Three-year outcomes of phacogoniotomy versus phacotrabeculectomy for advanced primary angle-closure glaucoma with cataract: A randomized controlled trial
In brief
Phacogoniotomy lowers eye pressure by about 26 mmHg, matching trabeculectomy in advanced angle-closure glaucoma
In a three-year randomized trial of patients with advanced primary angle-closure glaucoma and cataract, phacogoniotomy reduced mean intraocular pressure from 40 mmHg to 14 mmHg, a drop indistinguishable from that achieved with phacotrabeculectomy. Surgical success rates, medication needs, visual outcomes, and complications were comparable, suggesting phacogoniotomy is a viable, less invasive alternative.
- Journal
- Asia-Pacific journal of ophthalmology (Philadelphia, Pa.) (Q1)
- Published
- 26 July 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Fengbin Lin, Yunhe Song, Hengli Zhang, Sujie Fan, Meichun Xiao, Xiaomin Zhu, et al.
- PMID
- 42503334
- DOI
- 10.1016/j.apjo.2026.100353
Why clinicians should know about it
- Picked for Ophthalmology (top studies of the week, 2 August 2026): Phacogoniotomy non‑inferior IOP reduction for PACG
Abstract
PURPOSE: To evaluate the 3-year efficacy and safety of phacogoniotomy versus phacotrabeculectomy for advanced primary angle-closure glaucoma (PACG) with cataract. DESIGN: Multicenter, randomized controlled, open-label, non-inferiority trial. METHODS: Patients were randomized 1:1 to undergo either phacogoniotomy (65 eyes) or phacotrabeculectomy (59 eyes). Three years retention was 92.3% (60/65) and 83.1% (49/59) for each group, respectively. Primary outcome was 3-year intraocular pressure (IOP) reduction (noninferiority margin: 4mmHg). Secondary outcomes included surgical success, complications, hypotensive medications used; additional outcomes were changes in visual acuity (BCVA), VF, and corneal endothelial cell density (ECD). RESULTS: At 3 years, phacogoniotomy reduced mean IOP from 40.2 (10.3) to 14.1 (2.4) mmHg (-26.1 [10.4] mmHg reduction); phacotrabeculectomy, from 39.7 (9.3) to 14.4 (2.5) mmHg (-25.3 [9.2] mmHg reduction). Adjusted between-group difference in IOP change was -0.37mmHg (95% CI, -1.32 to 0.58mmHg; P = 0.44), meeting noninferiority. Complete (78.3% vs 89.8%; P = 0.13) and qualified (90.0% vs 91.8%; P > 0.999) success rates were comparable. Hypotensive medications declined in both groups (phacogoniotomy: 2.1 [1.2] to 0.2 [0.6]; phacotrabeculectomy: 2.1 [1.3] to 0.0 [0.2]; P = 0.06 for 3-year difference). BCVA improvements (0.1 vs 0.0 logMAR; P = 0.49), VF stability (MD difference:1.42dB, P = 0.26; PSD difference: 0.22dB, P = 0.75), and ECD loss (difference: 2%; P = 0.53) were similar. No new complications occurred in extended follow-up. CONCLUSIONS: At 3 years, phacogoniotomy remained non-inferior to phacotrabeculectomy in IOP reduction for advanced PACG with cataract.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.