Long-Term Outcomes of Gonioscopy-Assisted Transluminal Trabeculotomy in Open Angle Glaucoma.

Précis: GATT significantly reduced intraocular pressure and reduced medication use in POAG and PXG patients over 5 years, with high success rates. Previous glaucoma surgeries and early intraocular pressure spikes were risk factors for failure.

Purpose

To evaluate the long-term outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) in managing primary open angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG) over 5 years.

Patients and methods: This retrospective study involved 51 eyes of 42 patients who underwent GATT using prolene suture by a single surgeon with a follow-up duration of at least 5 years.

Results

Mean follow-up duration was 69.0±12.1 months. Mean intraocular pressure (IOP) significantly reduced in POAG patients (n=26), from 27.4±5.6 mmHg to 14.5±1.9 mm Hg ( P <0.001), and in PXG patients (n=25), from 26.4 ± 6.6 mm Hg to 13.3±2.1 mm Hg ( P <0.001) at the final visit. Correspondingly, the average number of antiglaucomatous medications decreased from 3.2±0.7 to 2.1±1.5 in POAG ( P =0.019) and from 3.5±0.7 to 1.5±1.4 in PXG ( P <0.001). The qualified cumulative surgical success rates at a target IOP ≤18 mm Hg were 83.1% (95% CI: 72.5%-93.7%) for POAG and 91.2% (95% CI: 84.7%-97.7%) for PXG, and at a target IOP ≤15 mm Hg were 68.2% (95% CI: 55.0%-81.4%) and 83.5% (95% CI: 74.4%-92.7%), respectively. Factors such as prior incisional glaucoma surgery and higher IOP levels during the first postoperative week were identified as risks for surgical failure.

Conclusion

GATT showed promising long-term efficacy and safety in POAG and PXG patients followed for 5 years, achieving significant reductions in IOP and medication dependence. Prior incisional glaucoma surgery and early postoperative IOP elevations were identified as risk factors for failure.