Evaluation of peripheral anterior synechia formation following gonioscopy-assisted transluminal trabeculotomy surgery.

Abstract

To quantitatively assess the development of peripheral anterior synechia (PAS) formation rate and PAS locations on gonioscopic examination following gonioscopy-assisted transluminal trabeculotomy (GATT) surgery and investigate the surgical outcomes. A total of 35 eyes from 31 patients with open angle glaucoma who underwent GATT or combined GATT and phacoemulsification surgery were analyzed. Presence of PAS was assessed on gonioscopy in nasal, temporal, superior and inferior quadrants at months 1, 3 and 6 following surgery. Surgical outcomes were also noted. Frequencies of PAS formation were 38.3%, 25.3%, 17.0% and 19.1% at postoperative 1month, 34.0%, 26.4%, 17% and 22.6% at postoperative 3months and 32.3%, 25.8%, 16.1% and 25.8% at postoperative 6months, in nasal, temporal, superior and inferior quadrants, respectively. The highest amount of PAS involvement was 3 clock hours in the study which was identified only in nasal and inferior quadrants. Frequency of PAS formation did not significantly differ between nasal, temporal, superior and inferior quadrants at all time points (p > 0.05). No significant differences of mean IOP levels were observed between patients who developed PAS and who did not develop PAS at postoperative 1month (p = 0.72), 3months (p = 0.21) and 6months (p = 0.59). The mean IOP and mean number of antiglaucoma medications decreased from 31.5 ± 7.2mmHg and 3.6 ± 0.6 at baseline to 13.8 ± 3.1mmHg and 1.6 ± 1.3 at postoperative 6months, respectively (p < 0.001, for both). Cumulative success rate (95% confidence interval) was 74.3% (69.9-78.6%) at the end of the study. Mild to moderate degrees of hyphema occurred in all cases postoperatively. Although PAS formation was observed to be relatively higher in nasal quadrant, PAS frequency was not statistically different between the angle quadrants.