.2% in Group 2). Conclusions: Both PHACO-GATT and standalone GATT demonstrated comparable efficacy and safety over a two-year period. PHACO-GATT provided significant visual acuity improvements due to cataract extraction, making it a suitable option for patients with coexisting cataracts and glaucoma. Full article