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

Background: Trabeculectomy and minimally invasive glaucoma surgery (MIGS) such as goniotomy aim to reduce intraocular pressure (IOP) and medication burden but are often performed in patients with differing disease severity. Methods: We retrospectively reviewed 100 eyes from 76 adults with glaucoma that underwent either goniotomy (n = 50; Kahook Dual Blade = 42, OMNI = 8) or trabeculectomy ab externo (n = 50) at a tertiary center between May 2022 and June 2023, with at least six months of follow-up. Baseline and six-month IOP, number of medications, and postoperative complications were recorded. Eyes undergoing trabeculectomy had higher preoperative IOP than those undergoing goniotomy (22.6 ± 7.7 vs. 19.1 ± 5.9 mmHg). Results: At six months, trabeculectomy achieved a greater absolute IOP reduction (8.8 ± 0.8 vs. 5.4 ± 0.8 mmHg; p = 0.004), likely reflecting higher baseline IOP, while goniotomy yielded a larger medication reduction (1.47 ± 0.30 vs. 0.72 ± 0.20; p = 0.041). Hyphema occurred more often after trabeculectomy, and the small number of OMNI cases precluded device comparison. Conclusions: In this short-term retrospective series, trabeculectomy achieved larger absolute IOP reduction whereas goniotomy offered greater medication reduction, highlighting the need to individualize surgical choice and confirm these findings in larger prospective studies.