Balancing Pressure and Pills: Short‑Term Outcomes of Goniotomy vs Trabeculectomy in Adult Glaucoma

Glaucoma surgery aims to reduce intraocular pressure (IOP) and medication dependence while minimizing complications. This study compared short-term outcomes of goniotomy versus tra-beculectomy ab externo in adult glaucoma. We conducted a retrospective review of 76 patients (100 eyes) who underwent either goniotomy (n = 50) or trabeculectomy (n = 50) at a tertiary center between May 2022 and June 2023, with a minimum of six months follow-up. Baseline and 6-month IOP, number of glaucoma medications, and postoperative complications (hyphema, in-fection, reoperation) were recorded. T-tests and Fisher’s exact tests were used, with significance set at p < 0.05. Trabeculectomy resulted in a greater mean IOP reduction than goniotomy (8.78 ± 0.84 vs. 5.36 ± 0.81 mmHg, p = 0.004), while goniotomy achieved a larger decrease in medication use (1.47 ± 0.30 vs. 0.72 ± 0.20, p = 0.041). Hyphema occurred more frequently after trabeculecto-my (p = 0.031), whereas infection and reoperation rates were comparable between groups. Device type did not affect goniotomy outcomes. Over six months, trabeculectomy provided superior pressure lowering, while goniotomy offered greater medication reduction. These findings support individualized surgical planning based on baseline IOP, tolerance of medications, and complica-tion risk, with longer-term studies warranted.