Two-Year Outcomes of Goniotomy After Failed Surgery for Glaucoma: A Multicenter Study.
Lin Fengbin, Li Liu, Xiaokaiti Dilimulati, Fan Sujie, Zhang Zhihong, Yang Yangfan, Tang Guangxian, Zhang Hengli, Li Yawen, Song Yunhe
AI Summary
Goniotomy effectively lowered IOP and medication use for two years in patients with prior failed glaucoma surgery, demonstrating a safe, viable option for refractory cases.
Abstract
Purpose
To evaluate the 2-year outcomes of goniotomy (GT) in patients with prior failed glaucoma surgery.
Design
A prospective, observational multicentered study.
Participants
Patients who underwent GT after previous failed glaucoma surgery.
Methods
Patients were enrolled from May 2021 to October 2022. They underwent comprehensive ophthalmic examination, including medical history review, slit lamp examination, best-corrected visual acuity, and intraocular pressure (IOP) assessments preoperatively and postoperatively. Postoperative complications were also evaluated. Complete success was defined as IOP of 6 to 18 mmHg with ≥20% reduction from baseline, without medication. Qualified success required similar IOP control with medication.
Main outcome measures
Intraocular pressure change, medication use, treatment success rate, and postoperative complications over 24 months.
Results
A total of 61 eyes from 51 patients were included, with 20 eyes (17 patients) diagnosed with primary open-angle glaucoma and 41 eyes (34 patients) with primary angle-closure glaucoma as their primary condition. The mean age was 60.6 ± 10.6 years, with 30 (58.8%) female patients. Prior surgeries included peripheral iridectomy (23 eyes), trabeculectomy (39 eyes), XEN Gel implant (1 eye), Ahmed valve implant (1 eye), and phacoemulsification and intraocular lens implantation (17 eyes). Among these, complete success was achieved in 26 eyes (42.6%) and qualified success in 52 eyes (85.2%). The mean IOP dropped from 26.4 ± 6.2 mmHg preoperatively to 16.3 ± 4.8 mmHg at 24 months (35.8% reduction; P < 0.001). Antiglaucoma medications decreased from 2.6 ± 1.2 to 1.4 ± 1.4 over 24 months ( P < 0.001). Best-corrected visual acuity remained stable during the follow-up ( P = 0.987). Complications included hyphema (n = 7), IOP spikes (n = 6), mild corneal edema (n = 3), and shallow anterior chamber (n = 2), all within the first postoperative month. Regression analysis showed that older age was positively correlated with complete success (odds ratio = 1.06; 95% confidence interval, 1.00-1.12; P = 0.044) and qualified success (odds ratio = 1.16; 95% confidence interval, 1.05-1.28; P = 0.004). Primary open-angle glaucoma was negatively associated with qualified success (odds ratio = 0.18; 95% confidence interval, 0.04-0.84; P = 0.029).
Conclusions
Goniotomy proves to be a safe and effective procedure for patients with previous failed glaucoma surgery over the 24-month study period.
Financial disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Shields Classification
Key Concepts6
Goniotomy (GT) achieved complete success (IOP of 6 to 18 mmHg with ≥20% reduction from baseline, without medication) in 26 eyes (42.6%) and qualified success (similar IOP control with medication) in 52 eyes (85.2%) in patients with prior failed glaucoma surgery over a 24-month study period.
The mean intraocular pressure (IOP) in patients undergoing goniotomy after previous failed glaucoma surgery dropped from 26.4 ± 6.2 mmHg preoperatively to 16.3 ± 4.8 mmHg at 24 months (35.8% reduction; P < 0.001).
Antiglaucoma medications decreased from 2.6 ± 1.2 to 1.4 ± 1.4 over 24 months (P < 0.001) in patients who underwent goniotomy after previous failed glaucoma surgery.
Complications of goniotomy in patients with previous failed glaucoma surgery included hyphema (n = 7), IOP spikes (n = 6), mild corneal edema (n = 3), and shallow anterior chamber (n = 2), all occurring within the first postoperative month.
Regression analysis showed that older age was positively correlated with complete success (odds ratio = 1.06; 95% confidence interval, 1.00-1.12; P = 0.044) and qualified success (odds ratio = 1.16; 95% confidence interval, 1.05-1.28; P = 0.004) of goniotomy in patients with previous failed glaucoma surgery.
Primary open-angle glaucoma was negatively associated with qualified success (odds ratio = 0.18; 95% confidence interval, 0.04-0.84; P = 0.029) of goniotomy in patients with previous failed glaucoma surgery.
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