Abstract
BackgroundTo compare the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) and Kahook Dual Blade (KDB) excisional goniotomy in patients with uncontrolled juvenile open-angle glaucoma (JOAG).MethodsThirty-three patients (46 eyes) were included in this single-center, retrospective, comparative study and treated with GATT (36 eyes) or KDB goniotomy (13 eyes). Intraocular pressure (IOP), number of glaucoma medications, adverse events, and additional anti-glaucoma procedures were collected during pre- and postoperative visits. Surgical success was defined as 6 mmHg ≤ IOP ≤ 18 mmHg and ≥ 20% IOP reduction from baseline with (partial success) or without (complete success) IOP-lowering medications.ResultsThe mean ± SD preoperative IOP was 30.48 ± 12.9 mmHg and 26.08 ± 13.1 mmHg (P = 0.164) on 3.71 ± 0.46 and 3.08 ± 0.86 (P = 0.023) glaucoma medications in GATT and KDB group, respectively. At 3 months, the mean ± SD IOP was 15.48 ± 5.93 mmHg and 20.0 ± 10.8 mmHg after GATT and KDB, respectively (P = 0.072). The percentage of IOP lowering from baseline was 44.4 in the GATT group and 14.1 in the KDB group (P = 0.011). The mean reduction in medications was 2.6 ± 1.7 and 0.8 ± 1.2 three months after GATT and KDB, respectively (P < 0.001). Cumulative proportion of partial and complete success were 65.6 and 44.7% in the GATT group, 30.8 and 15.4% in the KDB group at 6 months. Additional procedures were required in 13.9% of cases after GATT and in 61.5% after KDB (P = 0.001). Patients in the GATT group with prior anti-glaucoma procedures and postoperative IOP spikes were more likely to fail, while those with complete trabeculotomy had a better prognosis.ConclusionsReduction of IOP and medications were greater after GATT in uncontrolled JOAG eyes. Whereas, more additional IOP-lowering procedures were required after KDB goniotomy.Trial registrationThis study was registered under the Chinese Clinical Trial Registry (ChiCTR2000034172, 27/06/2020).
Highlights
To compare the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) and Kahook Dual Blade (KDB) excisional goniotomy in patients with uncontrolled juvenile open-angle glaucoma (JOAG)
Data for this analysis were drawn from 46 eyes of 33 patients, 36 eyes/28 patients in the GATT group and 13 eyes/10 patients in the KDB group
Almost all clinical features were comparable between the two groups except that the KDB group had fewer preoperative medications (p = 0.023) and a longer follow-up duration (p = 0.002)
Summary
This was a retrospective case series of JOAG patients who underwent either GATT with a 5–0 prolene suture or goniotomy with KDB by a single experienced glaucoma specialist (JYC) at Eye and ENT Hospital, Fudan University between August 2019 and March 2021. GATT was performed alternating with KDB goniotomy in consecutive patients. A small goniotomy in the nasal TM was created with a microsurgical blade through the temporal site. The tip of a prolene suture was thermally blunted via electrocoagulation and inserted into SC through the goniotomy incision by microsurgical forceps introduced in the temporal site. These included reintroducing the suture into the SC from the original nasal incision in the opposite direction or creating an additional inferior or temporal incision if a 360° trabeculotomy was still not achieved. KDB After placing a temporal incision, the microscope and patient’s head were adjusted as described above. At the end of both procedures, the viscoelastic was removed from the anterior chamber
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