Outcomes Of Gonioscopy-assisted Transluminal Trabeculotomy Research Articles

Outcomes of gonioscopy-assisted transluminal trabeculotomy in advanced pigmentary glaucoma

PurposeTo compare outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) over a 12-month period with trabeculectomy in patients with advanced pigmentary glaucoma (PG).MethodsThis was a pilot randomised controlled trial of patients with...

Outcomes of Gonioscopy-Assisted Transluminal Trabeculotomy in Eyes With Prior Failed Glaucoma Surgery.

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. To report outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) in eyes with prior failed glaucoma surgery. 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 ≤21/16mmHg without glaucoma medications and qualified with medications. 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±6mmHg (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 16mmHg. The qualified success probability at 1 year was 82% (67-100) for an IOP criterion of 21mmHg and 57% (38-84) for an IOP criterion of 16mmHg. 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 1 week and all by 2 weeks. None needed any intervention. 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 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.

Four-year Surgical Outcomes of Gonioscopy-assisted Transluminal Trabeculotomy in Patients with Open-Angle Glaucoma

To provide 4-year data on the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with open-angle glaucoma. Retrospective case series. Eyes of patients > 18 years of age who underwent GATT by a single surgeon at Wills Eye Hospital with at least 36 months follow-up. Postoperative changes in outcome measures including intraocular pressure (IOP), medication use and visual acuity were recorded. Failure was defined as IOP > 21 mmHg or less than 20% reduction below baseline at any postoperative visit after 3 months or need for further glaucoma surgery. Main outcome measures were failure rate, IOP, number of glaucoma medications, and visual acuity at 4 years. Fifty-nine patients (74 eyes), age 57.1±18.5 years (37.8% female) underwent the GATT procedure. Average follow-up was 47.0±6.7 months (range 35.6-76.5 months). Mean IOP was 27.0±10.0 mmHg preoperatively and 14.8±6.5 mmHg at 4 years (45% IOP decrease; P<0.01). Mean number of medications decreased from 3.2±1.0 preoperatively to 2.3±1.0 at 4 years (P<0.01). The cumulative failure rate at 4 years was 53.9%, and the cumulative reoperation rate was 42.0%. No significant differences between patients with primary open-angle glaucoma and other types of glaucoma were found. Gonioscopy-assisted transluminal trabeculotomy can be a safe and effective conjunctival-sparing surgery for treating various forms of open-angle glaucoma at 4 years. Proprietary or commercial disclosure may be found after the references.

Safety and Efficacy of Resident-Performed Gonioscopy-Assisted Transluminal Trabeculotomy.

GATT can be performed efficaciously and safely by PGY-3 and PGY-4 residents, with clinical outcomes and complication rates that mirror those of attending-performed GATT cohorts from the literature. Report outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) performed by PGY-3 and PGY-4 residents. A retrospective chart review was performed for patients undergoing resident-performed GATT. Eyes with previous traditional glaucoma surgery (trabeculectomy or aqueous shunt) or neovascular glaucoma were excluded from this analysis. The primary aim was to assess whether resident-performed GATTs demonstrated success rates comparable with the GATT literature. Surgical success was defined as intraocular pressure (IOP)<21mmHg, and an IOP reduction of 20% from baseline, and no subsequent IOP-lowering surgery. The secondary and tertiary aims were to describe complication rates and operating times for resident-performed GATTs, respectively. A total of 50 eyes from 40 patients with various types of glaucoma were included. Eyes either underwent resident-performed GATT-alone (N=9) or GATT+cataract extraction with intraocular lens implantation (CEIOL) (N=41). The surgical success rate at 6 months was 71% for GATT-alone and 42% for GATT+CEIOL. Three eyes required subsequent IOP-lowering surgery. The hyphema rate was 16% at postoperative week 1 and 6% at postoperative month 1. The IOP spike (>30mmHg) rate was 18%. Mean surgical time for both GATT-alone and GATT+CEIOL was longer for PGY-4s than for PGY-3s, attributable to less attending assistance during PGY-4 cases and more resident-performed cataracts in PGY-4 GATT+CEIOL cases (85%) compared with PGY-3 cases (35%). GATT can be performed efficaciously and safely by PGY-3 and PGY-4 residents, with clinical outcomes and complication rates that mirror those of attending-performed GATT cohorts from the literature.

Gonioscopy-Assisted Transluminal Trabeculotomy for the Treatment of Glaucoma in Uveitic Eyes

ABSTRACT Purpose To evaluate the outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) in adult eyes with uncontrolled uveitic glaucoma. Methods We reviewed 16 eyes from 13 patients. Surgical success was defined as intraocular pressure (IOP) reduction >20% from baseline or IOP between 5 and 21 mmHg by the 3-month visit while on a stable number or fewer IOP-lowering agents and no need for additional glaucoma surgery. Results At 12 months, the cumulative success rate was 81%. Mean IOP was 37.8 ± 13.0 mmHg at baseline and 12.2 ± 3.0 mmHg at 12 months (68% reduction; p < .0001). The average number of glaucoma medications was 4.6 ± 1.3 at baseline and 2.2 ± 0.7 at 12 months (52% reduction; p < .0001). Transient hyphema was seen in 44% of eyes at 1 week. Conclusions This small retrospective study suggests that GATT is effective and safe as an initial surgical treatment for medically refractory glaucoma in uveitic adult eyes.

Gonioscopy-assisted transluminal trabeculotomy in primary angle-closure glaucoma.

This study aims to report on outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) in eyes with primary angle-closure glaucoma (PACG). This study is a prospective, interventional, non-comparative case series. A total of 103 eyes from 88 patients with PACG underwent an ab interno trabeculotomy, using either a 5.0 polypropylene suture or an illuminated microcatheter, with up to 24months of follow-up. The main outcome measures were intraocular pressure (IOP), number of antiglaucoma medications, success rate (IOP reduction ≥ 20% from baseline or IOP between 6 and 21mmHg, without further glaucoma surgery) and complication rate. The mean preoperative IOP was 21.4 (SD 7.4) mmHg using 2.5 (SD 1.1) glaucoma medications. These decreased postoperatively to 12.1 (SD 2.4) mmHg and 0.8 (SD 1.2) medications, at 24months (P < 0.05). Success rate was 78% at 24months of follow-up, and complication rate was 4.8%. At 24months of follow-up, our results for GATT in PACG demonstrate that this procedure effectively lowers IOP in this subtype of glaucoma, with a low complication rate.

Surgical Outcomes of Gonioscopy-Assisted Transluminal Trabeculotomy (GATT) in Patients with Open-Angle Glaucoma - A Retrospective Case Series.

To evaluate the outcome of gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with open-angle glaucoma (OAG). A retrospective case series of patients with uncontrolled OAG treated by GATT at the cantonal Hospital Lucerne, a tertiary referral center, between October 2018 and July 2019 with a minimal 6-month follow-up period. Main outcome measures were intraocular pressure (IOP), number of antiglaucoma medications, and complications. Thirty-one eyes of 29 patients with a mean age of 70.9 years and a minimal follow-up period of 6 months were included in this study. Twenty eyes were treated for pseudoexfoliation (64.5%), seven for primary open-angle (22.6%), three for pigmentary (9.7%), and one for traumatic (3.2%) glaucoma. Twenty-six eyes had data at the 6-month follow-up and 12 eyes at the 12-month follow-up. Twenty-two eyes (70.9%) were pseudophakic prior to the operation. Mean preoperative IOP was 33 mmHg (standard deviation [SD] 8.0 mmHg). The postoperative IOP was 13.9 mmHg [SD 2.2] at the 6- and 13.9 mmHg [SD 3.1] at the 12-month follow-up. The postoperative IOP evolution translated into a 58% decrease between 6 and 12 months (p < 0.001). Thirteen patients (41.9%) were treated with oral Diamox prior to GATT. The number of antiglaucoma medications decreased from a preoperative average of 2.9 [SD 1.2] to postoperative 1 [SD 1] drug (p < 0.001). The most frequent adverse event was the occurrence of postoperative hyphema. Hyphema was observed in 21 (68.0%), 7 (22.6%), and 2 (6.4%) eyes at days 1, 7, and 30 after GATT, respectively. Intraocular hypertension over 25 mmHg was seen in eight eyes (25.8%), and in four of them, a steroid response was suspected. One patient developed an anterior uveitis and a macular edema. GATT is an effective and safe intervention for OAG, particularly in pseudoexfoliation glaucoma (PEX). The advantages of GATT compared to filtration surgery are the low rate of long-term complications and that the intervention is feasible even when difficult conjunctival conditions are encountered.

Outcomes of gonioscopy-assisted transluminal trabeculotomy in juvenile-onset primary open-angle glaucoma.

To report the outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) for juvenile-onset primary open-angle glaucoma (JOAG). A consecutive case series of JOAG patients who underwent GATT was reviewed with follow-up period of up to 18 months. Intraocular pressure (IOP), number of glaucoma medications and success rate were compared between eyes with and without prior glaucoma surgery, and between mild-to-moderate and severe cases defined based on Humphrey Visual Field mean deviation. In total, 59 eyes of 48 patients were included. Overall, IOP was reduced from 26.5 ± 9.0 mmHg on 3.7 ± 0.9 medications preoperatively to 14.7 ± 3.0 mmHg on 0.7 ± 1.2 medications at 12 months and to 14.1 ± 2.3 mmHg on 0.4 ± 0.8 medications at 18 months postoperatively (P < 0.001). The complete and qualified success rates were 70.8% and 81.2% at 12 months, and 58.6% and 81.2% at 18 months, respectively. Eyes with and without prior glaucoma surgery did not differ significantly in terms of postoperative IOP, glaucoma medication and success rate. In addition, GATT was effective for both mild-to-moderate and severe cases; the latter achieved a surgical success of 79.1%. GATT is effective for JOAG. In particular, this case series suggests that GATT is promising in treating severe JOAG and those with prior glaucoma surgery.

Outcomes of Gonioscopy-assisted Transluminal Trabeculotomy in Vitrectomized Patients With Secondary Glaucoma After Silicone Oil Removal.

The present study demonstrates that surgical success rates of gonioscopy-assisted transluminal trabeculotomy (GATT) with a target intraocular pressure (IOP)≤21 mm Hg are 93.3% (for qualified success) and 26.7% (for complete success) in vitrectomized patients exhibiting secondary open-angle glaucoma (SOAG) after silicone oil (SO) removal, for an average follow-up of 37.5 months. To report the long-term outcomes of GATT in vitrectomized patients exhibiting SOAG after SO removal. Retrospective case-series study. This retrospective case-series study enrolled vitrectomized patients who underwent uneventful GATT surgery between May 2014 and May 2019 at Gazi University Hospital for the treatment of medically uncontrolled SOAG after SO removal. At baseline and at each postoperative visit, a detailed ophthalmic examination consisting of slit-lamp biomicroscopy, indirect ophthalmoscopy, macular optical coherence tomography, and Goldmann applanation tonometry was performed in all patients. Baseline demographic and clinical characteristics, duration between pars plana vitrectomy and SO removal, duration between SO removal and onset of SOAG, follow-up time, need for antiglaucoma medication, visual acuity, and IOP measurements were noted. Surgical success was defined as an IOP≤21 and ≥6 mm Hg with (qualified success) and without (complete success) IOP-lowering medication. A total of 15 patients had a history of pars plana vitrectomy with 1000 centistoke SO tamponade before the GATT surgery. GATT was performed in all patients with SOAG after SO removal. The mean age and follow-up of the patients were 53.6±11.8 years (range, 34 to 72 y) and 37.5±15.1 months (range, 12 to 61 mo), respectively. The average duration of SO tamponade in the vitreous cavity was 7.5±1.6 months (range, 5 to 10 mo). The average duration between the SO removal and the development of SOAG was 14.1±13.2 months (range, 2 to 46 mo). The mean IOP decreased from 31.0±4.1 mm Hg at baseline to 15.6±4.6 mm Hg at final visit. The mean final logMAR BCVA was 0.92±0.58 (range, 2 to 0.045). Qualified surgical success was achieved in 14 (93.3%) patients, whereas complete success was achieved in only 4 (26.7%) patients (P<0.001). GATT seems to be safe and successful procedure for controlling IOP in patients exhibiting SOAG after SO removal. However, most patients may require antiglaucoma medication during the follow-up, particularly within the first 2 postoperative years.

Gonioscopy-Assisted Transluminal Trabeculotomy in Younger to Middle-Aged Adults: One-Year Outcomes

To assess the 1-year surgical outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) in young to middle-aged patients. Retrospective case series. Eyes of patients between 18 and 64 years of age who underwent GATT, with and without concomitant cataract surgery, at 2 academic centers in Montreal, Canada. Success was defined as intraocular pressure (IOP) between 6 and 21 mmHg (criterion A) or between 6 and 18 mmHg (criterion B) and a relative IOP reduction of 20% or more compared with baseline. Failure consisted of not meeting the success criteria at 2 or more consecutive visits after the first postoperative month, reoperation because of uncontrolled IOP or disease progression, or loss of light perception. Predictors of success and postoperative changes in outcome measures, including IOP and medication use, were assessed. Intraoperative and postoperative adverse events were noted. Success, IOP, and medication reduction at the 1-year follow-up and baseline predictors of surgical success. Fifty-six eyes with a mean age of 46.94 ± 11.81 years and preoperative IOP of 27.70 ± 10.30 mmHg taking 3.73 ± 0.98 glaucoma medications were included. At 1 year, IOP decreased from 27.70 ± 10.30 mmHg before surgery to 14.04 ± 3.75 mmHg (49% reduction; P < 0.001) and medication use decreased from 3.73±0.98 medications before surgery to 1.82 ± 1.47 (51% reduction; P < 0.001). The 12-month success was 84% (according to both criteria), and younger age at diagnosis of glaucoma (18-39 years) was predictive of surgical success. The most common postoperative adverse events included transient hyphema, IOP spikes, and transient microcystic corneal edema. A paucity of evidence exists regarding the efficacy of GATT in young to middle-aged adults. Our results highlight that this surgical procedure has good 1-year outcomes with an acceptable safety profile, supported by the significant IOP and medication reduction observed after surgery. With younger age at diagnosis of glaucoma being a predictor of surgical success, the pathophysiologic features of open-angle glaucoma in younger patients may be more localized to the trabecular meshwork, therefore making GATT a particularly suitable procedure for these patients.

Outcomes of gonioscopy-assisted transluminal trabeculotomy in pseudoexfoliative glaucoma: 24-month follow-up

AimTo report on outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) in eyes with pseudoexfoliative glaucoma (PXG).MethodsProspective, interventional, non-comparative case series. A total of 103 eyes from 84 patients with PXG were...

Surgical Outcomes of Gonioscopy-assisted Transluminal Trabeculotomy (GATT) in Patients With Open-angle Glaucoma.

To evaluate the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with open-angle glaucoma. A retrospective chart review of adult patients who underwent GATT due to inadequately controlled intraocular pressure (IOP) or intolerance to medication. Main outcome measures were success rate, IOP, and number of glaucoma medications. Success was defined as IOP reduction >20% from baseline or IOP between 5 to 21 mm Hg, and no need for further glaucoma surgery. When success criteria were not met for any postoperative visit >3 months after surgery, failure was determined. In total, 66 patients, average age 62.9±14.9 years (50.8% female) were included in the analysis. Average follow-up was 11.9 months (range, 3 to 30 mo) and overall success rate was 63.0%. Mean IOP was 26.1±9.9 mm Hg preoperatively and 14.6±4.7 mm Hg at 12 months (44% IOP decrease; P<0.001). Mean number of medications decreased from 3.1±1.1 preoperatively to 1.2±0.9 at 12 months (P<0.001). No significant differences between patients with primary open-angle glaucoma and other types of glaucoma were found.The rate of hyphema at 1 week and 1 month postoperatively was 38% and 6%, respectively. Overall GATT success rate among white and black patients was 69% and 42%, respectively, which was statistically significant (P<0.05). The future of GATT as a minimally invasive glaucoma surgery in adults seems promising. This position is supported by its low rate of long-term complications and the conjunctiva-sparing nature of the surgery.

Outcomes of Gonioscopy-assisted Transluminal Trabeculotomy (GATT) in Eyes With Prior Incisional Glaucoma Surgery.

To report on outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) in eyes with prior incisional glaucoma surgery. A retrospective review was performed for all patients who underwent a GATT procedure with a history of prior incisional glaucoma surgery. Thirty-five eyes of 35 patients were treated. The mean age was 67.7 years. Nineteen eyes had a prior trabeculectomy, 13 eyes had a prior glaucoma drainage device, 4 eyes had a prior trabectome, and 5 eyes had prior endocyclophotocoagulation. Mean follow-up time was 22.7 months. For all eyes, the mean preoperative intraocular pressure (IOP) (SD) was 25.7 (6.5) mm Hg on 3.2 (1.0) glaucoma medications and at 24 months, the mean IOP (SD) was 15.4 (4.9) mm Hg on 2.0 (1.4) glaucoma medications (P<0.001). The prior trabeculectomy group had a preoperative IOP (SD) of 24.6 (6.4) mm Hg on 3.2 (1.0) medications and at month 24, the mean IOP (SD) was 16.7 (5.6) mm Hg on 2.1 (1.4) glaucoma medications. In the prior glaucoma drainage device group, the mean preoperative IOP (SD) was 27.0 (7.1) mm Hg on 3.4 (1.1) glaucoma medications and at 24 months, the mean IOP (SD) was 12.9 (2.6) mm Hg on 2.1 (1.2) glaucoma medications. At 24 months, the cumulative proportion of failure was 0.4 and the cumulative proportion of reoperation was 0.29. GATT appears to be safe and successful in treating 60% to 70% of open-angle patients with prior incisional glaucoma surgery. When considering all eyes, there was a significant decrease in IOP and required glaucoma medications at 24 months. This surgery should be considered in certain patients with open angles who have failed a primary traditional glaucoma surgery.