Gonioscopy-Assisted Transluminal Trabeculotomy for Glaucoma: 1-Year Outcomes and Success Predictors. Issue 6 (29th June 2022)

• Record Type: Journal Article
• Authors: Faria, Bruno M.; Costa, Vital P.; Melillo, Gustavo H.L.; Daga, Fabio B.; Scoralick, Ana L.B.; Paranhos, Augusto; Kanadani, Fábio N.; Prata, Tiago S.
• Is Part Of: Journal of glaucoma. Volume 31:Issue 6(2022)
• Page Start: 443
• Page End: 448
• Publication Date: 2022-06-29
• Subjects: open-angle glaucoma -- trabecular meshwork -- aqueous humor; Glaucoma -- Periodicals; 617.741005
• DOI: 10.1097/IJG.0000000000002025
• Languages: English
• ISSNs: 1057-0829

Abstract

Abstract : Précis: Our results suggest gonioscopy-assisted transluminal trabeculotomy (GATT) as an effective and safe option for the surgical management of open-angle glaucoma (OAG). Older age was the only risk factor for failure in our analysis. Purpose: To report 12-month clinical outcomes, safety profile and success predictors of GATT in patients with OAG. Patients and Methods: A retrospective study of patients (18 y old and above) with medically uncontrolled OAG who underwent GATT as a solo procedure or combined with phacoemulsification (PHACO-GATT) between January 2018 and January 2020. Success at 12 months (primary outcome) was defined as intraocular pressure (IOP) <15 mm Hg, with an IOP reduction of at least 20%, OR a reduction of at least 2 glaucoma medications, compared with baseline. Secondary outcomes were success predictors and safety parameters. Results: A total of 73 eyes (GATT=38; PHACO-GATT=35) from 58 patients with a mean age of 54.8±11.6 years were included. Overall, after 12 months of follow-up, the mean IOP was reduced from 24.9±8.5 to 12.1±2.1 mm Hg ( P <0.001). The mean number of glaucoma medications was reduced from 3.5±0.7 to 1.2±1.2 ( P <0.001). The success rate was 87% at 12 months, with no significant differences between GATT (85%) and PHACO-GATT (91%) eyes ( P =0.330). Age was the only factor significantly associated with surgical success (hazard ratio=1.35; P =0.012; after adjusting for preoperative IOP and number of glaucoma medications). Patients older than 60 years had a significant greater chance of failure (hazard ratio=10.96; P =0.026) compared with those younger than 60 years. The most common postoperative complication was transient hyphema (39%; median duration, 5 d). No sight-threatening adverse event was documented. Conclusions: GATT was effective and safe at lowering IOP with or without cataract extraction in OAG. Patients 60 years or older had a higher risk of failure compared with those younger in age.