Outcomes of combined gonioscopy-assisted transluminal trabeculotomy and goniosynechialysis in primary angle closure: a retrospective case series

Ab interno canaloplasty versus gonioscopy-assisted transluminal trabeculotomy in open-angle glaucoma: a randomised controlled trial

OBJECTIVE

To compare the efficacy and safety of ab interno canaloplasty (ABiC) with gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with open-angle glaucoma (OAG).

METHOD

This randomised clinical trial recruited eyes with OAG and no previous incisional ocular surgery, among which 38 were randomised to ABiC and 39 to GATT. Follow-ups were performed at 1, 3, 6 and 12 months postoperatively. The primary outcome measures were intraocular pressure (IOP) and use of glaucoma medication at 12 months postoperatively. The secondary outcome measure was complete surgical success (not requiring glaucoma surgery, IOP ≤21 mm Hg and non-use of glaucoma medications).

RESULTS

Both groups had similar demographic and ocular characteristics. A total of 71 of the 77 subjects (92.2%) completed 12-month follow-up. At 12 months, mean IOP was 19.0±5.2 mm Hg in the ABiC group and 16.0±3.1 mm Hg in the GATT group (p=0.003). Overall, 57.2% of ABiC patients and 77.8% of GATT patients were medication free (p=0.06). The number of glaucoma medications was 0.9±1.3 in the ABiC group and 0.6±1.2 in the GATT group (p=0.27). The 12-month cumulative rate of complete surgical success was 56% in the ABiC group and 75% in the GATT group (p=0.09). Three eyes in the ABiC group and one eye in the GATT group required additional glaucoma surgery. Hyphema (87% vs 47%) and supraciliary effusion (92% vs 71%) were noted more often in the GATT group than in the ABiC group.

CONCLUSIONS

The preliminary result showed that GATT had an advantage over ABiC in IOP reduction for OAG patients, accompanied by favourable safety at 12-month postoperatively.

TRIAL REGISTRATION NUMBER

ChiCTR1800016933.

Canaloplasty and Trabeculotomy Combined With Phacoemulsification for Primary Angle-Closure Glaucoma: A Single-Surgeon Case Series

PURPOSE

To evaluate the outcomes of combined canaloplasty and trabeculotomy with phacoemulsification for primary angle-closure glaucoma (PACG).

METHODS

In this retrospective, consecutive, single-surgeon case series, we analyzed the pre- and postoperative measurements of PACG patients who had the procedure. Adverse events were recorded. The main outcomes were mean intraocular pressure (IOP) in each quartile of the follow-up year and the number of IOP-lowering medications the patients were on by the end of each quartile compared to their baseline values.

RESULTS

 A total of 46 eyes from 39 PACG patients were included. The preoperative IOP and glaucoma medications taken were 19.33±6.03 mm Hg and 1.80±1.39, respectively (N=46). Postoperative IOP means (mm Hg) in the subsequent four quartiles were 14.00±3.33 (N=44), 13.44±2.83 (N=32), 14.38±2.39 (N=16), and 14.92±2.90 (N=13) (p<0.0001). The mean number of meds was 0.32±0.80, 0.22±0.42, 0.59±0.80, and 0.08±0.28 in each respective quartile (p<0.0001), while the median was 0 across all quartiles.

CONCLUSIONS

Combining the OMNI surgical system with phacoemulsification led to substantial reductions in mean IOP and the number of IOP-lowering medications when compared to baseline measurements.

Phacoemulsification with gonioscopy-assisted transluminal trabeculotomy versus phacoemulsification alone in primary angle closure glaucoma: A randomized controlled study

PURPOSE

To assess the safety and efficacy of combining phacoemulsification with gonioscopy-assisted transluminal trabeculotomy (GATT) compared to phacoemulsification alone in the management of primary angle closure glaucoma (PACG).

METHODS

Prospective, institutional study in which eyes requiring surgery for PACG were randomized to undergo phacoemulsification followed by GATT (phaco-GATT group) or phacoemulsification alone. Success was defined as having a final IOP of 6-20 mmHg with no subsequent glaucoma surgery or vision-threatening complications.

RESULTS

Thirty-six eyes underwent phaco-GATT with 360° angle incision and 38 eyes underwent phacoemulsification alone. IOP and glaucoma medications were significantly lower in the phaco-GATT group at 1, 3, 6, 9 and 12 months. The success rate in the phaco-GATT group was 94.4% after 12.16 ± 2.03 months, with 75% of eyes being off medications compared to 86.8% after 12.47 ± 4.27 months in the phaco group, with 42.1% off medications. (p = 0.008). Hyphema and fibrinous anterior chamber reaction were the most common complications in the phaco-GATT group and resolved with conservative treatment or required YAG capsulotomy. Although this delayed visual rehabilitation in the phaco-GATT group, it did not affect the final visual outcome with no significant difference in the final best-corrected visual acuity between both groups (p = 0.25).

CONCLUSION

Combining phacoemulsification with GATT in PACG yielded more favourable outcomes in terms of IOP, glaucoma medications and surgical success. Although the postoperative hyphema and fibrinous reaction may delay visual rehabilitation, GATT further lowers the IOP by breaking residual peripheral anterior synechiae and removing the dysfunctional trabeculum circumferentially, while avoiding the risks inherent in more invasive filtering procedures.

Minimally Invasive Glaucoma Surgery in Primary Angle-Closure Glaucoma

Primary angle-closure glaucoma (PACG) is responsible for half of the glaucoma-related blindness worldwide. Cataract surgery with or without trabeculectomy has been considered to be the first-line treatment in eyes with medically uncontrolled PACG. While minimally invasive glaucoma surgery has become an important surgical approach for primary open-angle glaucoma, its indications and benefits in PACG are less clear. This review summarizes the efficacy and safety profile of minimally invasive glaucoma surgery in PACG to unfold new insights into the surgical management of PACG.

Gonioscopy-Assisted Transluminal Trabeculotomy; A Review

AIM

To review the recent evidence in the literature regarding the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) in the management of pediatric and adult glaucoma.

METHODS

A literature search was performed in the electronic databases of PubMed, Google Scholar, Embase the Register of Controlled Trials, and Ovid Medline for studies evaluating the safety and outcomes of GATT in glaucoma.

RESULTS

GATT is a novel minimally invasive glaucoma surgery that allows the incision of the inner wall of Schlemm's canal increasing aqueous drainage through the physiologic outflow pathway with subsequent intraocular pressure reduction in different types if of glaucoma.

CONCLUSION

GATT demonstrated favorable results in a wide range of both primary and secondary open-angle and angle-closure glaucoma.

Gonioscopy-assisted transluminal trabeculotomy in primary angle-closure glaucoma

PURPOSE

This study aims to report on outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) in eyes with primary angle-closure glaucoma (PACG).

METHODS

This study is a prospective, interventional, non-comparative case series. A total of 103 eyes from 88 patients with PACG underwent an ab interno trabeculotomy, using either a 5.0 polypropylene suture or an illuminated microcatheter, with up to 24 months of follow-up. The main outcome measures were intraocular pressure (IOP), number of antiglaucoma medications, success rate (IOP reduction ≥ 20% from baseline or IOP between 6 and 21 mmHg, without further glaucoma surgery) and complication rate.

RESULTS

The mean preoperative IOP was 21.4 (SD 7.4) mmHg using 2.5 (SD 1.1) glaucoma medications. These decreased postoperatively to 12.1 (SD 2.4) mmHg and 0.8 (SD 1.2) medications, at 24 months (P < 0.05). Success rate was 78% at 24 months of follow-up, and complication rate was 4.8%.

CONCLUSION

At 24 months of follow-up, our results for GATT in PACG demonstrate that this procedure effectively lowers IOP in this subtype of glaucoma, with a low complication rate.