Gonioscopy-assisted transluminal trabeculotomy in patients with moderate-severe staged primary open-angle glaucoma: 24-month outcomes

Authors: Sunil Ruparelia , Darcie Wilson, Nir Shoham-Hazon. Dalhousie Medical School.

Author Disclosures: S. Ruparelia: None. D. Wilson: None. N. Shoham-Hazon: Any direct financial payments including receipt of honoraria; Name of for-profit or not-for-profit organization(s); Abbvie, Bayer, B&L, Iridex, Lightmed, Novartis. Any direct financial payments including receipt of honoraria; Description of relationship(s); Speaker honorarium.
 

Abstract Body:

Purpose: Gonioscopy-assisted transluminal trabeculotomy (GATT) offers a less invasive surgical option for the management of uncontrolled intraocular pressure. However, outcomes of GATT in moderate-severe disease are not well understood. 

Study Design: Retrospective cohort study. 

Methods: This retrospective study identified patients with primary open-angle glaucoma (POAG) who had undergone combined GATT with phacoemulsification by a single surgeon at a single center. Patients with moderate-severe staged POAG were included in the study. Visual field mean deviation on Humphry visual field 24-2 SITA-fast tests were used to classify patients as moderate (-6 to -12 dB) or severe (MD < -12 dB OR loss of central 10 degrees) staged disease. Outcome measures included surgical success, changes in intraocular pressure (IOP), number of topical IOP-lowering drops, best-corrected visual acuity (BCVA), visual field mean deviation (MD) and post-operative complications. Surgical success was defined using two criteria: Criterion A (IOP <17 mmHg and >20% reduction) and Criterion B (IOP <12 mmHg and >20% reduction). 

Results: One hundred and twelve (112) eyes of 112 patients were included in this study. Of these, 91 patients
were followed for 24 months or greater to assess endpoint surgical success. Overall success defined by Criterion A was achieved by 93.4% (85 of 91) patients at 24 months. Success defined by Criterion B was achieved by 30.8% (28 of 91) patients at 24 months. IOP reduction from baseline (21.9 ± 5.8 mmHg) to 24-months follow-up (13.6 ± 2.9 mmHg) was 37.9% for the overall cohort. After initial improvement following surgery, BCVA was stable up to the 24-month endpoint. 

Conclusions: Combined GATT with phacoemulsification was associated with favorable outcomes and a low complication rate for patients with moderate-severe POAG. To the best of the author’s knowledge, this is the largest study to describe the 2-year outcomes of GATT in moderate-severe staged POAG. Our findings suggest that GATT may be safe and effective management technique in patients with moderate-severe staged POAG up to 24-months follow-up.

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