PEI-GT Trial for Initial Treatment of Primary Open-Angle Glaucoma With Cataract

Inclusion Criteria: * Provides written informed consent voluntarily. * Age 40 to 85 years. * Male or female. * Treatment-naive for glaucoma, with no prior IOP-lowering medication, glaucoma laser procedure, or glaucoma surgery. * Lens opacity causing decreased visual quality and clinically significant cataract. * Diagnosis of POAG combined with cataract by the treating ophthalmologist. * Best-corrected visual acuity of 0.1 or better on the Snellen chart, corresponding to LogMAR 1.0 or less. * Ability and willingness to complete scheduled follow-up visits and study examinations. Exclusion Criteria: * Secondary glaucoma, including uveitic, pseudoexfoliative, pigmentary, steroid-induced, neovascular, traumatic, or other secondary glaucoma. * Angle-closure glaucoma or narrow angle inconsistent with POAG. * POAG without visually significant cataract. * Previous anti-glaucoma medication use, glaucoma surgery, or glaucoma laser treatment. * Advanced visual field loss, defined as visual field mean deviation worse than -12 dB. * Severe ocular comorbidity or inability to perform reliable visual acuity testing. * Known contraindication to required study medications. * Average RNFL thickness or GCIPL thickness less than 54 micrometers. * Axial length greater than 26 mm. * Monocular status or functional vision in only one eye. * Inability to complete reliable visual field or OCT testing. * Systemic disease that may affect ocular status or study assessment, including diabetes mellitus, uncontrolled hypertension, malignancy, renal disease, autoimmune disease, neurological disease, liver disease, cardiovascular disease, or systemic inflammatory disease. * Visual impairment mainly attributable to disease other than POAG or cataract. * Pregnancy, lactation, or planned pregnancy during the study period.