Efficacy and Safety of Gonioscopy-Assisted Transluminal Trabeculotomy for Primary Congenital Glaucoma

Abstract

Précis: Gonioscopy-assisted transluminal trabeculotomy (GATT) provided effective intraocular pressure (IOP) control in primary congenital glaucoma (PCG). Also, approximately two third of patients did not need antiglaucoma medication at an average follow-up of 1 year after surgery.Purpose: The purpose of this study was to assess the safety and efficacy of GATT surgery in eyes with PCG. Materials and Methods:This study is a retrospective review of patients who underwent GATT surgery for PCG. Outcome measures were changes in IOP and number of medications at all time points (1,3,6,9,12,18, 24, and 36 mo after surgery), and success rates. Success was defined as IOP < 21 mm Hg with at least a 30% reduction from the baseline, complete if without medications, or qualified if with or without medications. Cumulative success probabilities were analyzed using the Kaplan-Meier survival analyses.Results: Twenty-two eyes of 14 patients diagnosed with PCG were enrolled in this study. The mean IOP reduction was 13.1 mm Hg (57.7%) with a mean decrease of 2 glaucoma medications at the final follow-up. All mean IOP readings during postoperative follow-up were significantly lower than baseline (P < 0.05 for all). Cumulative probability of qualified success was 95.5% and the cumulative probability of complete success was 66.7%. Conclusion:GATT was safe and successfully lowered IOP in patients with PCG with the advantage of avoiding conjunctival and scleral incisions.

Outcomes of Gonioscopy-assisted transluminal trabeculotomy in Primary Congenital Glaucoma Treatment: A Retrospective Study

“…Additionally, our GATT study demonstrated excellent complete and partial success rates, consistent with previous reports [6,7,16,17].…”

“…It is reasonable speculation that a larger incision angle equates to more open areas for aqueous ow, thereby achieving a more optimal IOP-lowering effect. Nevertheless, there are still con icting views on the relationship between incision angle and surgical success rate, as well as its possible mechanisms [7,21,25]. In this study, we attempted a 360° trabeculotomy in each case.…”

“…Angle-based surgery is the primary treatment for PCG, with recent reports suggesting promising outcomes for gonioscopy-assisted transluminal trabeculotomy (GATT) in children with PCG [5][6][7]. GATT belongs to the category of minimally invasive glaucoma surgeries, encompassing ab-interno, conjunctiva-sparing procedures characterized by moderate IOP reduction e cacy and safety [8].…”

Minimally Invasive Glaucoma Surgery

“…Chira-Adisai et al observed a decrease in mean IOP from 21.8 ± 5.4 mm Hg to 14.5 ± 0.8 mm Hg at the 1-year follow-up, with a success rate of 71.8% at the last follow-up 79 . GATT has also been described as an effective approach for the management of uveitic glaucoma, steroid-induced glaucoma (IOP reduction up to 63%), PXG, juvenile OAG, and primary congenital glaucoma 80–85 …”

“…79 GATT has also been described as an effective approach for the management of uveitic glaucoma, steroid-induced glaucoma (IOP reduction up to 63%), PXG, juvenile OAG, and primary congenital glaucoma. [80][81][82][83][84][85] Several studies have demonstrated the strong efficacy of GATT compared with other MIGS. Yalinbas et al compared ab externo trabeculotomy with ab interno trabeculotomy and reported similar IOP reduction at 12 months in both groups.…”