Gonioscopy-assisted transluminal trabeculotomy for open-angle glaucoma with failed incisional glaucoma surgery: two-year results

Yiwei Wang; Weijia Zhang; Chen Xin; Jinghong Sang; Yang Sun; Huaizhou Wang

doi:10.1186/s12886-023-02830-7

Gonioscopy-assisted transluminal trabeculotomy for open-angle glaucoma with failed incisional glaucoma surgery: two-year results

BMC Ophthalmol. 2023 Mar 6;23(1):89. doi: 10.1186/s12886-023-02830-7.

Authors

Yiwei Wang^#^{1

2}, Weijia Zhang^#^{3

4

5}, Chen Xin^{2

5}, Jinghong Sang⁵, Yang Sun⁶, Huaizhou Wang⁷

Affiliations

¹ Department of Ophthalmology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, 450003, China.
² Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
³ Department of Ophthalmology, Peking University Third Hospital, Beijing, 100191, China.
⁴ Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, 100191, China.
⁵ Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, No.8 Chongwenmennei Street, Beijing, 100730, Dongcheng District, China.
⁶ Department of Ophthalmology, Stanford University, Palo Alto, CA, 94303, USA.
⁷ Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, No.8 Chongwenmennei Street, Beijing, 100730, Dongcheng District, China. trhz_wang@163.com.

^# Contributed equally.

Abstract

Background: To evaluate the safety and efficacy of gonioscopy-assisted transluminal trabeculotomy (GATT) in treating patients with open-angle glaucoma (OAG) who had failed prior incisional glaucoma surgery.

Methods: A consecutive case series of OAG patients aged ≥ 18 who underwent GATT with previous failed glaucoma incision surgery was retrospectively analyzed. Main outcome measures included intraocular pressure (IOP), the number of glaucoma medications, surgical success rate, and occurrence of complications. Success was defined as an IOP of ≤ 21 mmHg and a reduction of IOP by 20% or more from baseline with (qualified success) or without (complete success) glaucoma medications. For eyes with preoperative IOP of < 21 mmHg on 3 or 4 glaucoma medications, postoperative IOP of ≤ 18 mmHg without any glaucoma medications was also defined as complete success.

Results: Forty-four eyes of 35 patients (21 with juvenile-onset open-angle glaucoma and 14 with adult-onset primary open-angle glaucoma) with a median age of 38 years were included in this study. The proportion of eyes with 1 prior incisional glaucoma surgery was 79.5%, and the others had 2 prior surgeries. IOP decreased from 27.4 ± 8.8 mm Hg on 3.6 ± 0.7 medications preoperatively to 15.3 ± 2.7 mm Hg on 0.5 ± 0.9 medications at the 24-month visit (P < 0.001). The mean IOP and the number of glaucoma medications at each follow-up visit were lower than the baseline (all P < 0.001). At 24 months postoperatively, 82.1% of the eyes had IOP ≤ 18 mmHg (versus 15.9% preoperatively, P < 0.001), 56.4% reached IOP ≤ 15 mmHg (versus 4.6% preoperatively, P < 0.001), and 15.4% achieved IOP ≤ 12 mmHg (compared to none preoperatively, P = 0.009). While 95.5% of eyes took 3 or more medications preoperatively, 66.7% did not take glaucoma medication 24 months after GATT. Thirty-four (77.3%) eyes achieved IOP reduction greater than 20% on fewer medications. The complete and qualified success rates were 60.9% and 84.1%, respectively. No vision-threatening complications occurred.

Conclusions: GATT was safe and effective in treating refractory OAG patients who failed prior incisional glaucoma surgery.

Keywords: GATT; Gonioscopy-assisted transluminal trabeculotomy; Juvenile onset open-angle glaucoma; Minimally invasive glaucoma surgery; Primary open-angle glaucoma; Refractory glaucoma; Treatment.

MeSH terms

Adult
Glaucoma*
Glaucoma, Open-Angle* / surgery
Gonioscopy
Humans
Retrospective Studies
Trabeculectomy*