Gonioscopy-assisted Transluminal Trabeculotomy Research Articles

False Passage of 5-0 Polypropylene Suture into Episcleral Vein during Gonioscopy Assisted Transluminal Trabeculotomy

Gonioscopy-assisted transluminal trabeculotomy (GATT) is a promising cost effective minimally invasive glaucoma surgery (MIGS). The main advantage being safety with regards to low risk for hypotony and its related complications. However, the Schlemm’s canal (SC) based procedures have a different set of complications, the most common being hyphema and transient intraocular pressure spike. The other rare complications being, false passage of the suture by traversing the external wall of the SC into the suprachoroidal space or posterior chamber; or breaching the internal wall of SC into the anterior chamber. Although these complications are rare, knowledge about them is important not only for early identification but for prevention and management if they occur. Through this case report, we describe a rare complication where the suture had traversed through a dilated episcleral vein during GATT. To our knowledge, there has been no prior report of such a complication.

Surgery Outcomes of Prolene Suture Gonioscopy Assisted Transluminal Trabeculotomy (GATT)– up to 4 years follow-up and Prognostic Factors

Precis: Long-term success was achievable after GATT. GATT performed at early stage of glaucoma had better surgery outcomes. Trabeculoplasty may compromise surgery success. Purpose: To evaluate the long-term effectiveness of prolene suture gonioscopy assisted transluminal trabeculotomy (GATT) and identify factors that may affect surgical outcomes. Patients and Methods: This is a retrospective cohort study of adult patients with prolene suture GATT performed by a single surgeon at one medical center. Results: Of the 145 eyes from 124 patients studied, intraocular pressure was reduced from 22.1±7.8 to 15.1±3.2 and 15.1±3.5 mmHg, and the number of glaucoma medications was reduced from 3.2±1.1 to 1.3±1.4 and 1.4±1.5 at postoperative years 3 and 4, respectively. 93 and 71 eyes completed a 3 and 4-year follow-up, with 44% of the eyes at year 4 remaining medication free. Compared to eyes with combined GATT/cataract extraction (CE), eyes with GATT alone had significantly more preoperative medications and a higher reoperation rate (31% vs. 16.5%). Eyes with prior trabeculoplasty had a higher reoperation rate (28.8%) than those without (16.1%). Kaplan-Meier survival analysis revealed that GATT/CE eyes without trabeculoplasty had a longer median time to failure (48 mo) than GATT/CE eyes with trabeculoplasty (18 mo), and GATT eyes with or without trabeculoplasty (9 mo and 12 mo, respectively). Conclusion: Prolene suture GATT successfully reduced IOP. Eyes with more preoperative medications responded less well to GATT. Prior laser trabeculoplasty was associated with poorer outcomes. Further study is needed to verify these findings.

Outcomes of Gonioscopy - Assisted Transluminal Trabeculotomy in Eyes with prior failed Glaucoma Surgery

Purpose: To report outcomes of Gonioscopy - assisted Transluminal Trabeculotomy(GATT) in eyes with prior failed glaucoma surgery. Patients and Methods: A retrospective study involving 30 eyes of 30 patients, all of whom had open angles on gonioscopy, experienced prior glaucoma surgery failures, and subsequently underwent GATT. The primary outcome measure was success defined as complete when the intraocular pressure (IOP) was >5 and ≤21/16 mmHg without glaucoma medications and qualified with medications. Results: The mean age was 51.8±16.1 years. Twenty-one eyes underwent GATT and 9-eyes underwent Phaco-GATT. Twenty-seven eyes had failed trabeculectomy and 3 eyes had failed glaucoma drainage device. Post GATT, the IOP decreased from 27.1±7 to 16.9±6 mmHg (P<0.001) at the end of 15 months, with a mean drop in AGM from 4.9±1.0 to 2±1.6. At postoperative 1-year, the probability of complete success was 20%(95% CI: 9, 43] for an IOP criterion of both 21 and 16 mmHg. The qualified success probability at 1-year was 82%(67,100) for an IOP criterion of 21 mmHg and 57%(38, 84) for an IOP criterion of 16 mmHg. Risk factor for failure was older age (hazard ratio (HR) 1.03, 95% CI;1.01,1.06). The complications noted were hyphema in 14 eyes(46%), majority resolved within one week and all by 2 weeks. None needed any intervention. Conclusions: This study concludes that GATT can be an effective and safe surgical alternative for managing IOP in eyes with prior failed glaucoma surgeries, associated with minimal complications.

Gonioscopy-assisted transluminal trabeculotomy as a primary surgical option for glaucoma in Fuchs uveitis syndrome: A case series.

Fuchs uveitis syndrome (FUS) is a chronic intraocular inflammatory disease. It can lead to glaucoma which can be intractable to both medical and surgical treatment. In the present report, we describe our experience with GATT as a primary surgical option in the treatment of glaucoma secondary to FUS. Four consecutive patients with FUS-associated glaucoma underwent GATT in a single institution. Case 1 was a 28-year-old pseudophakic male with a preoperative intraocular pressure (IOP) of 43 mmHg had unsuccessful circumferential cannulation; his IOP remained high after GATT and received trabeculectomy followed by Ahmed glaucoma valve (AGV) implantation to control IOP. Although IOP was stable following AGV, he required descemet membrane endothelial keratoplasty due to persistent corneal decompansation. He had a stable IOP of 12 mmHg over 21 months. Case 2 was a 42-year-old male with preoperative IOP of 35 mmHg and posterior subcapsular cataract had 360-degree GATT combined with phacoemulsification; his IOP reduced to 14 mmHg over 18 months. Case 3 was an 52-year-old pseudophakic male with a preoperative IOP of 28 mmHg had 360-degree GATT; his IOP remained stable at 10 mmHg over 18 months. Case 4 was an 47-year-old pseudophakic female with a preoperative IOP of 39 mmHg had 360-degree GATT; her IOP remained stable at 14 mmHg over 12 months. GATT may be used as an initial approach in secondary glaucoma due to FUS. But, further evidence is still warranted to better ascertain the usefulness of GATT in this specific patient population.

Bent ab interno needle goniotomy versus gonioscopy-assisted transluminal trabeculotomy in primary open-angle glaucoma: study protocol of a randomized clinical trial

BackgroundMinimally invasive glaucoma surgery (MIGS) is a new class of surgeries, which combines moderate to high success rates and a high safety profile. Bent Ab interno Needle Goniotomy (BANG) and Gonioscopy-Assisted Transluminal Trabeculotomy (GATT) are two low-cost MIGS procedures that communicate the anterior chamber to Schlemm’s canal. Most of the available publications on MIGS are either case series or retrospective studies, with different study protocols. The aim of this manuscript is to describe a randomized clinical trial (RCT) protocol to compare the long-term intraocular pressure (IOP) control and the safety of both procedures in eyes with primary open-angle glaucoma.MethodsThis is a parallel, double-arm, single-masked RCT that includes pseudophakic primary open-angle glaucoma (POAG) eyes. After inclusion criteria, medications will be washed out to verify baseline IOP before surgery. Patients will be randomized to BANG or GATT using a sealed envelope. Follow-up visits will be 1, 7, 15, 30, 60, 90, 180, 330 and 360 days after surgery. On PO330, a new medication washout will be done. The main outcome is the IOP reduction following the procedures. Complimentary evaluation of functional and structural parameters, safety, and quality of life will be done after 30, 90, 180, and 360 days.DiscussionOur study was designed to compare the long-term efficacy and safety of two low-cost MIGS. Most of the published studies on this subject are case series or retrospective cohorts, with different study protocols, which included different types and severities of glaucomas, combined with cataract extraction. Our study only included mild to moderate POAG eyes, with previous successful cataract extraction. Moreover, it provides a standardized protocol that could be replicated in future studies investigating various types of MIGS. This would allow comparison between different techniques in terms of efficacy, safety, and patients’ quality of life.Trial registrationRetrospectively registered at the Registro Brasileiro de Ensaios Clínicos (ReBEC) platform RBR-268ms5y. Registered on July 29, 2023.The study was approved by the Ethics Committee of the University of Campinas, Brazil.

Comparison of GATT versus micropulse transscleral diode laser cyclophotocoagulation combined with GATT in patients with advanced glaucoma.

To compare the efficacy of gonioscopy-assisted transluminal trabeculotomy (GATT) versus micropulse transscleral diode laser cyclophotocoagulation(MP-TDLC) combined with GATT in the treatment of advanced glaucoma. This retrospective comparative study study included 82 patients (82 eyes) with a diagnosis of advanced glaucoma: 36 patients underwent GATT, and 46 underwent GATT + MP-TDLC. Intraocular pressure (IOP) changes in patients who underwent GATT and GATT MP-TDLC were analyzed retrospectively at regular intervals during the 6-month follow-up period. For the 82 patients included in this study, the mean ± SD IOPs before the procedures were 27.2 ± 8.5 mmHg in the GATT group and 26.6 ± 6.9 mmHg in the GATT + MP-TDLC group (p = 0.866), and the numbers of glaucoma medications used were 3.41 ± 0.5 in the GATT group and 3.36 ± 0.4 in the GATT + MP-TDLC group (p = 0.605). The mean IOP after GATT was 13.6 ± 3.9 mmHg at day 1, 13.9 ± 3.7 mmHg at week 1, 14.6 ± 4.0 mmHg at month 1, 15.3 ± 4.3 mmHg at month 3, and 14.7 ± 3.3 mmHg at month 6. In the GATT + MP-TDLC group, the postoperative day 1, week 1, month 1, month 3, and month 6 IOP values were 12.4 ± 2.5, 11.8 ± 1.8, 12.1 ± 2.0, 11.8 ± 1.09, and 11.8 ± 1.5 mmHg, respectively. GATT was found to be effective in the treatment of patients with advanced glaucoma, and results closer to the targeted low teens IOP values were obtained with GATT + MP-TDLC.

Gonioscopy-assisted Transluminal Trabeculotomy in Uveitis-related Ocular Hypertension and Glaucoma.

Gonioscopy-assisted Transluminal Trabeculotomy may be an effective first line surgery for decreasing intraocular pressure and medication burden in patients with uveitis-related ocular hypertension or glaucoma. The purpose of the study is to determine the efficacy of Gonioscopy-assisted transluminal trabeculotomy (GATT) to lower the intraocular pressure (IOP) in uveitis-related ocular hypertension (OHT) or glaucoma. Retrospective case series that included patients with uveitis-related OHT or glaucoma that underwent GATT with or without concomitant cataract extraction and intraocular lens implantation at two Canadian academic centres from July 2018 to May 2022. Primary outcomes were : complete (no medications) and qualified success (with medication), and failure defined as (1) IOP > 21mmHg with maximal medical therapy, (2) the need of additional glaucoma procedure, (3) loss of light perception secondary to glaucoma, (4) IOP < 6mmHg for 3 months. Twenty-one eyes from 18 patients were included with a mean preoperative IOP of 26.2±7.3mmHg on 4.3±0.7 classes of glaucoma drops. Average follow-up was 29.2±17.6 months and 76% of eyes (n=16) had reached at least 12 months of follow-up. At the 12 month follow-up visit, there was a significant decrease in average IOP by 9.9±7.9mmHg (38%, P=0.005) and a decrease of 1.9 in glaucoma medication classes (P=0.002). Fourteen percent of eyes achieved complete success while 80% of eyes achieved qualified success. Six eyes failed (29%) and five patients (24%) required an additional glaucoma surgery. The most common postoperative complication was hyphema (n=9; 43%). This small case series suggests that GATT may be an effective first line surgery for decreasing IOP and medication burden in patients with uveitis-related OHT or glaucoma. Further studies with longer follow-up should be conducted to assess its long-term outcomes.

Uveitic Flare-Ups After Gonioscopy-Assisted Transluminal Trabeculotomy (GATT) in Patients with Uveitic Glaucoma

ABSTRACT Purpose To assess the risk of gonioscopy-assisted transluminal trabeculotomy (GATT) inducing an uveitic flare-up in patients with uveitic glaucoma (UG). Methods This retrospective study included consecutive UG patients who underwent GATT at a single medical center between June 2020 and September 2022. The main outcome measure was the occurrence of a surgery-related uveitic complication defined as either an uveitic flare-up defined by the Standardization of Uveitis Nomenclature (SUN) criteria, or the appearance of cystoid macular edema (CME) from 2 weeks to 3 months after surgery. Results A total of 25 eyes of 22 patients were included in the study. Age ranged from 10–78 and 64% were women. The most common uveitic etiologies were juvenile idiopathic arthritis (JIA, 24%) and herpetic infection (24%). A total of 48%of the patients were on systemic immunosuppressants prior and unrelated to surgery. Eight eyes (32%) had severe glaucomatous damage prior to surgery, and 20% of the patients had undergone previous glaucoma surgery. Two cases (8%) demonstrated uveitic flare-up in the early postoperative period: a case of mild anterior chamber reaction and a case of CME with persistent edema prior to surgery. Average intraocular pressure (IOP) was reduced from 26.7 mm Hg on four medications to 12.2 on 1.1 after 1 year. One patient required reoperation for IOP control. Conclusions With careful pre and postoperative care, GATT seems to be a low-risk procedure for uveitic flare-ups in patients with UG.

Gonioscopy-Assisted Transluminal Trabeculotomy Outcomes Under Different Levels of Glaucoma Severity: A Multicenter, Comparative Study

To evaluate the outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) under different levels of glaucoma severity. Retrospective, multicenter, before-and-after study. One eye from all primary open-angle glaucoma patients who underwent GATT combined with cataract surgery (Phaco-GATT) or GATT stand-alone with 12 months of follow-up were included and divided according to glaucoma severity (mild = GI, moderate = GII, and advanced = GIII) and the outcomes compared. A total of 270 eyes were included: 90 in GI, 75 in GII, and 105 in GIII. The IOP was reduced from 18.6 ± 6.0 mm Hg in GI, 19.7 ± 6.4 mm Hg in GII, and 21.0 ± 7.9 mm Hg in GIII, preoperatively, to 11.9 ± 2.6 mm Hg in GI, 11.8 ± 2.1 mm Hg in GII, and 11.9 ± 3.0 mm Hg in GIII at 12 months postoperatively (P < .001 for all). The number of hypotensive ocular medications were reduced from 2.7 ± 1.0 in GI, 3.1 ± 0.8 in GII, and 3.2 ± 1.2 in GIII to 0.6 ± 0.9 in GI, 1.0 ± 1.1 in GII, and 1.2 ± 1.1 in GIII at the last postoperative visit (P < .001 for all). Relative success was achieved, at 1 year, in 93.8% of the eyes in GI, 89.0% in GII, and 88.1% in GIII (P = .3). Complete success was achieved in 61.8% of the eyes in GI, 43.8% in GII, and 37.6% in GIII (P = .007). No serious adverse event was observed in any group. GATT is a safe and effective procedure in glaucoma, regardless of its preoperative severity.

Outcomes of gonioscopy-assisted transluminal trabeculotomy in primary congenital glaucoma treatment: a retrospective study

BackgroundThis retrospective study aimed to evaluate the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) in Chinese patients with primary congenital glaucoma (PCG) and identify factors influencing surgical success.MethodsFourteen patients (24 eyes) diagnosed with PCG who underwent gonioscopy-assisted transluminal trabeculotomy were recruited, and data on intraocular pressure (IOP), antiglaucoma medication, surgery-related complications, and additional treatments were collected during preoperative and postoperative visits. Surgical success was defined as IOP ≤ 21 mmHg and a reduction of > 30% from baseline, with (partial success) or without (complete success) antiglaucoma medication.ResultsMean preoperative IOP was 30.41 ± 6.09 mmHg. At the final visit, mean IOP reduction was 16.1 ± 9.1 mmHg (52%), and 19 of 24 eyes were topical medication–free. IOP was significantly decreased at each postoperative visit compared with baseline (P < 0.05 for all time points). Cumulative proportions of complete and partial success were 79.2% and 95.8%, respectively, at three years postsurgery. Patients without prior antiglaucoma procedures, without postoperative IOP spikes, and those undergoing complete trabeculotomy exhibited improved surgical prognosis. No permanent vision-threatening complications occurred in the 24 eyes by the end of the respective follow-ups.ConclusionGonioscopy-assisted transluminal trabeculotomy emerged as a safe and effective procedure for PCG treatment, characterized by outstanding IOP reduction efficacy and high surgical success rates.

Anterior Segment Changes and Refractive Outcomes after Cataract Surgery Combined with Gonioscopy-Assisted Transluminal Trabeculotomy in Open-Angle Glaucoma

To compare the accuracy of intraocular lens (IOL) calculation formulas in patients undergoing phacoemulsification combined with gonioscopy-assisted transluminal trabeculotomy (phaco-GATT) and to determine the predictive factors for refractive errors. Fifty-three eyes of 53 patients undergoing phaco-GATT were retrospectively reviewed. The preoperative and postoperative 3-month anterior segment (AS) parameters were measured by Scheimpflug camera. The mean prediction error (PE), mean absolute error (MAE) in the Sanders-Retzlaff-Kraft/theoretical (SRK/T), Barrett- Universal II, Hill-radial basis function (Hill-RBF) and Kane formulas were compared. The influence of biometric parameters on PE were analyzed by correlation analysis. Postoperatively, there was a statistically significant decrease in axial length (AL) and significant enlargement in anterior chamber depth (ACD), anterior chamber angle (ACA), and anterior chamber volume (p<0.001). The mean PE using SRK/T (-0.08 diopters [D]) was more myopic than in the Barret (0.01 D) and Hill-RBF (0.01 D). The PE closest to zero was in the Kane formula (0.001 D). The Kane formula provided a lower MAE (0.30±0.28 D) than the SRK/T (0.38±0.32 D) and Barrett (0.36±0.30 D) (p<0.001). The MAE in Hill-RBF (0.32±0.28) was comparable with that in Kane (p=0.02). Preoperative AL was significantly associated with PE in all formulas except Kane. Barrett was the only formula that did not have a significant correlation between PE and postoperative ACD and ACA. The Kane formula may provide higher predictability of the IOL power calculation than the SRK/T and Barrett-Universal II formulas in phaco-GATT surgery, which can cause significant changes in the AS and AL.

'Intraoperative predictors for clinical outcomes after microinvasive glaucoma surgery".

To evaluate the clinical applicability of intraoperative predictors for surgical outcomes after gonioscopy-assisted transluminal trabeculotomy (GATT) and microincisional trabeculectomy (MIT). Consecutive patients with primary, or secondary glaucoma (trauma, aphakic, or status post-retinal surgeries) with uncontrolled IOP>21mm Hg, who were scheduled to undergo GATT or MIT with or without significant cataract surgery, at a tertiary eye centre in East India between September 2021 to March 2023, were included. All surgeries were done by a single surgeon. Blanching and Trypan blue (0.4%) staining after intracameral injection using a 25 canula, were analysed in each video. The extent/pattern of blanching and blue staining in each eye was analysed objectively using an overlay of a circle with 12 sectors and a protractor tool to quantify the degrees or quadrants of blanching/staining. Multivariate regression was used to identify predictors for surgical success or the need for medications after surgery. Of 167 eyes that were included (male: female- 134: 33), 49 eyes and 118 eyes underwent GATT and MIT, respectively, with 81 of 167 eyes undergoing concurrent cataract surgery. All eyes had a significant reduction in the number of medications after surgery. Blanching was seen in 154 of 167 eyes in a mean of 2±1.8 quadrants with 41% of eyes showing a blanching effect in >3 quadrants. Of 99 of 167 eyes where Trypan blue staining was assessed, staining in a venular, diffuse haze, or reticular pattern of staining was seen in 73 eyes, 26 eyes showed blue staining in >2 quadrants, with 16% staining in >3 quadrants. Surgical success was not predicted by the quadrants of blanching, blue staining, or other clinical variables (age, visual field, baseline intraocular pressure, type of surgery). The variables significantly predicting the need for medications included blanch (r = -0.1, p = 0.03), and blue staining (r = -0.1, p = 0.04) in <2 quadrants. Blanching and Trypan blue staining in >2 quadrants after GATT or MIT can serve as surrogate predictors for the need for medications. However more studies are mandated to find predictors for surgical success after GATT or MIT.

Intraocular pressure spikes after gonioscopy-assisted transluminal trabeculotomy (GATT).

Intraocular pressure (IOP) spikes (IOP > 30mmHg or > 10mmHg above baseline IOP) are a common and worrisome complication of gonioscopy-assisted transluminal trabeculotomy (GATT). The purpose of this study is to identify risk factors for IOP spikes and to describe their characteristics, management, and clinical course in a large cohort of patients. A retrospective, single-center study which included 217 consecutive eyes of patients that underwent GATT between December 2019 and April 2022 with follow-up of at least 90days. IOP spikes occurred in 52 of 217 (24%) eyes. Spikes occurred in 15.5% of patients in whom pre-operative IOP-lowering medications were continued after surgery (90 eyes), and in 29.9% in whom IOP-lowering medications were stopped after surgery (127 eyes). Spikes were diagnosed at a mean of 7.7 ± 6.5days after surgery. All IOP spikes occurred within the first month of surgery. The mean duration of a spike was 4.9 ± 5.4days. Management of IOP spikes included adding a mean of 3.13 ± 1.7 groups of glaucoma medications. Thirty-seven (72.5%) eyes were treated with oral carbonic anhydrase inhibitor, 11 (21.6%) were treated with IV mannitol, and anterior chamber paracentesis was performed in 16 (31.4%). Six (11.8%) eyes underwent additional glaucoma surgery to control IOP. Patients that continued their pre-operative IOP-lowering medications after surgery were 2.3 times less likely to develop a spike as compared to patients who discontinued their medications (P = 0.016). Spikes were found to be a risk factor for failure of GATT. IOP spikes are a common occurrence after GATT. They most commonly appear during the first two post-operative weeks and usually resolve with topical and systemic IOP-lowering treatment. The continuation of IOP-lowering medications after GATT is recommended to lower the risk of IOP spikes.

Comparison of clinical outcomes between gonioscopy-assisted transluminal trabeculotomy and trabeculectomy in advanced-stage pseudoexfoliation glaucoma.

To compare clinical outcomes between gonioscopy-assisted transluminal trabeculotomy (GATT) and trabeculectomy (TRAB) in patients with advanced-stage pseudoexfoliation glaucoma (PEXG). This comparative study comprised 62 patients who underwent GATT (N = 31) or TRAB (N = 31) for advanced-stage PEXG. Primary outcome was cumulative probability of surgical success at the end of 12-month follow-up. Success was determined as intraocular pressure (IOP) reduction ≥ 30% from baseline, IOP between 6 and 18mmHg and IOP upper limits for IOP < 15mmHg and < 12mmHg, separately. Secondary outcomes were IOP reduction, antiglaucoma medication (AGM) use, and complications in the study. Age, sex, cup/disc ratio, mean deviation, pattern standard deviation, and retinal nerve fiber layer thickness did not significantly differ between the groups (p > 0.05 for all). The probability of cumulative surgical success at the end of 12months was similar between the two groups for IOP < 15mmHg and < 18mmHg but significantly higher after TRAB (92.0%) than GATT (82.5%) for IOP < 12mmHg (log-rank test p = 0.035). Percentage of IOP reduction from baseline was similar between the groups (53.1 ± 18.6% in GATT group and 53.0 ± 16.6% in TRAB group, p = 0.98) at the end of 12months. No significant difference in the mean number of AGM was present at the 12-month visit (1.3 ± 1.4 in GATT and 1.1 ± 1.4 in TRAB, p = 0.65). At the end of 12months, IOP reduction rate was similar between GATT and TRAB. Cumulative surgical success was higher after TRAB than GATT for IOP < 12mmHg.

Cost–utility analysis of commonly used anti-glaucoma interventions for mild-to-moderate primary open-angle glaucoma patients in rural and urban China

ObjectiveAn increasing number of studies have explored the clinical effects of antiglaucoma surgical procedures; however, economic evidence was scarce. We aimed to compare the cost-effectiveness between maximal medical treatment (MMT)...

Minimally Invasive Glaucoma Surgery: A Review of the Literature.

Minimally invasive glaucoma surgery (MIGS) has emerged as a novel approach in the glaucoma treatment spectrum, offering a range of diverse procedures and devices aimed at reducing intraocular pressure (IOP). MIGS can be broadly classified into several categories: those that enhance trabecular outflow (Trabectome, iStent, Hydrus Microstent, Kahook Dual Blade, high frequency deep sclerotomy, and gonioscopy-assisted transluminal trabeculotomy), those that augment suprachoroidal outflow (CyPass Microstent and iStent Supra), those that target Schlemm's canal (TRAB360 and the OMNI Surgical System, Streamline, and Ab Interno Canaloplasty), and conjunctival bleb-forming procedures (EX-PRESS Glaucoma Filtration Device, Xen Gel Stent and PreserFlo MicroShunt). MIGS is considered to have a shorter surgical time and fewer severe complications when compared to traditional glaucoma surgeries such as trabeculectomy and glaucoma drainage device implantation (Ahmed, Baerveldt, and Molteno valves). This literature review comprehensively examines the distinct MIGS devices and procedures, their underlying mechanisms, and clinical outcomes, emphasizing the importance of evaluating the efficacy and complications of each approach individually. As the field of MIGS continues to evolve, it is crucial to prioritize high-quality, long-term studies to better understand the safety and effectiveness of these innovative interventions in glaucoma management.

Gonioscopy-assisted transluminal trabeculotomy in patients with advanced glaucoma.

To evaluate the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with advanced glaucoma. Records of 46 patients with advanced glaucoma were reviewed retrospectively in this single-center chart review. The main outcome measure was surgical success; intra-ocular pressure (IOP) and IOP lowering medication use were secondary outcome measures. Success was defined as an IOP of 18 mmHg or lower (criterion A) or 14 mmHg or lower (criterion B) and one of the following: IOP reduction >30% from baseline on the same or fewer medications or IOP ≤ of baseline on fewer medications as compared to baseline. Forty-seven eyes were included in the analysis. The average mean deviation was -17.5 ± 7.2 dB (range -8.0 to -33.0). The average follow-up was 6.8 months (range 3.2-22.3). Success at 6 months was 91% for criterion A and 75% for criterion B (n = 33). Mean IOP was reduced from 19.3 ± 6 mmHg (12-40) on 3.7 ± 1.4 medications to 13.2 ± 5.8 mmHg on 1.6 ± 1.4 medications at the 6th post-operative month (P < 0.001 for both IOP and medications). At the last follow-up visit, 37 patients (78%) had an IOP of 14 mmHg or lower, and ten of these patients were unmedicated. Transient hyphema and IOP spikes were the most prevalent adverse events following surgery. Three eyes required further surgery for IOP control. None of the patients lost vision because of surgery. GATT is a viable surgical option in cases of advanced glaucoma. Careful patient selection and attentive post-operative management are imperative.

Persistent Mydriasis Following Gonioscopy-Assisted Transluminal Trabeculotomy.

Herein we describe 2 cases of persistent mydriasis after gonioscopy-assisted transluminal trabeculotomy for open angle glaucoma. Both surgeries were uneventful, but the patients experienced postoperative hyphema and intraocular pressure elevation. They then developed persistent fixed and dilated pupils resistant to pilocarpine that led to intolerable photosensitivity and glare. An iris cerclage pupilloplasty was performed with adequate relief of symptoms in one case.

Efficacy and Safety Outcomes of XEN Implantation and Gonioscopy-assisted Transluminal Trabeculotomy for the Management of Advanced Open-angle Glaucoma.

Minimally invasive glaucoma surgery (MIGS) is not typically used in patients with advanced-stage glaucoma. This study describes the outcomes and complications of patients with advanced open-angle glaucoma (OAG) who underwent XEN implantation with cataract surgery or gonioscopy-assisted transluminal trabeculotomy (GATT) with cataract surgery. This retrospective study identified patients who had undergone XEN implantation or GATT for the management of advanced OAG. Outcomes included surgical success, intraocular pressure (IOP) reduction, number of topical IOP-lowering drops, visual field mean deviation (MD), best-corrected visual acuity (BCVA), and complications. Surgical success was defined as an IOP of <14 mm Hg and a 20% reduction at 12 months without topical IOP-lowering drops (complete success) or with topical IOP-lowering drops (qualified success). Exactly 70 eyes were enrolled in this study, including 35 who had undergone XEN implantation and 35 who had undergone GATT. The overall surgical success rate was 74.3% (26 of 35) for eyes that underwent XEN implantation and 71.4% (25 of 35) for eyes that underwent GATT. Percent IOP reduction from baseline to 12 months postoperatively was 48% in the XEN cohort and 32% in the GATT cohort. Significant reduction in the use of topical IOP-lowering drops was demonstrated for both XEN (3.26 ± 1.15-1.23 ± 1.28) (p < 0.001) and GATT (2.46 ± 1.12-0.43 ± 0.78) (p < 0.001) cohorts at 12 months postoperatively. The only complication reported was transient hyphema, which occurred in three patients from the XEN group and four from the GATT group, and resolved spontaneously. Both XEN implantation and GATT may be safe and effective management options when treating patients with advanced OAG. However, larger sample sizes are required to make direct statistical comparisons between these techniques. In this study, XEN implantation and GATT combined with cataract surgery were each associated with favorable outcomes in patients with advanced OAG. Ruparelia S, Sharif M, Shoham-Hazon N. Efficacy and Safety Outcomes of XEN Implantation and Gonioscopy-assisted Transluminal Trabeculotomy for the Management of Advanced Open-angle Glaucoma. J Curr Glaucoma Pract 2023;17(2):63-67.

Ab interno canaloplasty versus gonioscopy-assisted transluminal trabeculotomy in open-angle glaucoma: a randomised controlled trial

ObjectiveTo compare the efficacy and safety of ab interno canaloplasty (ABiC) with gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with open-angle glaucoma (OAG).MethodThis randomised clinical trial recruited eyes with OAG and...