REVIEW article
Front. Med.
Sec. Ophthalmology
Efficacy and Safety of Goniotomy and Gonioscopy-Assisted Transluminal Trabeculotomy for Exfoliation Glaucoma: A Systematic Review and Single-Arm Meta-Analysis
Weijia Li
Yulei Geng
Kuitang Shi
Guangxian Tang
Xiaowei Yan
Yawen Li
Tianyu Zhang
Jiaming Lu
Shuai Wang
Hengli Zhang
Shijiazhuang People’s Hospital, Shijiazhuang, China
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Abstract
Objective: To assess the efficacy and safety of goniotomy (GT) and gonioscopy-assisted transluminal trabeculotomy (GATT) with or without phacoemulsification(PEI) for exfoliation glaucoma (XFG). Methods: 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. Results: 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%). Conclusion: 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.
Summary
Keywords
exfoliation glaucoma, GATT, Goniotomy, Meta-analysis, minimally invasive glaucoma surgery
Received
03 October 2025
Accepted
09 February 2026
Copyright
© 2026 Li, Geng, Shi, Tang, Yan, Li, Zhang, Lu, Wang and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Hengli Zhang
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