Efficacy of Gonioscopy Assisted Transluminal Trabeculotomy in the Treatment of Uveitic Glaucoma with Respect to Intraocular Pressure and Uveitis Control

Authors: Carol Tadrous , Steven Schendel, Kaivon Vaezi, Kulbir S. Gill, Mahadev Bhalla, Derek Chan, Claudio Perez. University of British Columbia. 

Author Disclosures: C. Tadrous: None. S. Schendel: Any direct financial payments including receipt of honoraria; Name of for-profit or not-for-profit organization(s); Abbvie, Alcon, Glaukos, Labtician, Thea, Bausch and Lomb. Any direct financial payments including receipt of honoraria; Description of relationship(s); Speaker for presentations. Membership on advisory boards or speakers’ bureaus; Name of for-profit or not-for-profit organization(s); Abbvie, Alcon, Labtician, Thea, Bausch and Lomb, Valeo. Membership on advisory boards or speakers’ bureaus; Description of relationship(s); Advisory boards. Funded grants or clinical trials; Name of for-profit or not-for-profit organization(s); Alcon. Funded grants or clinical trials; Description of relationship(s); Funding for retrospective research study. K. Vaezi: None. K.S. Gill: Any direct financial payments including receipt of honoraria; Name of for-profit or not-for-profit organization(s); Abbvie, Labtician Thea. Any direct financial payments including receipt of honoraria; Description of relationship(s); paid consultant. M. Bhalla: None. D. Chan: None. C. Perez: None.

Abstract Body: 

Purpose: To determine the efficacy of gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with uveitic glaucoma with respect to intraocular pressure (IOP) and uveitis control outcomes. 

Study Design: Retrospective chart review. 

Methods: This study is a retrospective chart review of 53 eyes from 41 patients with uncontrolled IOP in the setting of underlying uveitic glaucoma, looking at outcomes post-GATT surgery from July 2017 to October 2022 at a tertiary academic centre in Vancouver, British Columbia. Ethics approval was obtained from the University of British Columbia ethics board. Surgical success is defined as IOP of 21 mmHg or less, >30% reduction from baseline, same or fewer number of ocular hypotensive medications after surgery, and no further glaucoma surgery within one year. We also looked at uveitis control post-GATT surgery, and defined successful control as having the same or a lesser number of corticosteroid and immunomodulatory therapies post-operatively. 

Results: The mean IOP pre-operatively was 34.53 + 10.19 mmHg, and the mean IOP at 3 months post-GATT was 14.13 + 6.19 mmHg. The mean IOP at 1 year post-GATT was 15.63 + 7.96 mmHg. The mean IOP at 2 years post-GATT was 12.42 + 3.55 mmHg. The mean number of IOP-lowering medications was 2.81 + 0.71, and the mean number of IOP-lowering medications post-GATT was 1.73 + 0.98. The mean percent reduction of IOP at 3 months was 56.19% (p-value <0.001). The percent of patients with 30% or more IOP reduction following GATT surgery was 94.23% (n=52 eyes). The percent of patients with the same or fewer number of IOP-lowering medications following GATT surgery was 96.15% (n=52 eyes). The percent of patients with IOP of 21 mmHg or lower 1 year following GATT surgery was 86.67% (n=30 eyes). We found that uveitis control was maintained at 6 months in 83.3% (n=42 eyes) of patients post-GATT surgery. 

Conclusions: This larger study provides further evidence that GATT surgery is successful in patients with uncontrolled intraocular pressures in the context of uveitic glaucoma, and these outcomes were successful throughout an extended period of time. We found that uveitis control was maintained post-operatively in a large proportion of patients, further indicating that this procedure is a safe and effective one in treating patients with uveitic glaucoma.