Two-Year Results of Gonioscopy-Assisted Transluminal Trabeculotomy in Primary Congenital Glaucoma.

Précis: Gonioscopy-assisted transluminal trabeculotomy yielded a 45% reduction in intraocular pressure in primary congenital glaucoma, with a success rate of 86.6%. Hyphema was the most common complication. We did not encounter any vision-threatening complications.

Background

To assess the outcome of gonioscopy-assisted transluminal trabeculotomy (GATT) in primary congenital glaucoma (PCG) and identify the potential prognostic factors for adverse outcomes.

Methods

This prospective study included patients aged <14 years, presenting with PCG from November 2019 till November 2021. We excluded eyes with hazy cornea, secondary glaucoma, peripheral anterior synechiae ≥90 degrees, and eyes in which the extent of GATT was <270 degrees. Success was defined as a final intraocular pressure (IOP) <18 mm Hg with IOP reduction >20%. Primary outcomes were reduction in IOP and medications, secondary outcomes were complications and correlation of IOP reduction and surgical success with possible risk factors.

Results

We included 60 eyes of 50 patients aged 1-156 months (mean: 25.5±36.5). A 353±21 degrees incision was created, with 85% achieving a 360-degree incision. There was a significant reduction in IOP and medications at all follow-up intervals up to 2 years, with a mean of 45% IOP reduction. The final success rate was 86.6%, with 76.7% being controlled without medications. There was a significant positive correlation between the preoperative cup-to-disc ratio (CDR) and failure rates ( P =0.03) and between the incision extent and the IOP reduction (r=0.4, P =0.001). Hyphema was the most common complication, affecting 33%, and resolved spontaneously in all cases. No vision-threatening complications occurred.

Conclusions

GATT is a safe and effective procedure in eyes with PCG and clear cornea, including eyes that had previous failed glaucoma surgery. Circumferential GATT is associated with more favorable outcomes, while eyes with a larger CDR are at a higher risk for failure.