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Zhang X, Chow A, Chen E. Surgery Outcomes of Prolene Suture Gonioscopy-Assisted Transluminal Trabeculotomy (GATT): Up to 4 Years Follow-Up and Prognostic Factors. J Glaucoma 2024; 33:645-651. [PMID: 39207444 DOI: 10.1097/ijg.0000000000002417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/13/2024] [Indexed: 09/04/2024]
Abstract
PRCIS Long-term success was achievable after GATT. GATT performed at early stage of glaucoma had better surgery outcomes. Trabeculoplasty may compromise surgery success. PURPOSE To evaluate the long-term effectiveness of prolene suture gonioscopy-assisted transluminal trabeculotomy (GATT) and identify factors that may affect surgical outcomes. PATIENTS AND METHODS This is a retrospective cohort study of adult patients with prolene suture GATT performed by a single surgeon at 1 medical center. RESULTS Of the 145 eyes from 124 patients studied, intraocular pressure was reduced from 22.1±7.8 to 15.1±3.2 and 15.1±3.5 mm Hg, and the number of glaucoma medications was reduced from 3.2±1.1 to 1.3±1.4 and 1.4±1.5 at postoperative years 3 and 4, respectively. Ninety-three and 71 eyes completed a 3- and 4-year follow-up, with 44% of the eyes at year 4 remaining medication free. Compared with eyes with combined GATT/cataract extraction (CE), eyes with GATT alone had significantly more preoperative medications and a higher reoperation rate (31% vs. 16.5%). Eyes with prior trabeculoplasty had a higher reoperation rate (28.8%) than those without (16.1%). Kaplan-Meier survival analysis revealed that GATT/CE eyes without trabeculoplasty had a longer median time to failure (48 mo) than GATT/CE eyes with trabeculoplasty (18 mo), and GATT eyes with or without trabeculoplasty (9 and 12 mo, respectively). CONCLUSION Prolene suture GATT successfully reduced IOP. Eyes with more preoperative medications responded less well to GATT. Prior laser trabeculoplasty was associated with poorer outcomes. Further study is needed to verify these findings.
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Affiliation(s)
- Xiaoyan Zhang
- Department of Ophthalmology, Kaiser Permanente Medical Group, San Francisco Medical Center, San Francisco, CA
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Magacho L, Franco CGVDS, I EA, Pereira ACA, Teno B, Lucena-Neto F, Faria BM, Vieira JM, Vianello MP, Kanadani FN. Gonioscopy-Assisted Transluminal Trabeculotomy Outcomes Under Different Levels of Glaucoma Severity: A Multicenter, Comparative Study. Am J Ophthalmol 2024; 264:75-84. [PMID: 38432563 DOI: 10.1016/j.ajo.2024.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/22/2024] [Accepted: 02/22/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE To evaluate the outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) under different levels of glaucoma severity. DESIGN Retrospective, multicenter, before-and-after study. METHODS One eye from all primary open-angle glaucoma patients who underwent GATT combined with cataract surgery (Phaco-GATT) or GATT stand-alone with 12 months of follow-up were included and divided according to glaucoma severity (mild = GI, moderate = GII, and advanced = GIII) and the outcomes compared. RESULTS A total of 270 eyes were included: 90 in GI, 75 in GII, and 105 in GIII. The IOP was reduced from 18.6 ± 6.0 mm Hg in GI, 19.7 ± 6.4 mm Hg in GII, and 21.0 ± 7.9 mm Hg in GIII, preoperatively, to 11.9 ± 2.6 mm Hg in GI, 11.8 ± 2.1 mm Hg in GII, and 11.9 ± 3.0 mm Hg in GIII at 12 months postoperatively (P < .001 for all). The number of hypotensive ocular medications were reduced from 2.7 ± 1.0 in GI, 3.1 ± 0.8 in GII, and 3.2 ± 1.2 in GIII to 0.6 ± 0.9 in GI, 1.0 ± 1.1 in GII, and 1.2 ± 1.1 in GIII at the last postoperative visit (P < .001 for all). Relative success was achieved, at 1 year, in 93.8% of the eyes in GI, 89.0% in GII, and 88.1% in GIII (P = .3). Complete success was achieved in 61.8% of the eyes in GI, 43.8% in GII, and 37.6% in GIII (P = .007). No serious adverse event was observed in any group. CONCLUSIONS GATT is a safe and effective procedure in glaucoma, regardless of its preoperative severity.
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Affiliation(s)
- Leopoldo Magacho
- From the Department of Ophthalmology, Federal University of Goiás (CEROF-UFG) (L.M., C.G.V.d.S.F., E.A.I.), Goiânia, Goiás, Brazil; VER Hospital (L.M.), Goiânia, Goiás, Brazil.
| | | | - Eduardo Akio I
- From the Department of Ophthalmology, Federal University of Goiás (CEROF-UFG) (L.M., C.G.V.d.S.F., E.A.I.), Goiânia, Goiás, Brazil
| | - Ana Cláudia Alves Pereira
- Department of Ophthalmology, Federal University of Mato Grosso do Sul (A.C.A.P.), Campo Grande, Mato Grosso do Sul, Brazil; Eye Hospital of Mato Grosso do Sul (A.C.A.P.), Campo Grande, Mato Grosso do Sul, Brazil
| | - Bruno Teno
- D'Olhos Day Hospital, São José do Rio Preto (B.T., F.L.-N.), São Paulo, Brazil
| | | | - Bruno M Faria
- Marco Rey Ophthalmology Institute (B.M.F.), Natal, Rio Grande do Norte, Brazil; Department of Ophthalmology, Federal University of Rio Grande do Norte (B.M.F.), Natal, Rio Grande do Norte, Brazil
| | - Júlia Maggi Vieira
- Glaucoma Institute (J.M.V., F.N.K.), Belo Horizonte, Minas Gerais, Brazil
| | - Marcos Pereira Vianello
- Department of Ophthalmology, Federal University of São Paulo, São Paulo (M.P.V., F.N.K.), São Paulo, Brazil
| | - Fábio N Kanadani
- Glaucoma Institute (J.M.V., F.N.K.), Belo Horizonte, Minas Gerais, Brazil; Department of Ophthalmology, Federal University of São Paulo, São Paulo (M.P.V., F.N.K.), São Paulo, Brazil; Department of Ophthalmology, Mayo Clinic (F.N.K.), Jacksonville, Florida, USA
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Gunay M, Cigiltepe IB, Turk A, Uzlu D, Kose B. A Prospective Comparison of 180 Versus 360-Degree Gonioscopy-Assisted Transluminal Trabeculotomy Outcomes in Pseudoexfoliation Glaucoma. J Glaucoma 2024; 33:559-565. [PMID: 38587449 DOI: 10.1097/ijg.0000000000002391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/16/2024] [Indexed: 04/09/2024]
Abstract
PRCIS Analysis of surgical success and intraocular pressure (IOP), best-corrected visual acuity (BCVA), and antiglaucomatous medication (AGM) changes between segmental 180-degree and 360-degree gonioscopy-assisted transluminal trabeculectomy (GATT) in patients with pseudoexfoliation glaucoma (PEXG) showed no significant difference. OBJECTIVE To compare surgical outcomes of segmental 180-degree and 360-degree GATT in patients with PEXG. MATERIALS AND METHODS Prospective, comparative study of 65 PEXG eyes, who underwent segmental 180-degree GATT (GATT 180-degree group, 31 eyes) and 360-degree GATT (GATT 360-degree group, 34 eyes) in a tertiary academic center over a 12-month of follow-up. Primary outcome was qualified and complete surgical success rates for criterion A (IOP <18 mm Hg and >30% reduction) and criterion B (IOP <15 mm Hg and >30% reduction). Secondary outcome measures included IOP reduction, BCVA change, AGM use, and postoperative complications. RESULTS The probabilities of qualified and complete success rates both for criteria A and B did not significantly differ between the groups ( P > 0.05). IOP and BCVA levels were similar at each time point ( P > 0.05). IOP reduction was 59.3 ± 9.5% in the GATT 180-degree group and 55.8 ± 18.1% in the GATT 360-degree group ( P = 0.33). No significant difference in the mean number of AGM was present at the 12-month visit (1.2 ± 1.1 in GATT 180-degree group vs 1.5 ± 1.2 in GATT 360-degree group, P = 0.25). Significantly higher incidences of postoperative hyphema and IOP spikes were observed in the GATT 360-degree group ( P = 0.01 and P = 0.008, respectively). CONCLUSION Both segmental 180-degree and 360-degree GATT similarly reduced IOP and AGM with comparable surgical success rates in patients with PEXG at the end of 12 months. Postoperative hyphema and IOP spike rates were significantly higher after 360-degree GATT. Segmental 180-degree GATT may be sufficient to adequately modulate IOP with a lower incidence of postoperative complications in PEXG.
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Affiliation(s)
- Murat Gunay
- Department of Ophthalmology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
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Naftali Ben Haim L, Yehezkeli V, Abergel Hollander E, Dar N, Sharon T, Belkin A. Intraocular pressure spikes after gonioscopy-assisted transluminal trabeculotomy (GATT). Graefes Arch Clin Exp Ophthalmol 2024; 262:927-935. [PMID: 37843563 DOI: 10.1007/s00417-023-06265-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 09/24/2023] [Accepted: 09/28/2023] [Indexed: 10/17/2023] Open
Abstract
PURPOSE Intraocular pressure (IOP) spikes (IOP > 30 mmHg or > 10 mmHg above baseline IOP) are a common and worrisome complication of gonioscopy-assisted transluminal trabeculotomy (GATT). The purpose of this study is to identify risk factors for IOP spikes and to describe their characteristics, management, and clinical course in a large cohort of patients. METHODS A retrospective, single-center study which included 217 consecutive eyes of patients that underwent GATT between December 2019 and April 2022 with follow-up of at least 90 days. RESULTS IOP spikes occurred in 52 of 217 (24%) eyes. Spikes occurred in 15.5% of patients in whom pre-operative IOP-lowering medications were continued after surgery (90 eyes), and in 29.9% in whom IOP-lowering medications were stopped after surgery (127 eyes). Spikes were diagnosed at a mean of 7.7 ± 6.5 days after surgery. All IOP spikes occurred within the first month of surgery. The mean duration of a spike was 4.9 ± 5.4 days. Management of IOP spikes included adding a mean of 3.13 ± 1.7 groups of glaucoma medications. Thirty-seven (72.5%) eyes were treated with oral carbonic anhydrase inhibitor, 11 (21.6%) were treated with IV mannitol, and anterior chamber paracentesis was performed in 16 (31.4%). Six (11.8%) eyes underwent additional glaucoma surgery to control IOP. Patients that continued their pre-operative IOP-lowering medications after surgery were 2.3 times less likely to develop a spike as compared to patients who discontinued their medications (P = 0.016). Spikes were found to be a risk factor for failure of GATT. CONCLUSIONS IOP spikes are a common occurrence after GATT. They most commonly appear during the first two post-operative weeks and usually resolve with topical and systemic IOP-lowering treatment. The continuation of IOP-lowering medications after GATT is recommended to lower the risk of IOP spikes.
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Affiliation(s)
- Liron Naftali Ben Haim
- Department of Ophthalmology, Meir Medical Center, 59 Tshernehovsky St, 4428164, Kfar Saba, Israel.
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Veronika Yehezkeli
- Department of Ophthalmology, Meir Medical Center, 59 Tshernehovsky St, 4428164, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eden Abergel Hollander
- Department of Ophthalmology, Meir Medical Center, 59 Tshernehovsky St, 4428164, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nimrod Dar
- Department of Ophthalmology, Meir Medical Center, 59 Tshernehovsky St, 4428164, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Sharon
- Department of Ophthalmology, Meir Medical Center, 59 Tshernehovsky St, 4428164, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avner Belkin
- Department of Ophthalmology, Meir Medical Center, 59 Tshernehovsky St, 4428164, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Yu S, Xu K, Zhang C. Efficacy and safety of Usights UC100 illuminated microcatheter in microcatheter-assisted trabeculotomy. Int J Ophthalmol 2024; 17:272-277. [PMID: 38371259 PMCID: PMC10827615 DOI: 10.18240/ijo.2024.02.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 11/29/2023] [Indexed: 02/20/2024] Open
Abstract
AIM To evaluate the efficacy and safety of Usights UC100 illuminated microcatheter in microcatheter-assisted trabeculotomy (MAT). METHODS Totally 10 eyes of 10 patients with primary open angle glaucoma (POAG) who underwent MAT facilitated by Usights UC100 (5 eyes) or iTrack (5 eyes) were reviewed. The success of this surgery was defined as intraocular pressure (IOP) <22 mm Hg with >30% reduction, without oral glaucoma medications, or additional glaucoma surgery. RESULTS The mean pre-operative IOP was 25.38±10.22 mm Hg in the Usights UC100 group and 19.98±3.87 mm Hg in the iTrack group. MAT was achieved in all eyes in both groups. The success rates for the Usights UC100 group and iTrack groups were in all and 4 eyes, respectively. Both microcatheters produced a statistically significant reduction in IOP, and eyes using Usights UC100 achieved a lower IOP than the iTrack group at 3mo follow-up (12.58±1.52 and 14.84±1.89 mm Hg, respectively), but no statistical significance was there. No severe side effects were observed in either group. CONCLUSION MAT using Usights UC100 or iTrack both achieve significant pressure reduction in cases of POAG, and Usights UC100 is as safe as iTrack.
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Affiliation(s)
- Shuo Yu
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing 100191, China
| | - Ke Xu
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing 100191, China
| | - Chun Zhang
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing 100191, China
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Zhang Y, Yu P, Zhang Y, Sugihara K, Zhu X, Zhang Y, Yang X, Li X, Liu Y, Zhang H, Yan X, Zhang H, Lin F, Song Y, Gao X, Yuan H, Tang G, Zhou W, Fan S, Dang G, Tang L, Chen W, Wang N, Park KH, Barton K, Aung T, Lam DSC, Weinreb RN, Xie L, Tanito M, Zeng L, Zhang X. Influence of Goniotomy Size on Treatment Safety and Efficacy for Primary Open-Angle Glaucoma: A Multicenter Study. Am J Ophthalmol 2023; 256:118-125. [PMID: 37573988 DOI: 10.1016/j.ajo.2023.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 08/15/2023]
Abstract
PURPOSE To compare the efficacy and safety of 120-, 240-, and 360-degree goniotomy (GT) with or without phacoemulsification with intraocular lens implantation (PEI) for patients with primary open-angle glaucoma (POAG). DESIGN Multicenter, retrospective, comparative, nonrandomized interventional study. METHODS Patients diagnosed with POAG who underwent GT with or without PEI were included, and divided into 6 groups: 1) standalone 120-degree GT (120GT); 2) standalone 240-degree GT (240GT); 3) standalone 360-degree GT (360GT); 4) PEI + 120GT; 5) PEI + 240GT; and 6) PEI + 360GT. Data on intraocular pressure (IOP), the number of ocular hypotensive medications, and complications were collected and compared. Success was defined as a postoperative IOP within the range of 6 to 18 mm Hg and a 20% reduction from baseline without further glaucoma surgery. Complete success and qualified success were defined as the above without and with ocular hypotensive medications, respectively. RESULTS Three hundred eight eyes of 231 patients were included with a mean follow-up of 14.4 ± 8.6 months (6.0-48.0 months). There were no significant differences in the reductions in IOP and number of medications and cumulative survival probability for complete and qualified success rates among the 3 groups of standalone GT and PEI + GT. The 360GT group had the highest proportion of hyphema with or without PEI. CONCLUSIONS 120GT, 240GT, and 360GT with or without PEI showed similar efficacy in reducing IOP and medications used in POAG. 360GT with or without PEI was more likely to cause hyphema compared with 120GT or 240GT. 120GT with or without PEI was sufficient for treating POAG with or without cataract..
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Affiliation(s)
- Yu Zhang
- From the State Key Laboratory of Ophthalmology (Yu Zhang, Yingzhe Zhang, F.L., Y.S., X.G., W.C., Xiulan Zhang), Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Ping Yu
- Department of Ophthalmology (P.Y., L.Z.), Chengdu First People's Hospital, Chengdu, Sichuan, China
| | - Yingzhe Zhang
- From the State Key Laboratory of Ophthalmology (Yu Zhang, Yingzhe Zhang, F.L., Y.S., X.G., W.C., Xiulan Zhang), Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Kazunobu Sugihara
- Department of Ophthalmology (K.S., M.T.), Shimane University Faculty of Medicine, Izumo, Japan
| | - Xiaomin Zhu
- Department of Ophthalmology (X.Z., L.X.), The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yao Zhang
- Department of Ophthalmology (Yao Zhang, L.T.), West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xiao Yang
- Jinan Mingshui Eye Hospital (X.Y., X.L., S.F.), Jinan, Shandong, China
| | - Xiaoyan Li
- Department of Ophthalmology (X.L.), Handan City Eye Hospital (The Third Hospital of Handan), Handan, Hebei, China
| | - Yacong Liu
- Cangzhou Aier Eye Hospital (Y.L., W.Z.), Aier Eye Hospital Group, Cangzhou, Hebei, China
| | - Hengli Zhang
- Department of Ophthalmology (Hengli Zhang, X.Y., G.T.), Shijiazhuang People's Hospital, Shijiazhuang, Hebei, China
| | - Xiaowei Yan
- Department of Ophthalmology (Hengli Zhang, X.Y., G.T.), Shijiazhuang People's Hospital, Shijiazhuang, Hebei, China
| | - Hengkai Zhang
- Department of Ophthalmology (Hengkai Zhang, H.Y.), The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Fengbin Lin
- From the State Key Laboratory of Ophthalmology (Yu Zhang, Yingzhe Zhang, F.L., Y.S., X.G., W.C., Xiulan Zhang), Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Yunhe Song
- From the State Key Laboratory of Ophthalmology (Yu Zhang, Yingzhe Zhang, F.L., Y.S., X.G., W.C., Xiulan Zhang), Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Xinbo Gao
- From the State Key Laboratory of Ophthalmology (Yu Zhang, Yingzhe Zhang, F.L., Y.S., X.G., W.C., Xiulan Zhang), Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Huiping Yuan
- Department of Ophthalmology (Hengkai Zhang, H.Y.), The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Guangxian Tang
- Department of Ophthalmology (Hengli Zhang, X.Y., G.T.), Shijiazhuang People's Hospital, Shijiazhuang, Hebei, China
| | - Wenzong Zhou
- Cangzhou Aier Eye Hospital (Y.L., W.Z.), Aier Eye Hospital Group, Cangzhou, Hebei, China
| | - Sujie Fan
- Department of Ophthalmology (X.L.), Handan City Eye Hospital (The Third Hospital of Handan), Handan, Hebei, China
| | - Guangfu Dang
- Department of Ophthalmology (G.D.), The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China
| | - Li Tang
- Department of Ophthalmology (Yao Zhang, L.T.), West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Weirong Chen
- From the State Key Laboratory of Ophthalmology (Yu Zhang, Yingzhe Zhang, F.L., Y.S., X.G., W.C., Xiulan Zhang), Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Ningli Wang
- Beijing Tongren Eye Center (N.W.), Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ki Ho Park
- Department of Ophthalmology (K.H.P.), Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Keith Barton
- NIHR Biomedical Research Centre (K.B.), Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, United Kingdom
| | - Tin Aung
- Singapore Eye Research Institute (T.A.), Singapore National Eye Center, Singapore, Republic of Singapore
| | - Dennis S C Lam
- International Eye Research Institute of The Chinese University of Hong Kong (Shenzhen) (D.S.C.L.), Shenzhen, China
| | - Robert N Weinreb
- Hamilton Glaucoma Center (R.N.W.), Viterbi Family Department of Ophthalmology, and Shiley Eye Institute, University of California San Diego, La Jolla, California, USA
| | - Lin Xie
- Department of Ophthalmology (X.Z., L.X.), The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Masaki Tanito
- Department of Ophthalmology (K.S., M.T.), Shimane University Faculty of Medicine, Izumo, Japan
| | - Liuzhi Zeng
- Department of Ophthalmology (P.Y., L.Z.), Chengdu First People's Hospital, Chengdu, Sichuan, China.
| | - Xiulan Zhang
- From the State Key Laboratory of Ophthalmology (Yu Zhang, Yingzhe Zhang, F.L., Y.S., X.G., W.C., Xiulan Zhang), Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China.
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Ruparelia S, Wilson D, Shoham-Hazon N. Hemi-GATT combined with phacoemulsification in patients with moderate-severe primary open-angle glaucoma: 2-year outcomes. Graefes Arch Clin Exp Ophthalmol 2023; 261:3257-3262. [PMID: 37421482 DOI: 10.1007/s00417-023-06166-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/20/2023] [Accepted: 06/28/2023] [Indexed: 07/10/2023] Open
Abstract
PURPOSE To describe the outcomes of inferior hemisphere 180° gonioscopy-assisted transluminal trabeculotomy (hemi-GATT) in patients with moderate-severe stage primary open-angle glaucoma (POAG). METHODS This single center, retrospective study identified patients with POAG who had undergone combined inferior hemi-GATT with phacoemulsification. Patients with moderate-severe staged POAG were included in the study. Outcome measures included surgical success, intraocular pressure (IOP), number of topical IOP-lowering drops, best-corrected visual acuity (BCVA), visual field mean deviation (MD) and complications. Success was defined using two criteria: Criterion A (IOP <17 mmHg and >20% reduction) and Criterion B (IOP <12 mmHg and >20% reduction). RESULTS One hundred-twelve eyes of 112 patients were included in this study. Of these, 91 patients were followed for 24 months or greater to assess endpoint surgical success. Kaplan-Meier survival analysis for Criterion A demonstrated a 64.8% probability of success without topical IOP-lowering therapy (complete success) and a 93.4% probability of success with or without topical IOP-lowering therapy (qualified success). Probabilities of complete and qualified success using Criterion B were 26.4% and 30.8%, respectively. IOP reduction from baseline (21.9 ± 5.8 mmHg) to 24-month follow-up (13.6 ± 3.9 mmHg) was 37.9% for the overall cohort. The most common complication was transient hyphema, which occurred in 25.9% (29 of 112) of patients. All cases of hyphema resolved spontaneously. CONCLUSIONS Combined hemi-GATT with phacoemulsification was associated with favorable outcomes and a low complication rate in this study of patients with moderate-severe POAG. Further studies are required comparing hemi-GATT to the 360° approach.
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Affiliation(s)
- Sunil Ruparelia
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Darcie Wilson
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Nir Shoham-Hazon
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Miramichi EyeNB Centre of Excellence, Miramichi, New Brunswick, Canada
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8
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Gunay M, Turk A, Ozturk H, Bulanik FT, Uzlu D. Evaluation of peripheral anterior synechia formation following gonioscopy-assisted transluminal trabeculotomy surgery. Int Ophthalmol 2023:10.1007/s10792-023-02704-3. [PMID: 37062015 DOI: 10.1007/s10792-023-02704-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 04/09/2023] [Indexed: 04/17/2023]
Abstract
PURPOSE To quantitatively assess the development of peripheral anterior synechia (PAS) formation rate and PAS locations on gonioscopic examination following gonioscopy-assisted transluminal trabeculotomy (GATT) surgery and investigate the surgical outcomes. METHODS A total of 35 eyes from 31 patients with open angle glaucoma who underwent GATT or combined GATT and phacoemulsification surgery were analyzed. Presence of PAS was assessed on gonioscopy in nasal, temporal, superior and inferior quadrants at months 1, 3 and 6 following surgery. Surgical outcomes were also noted. RESULTS Frequencies of PAS formation were 38.3%, 25.3%, 17.0% and 19.1% at postoperative 1 month, 34.0%, 26.4%, 17% and 22.6% at postoperative 3 months and 32.3%, 25.8%, 16.1% and 25.8% at postoperative 6 months, in nasal, temporal, superior and inferior quadrants, respectively. The highest amount of PAS involvement was 3 clock hours in the study which was identified only in nasal and inferior quadrants. Frequency of PAS formation did not significantly differ between nasal, temporal, superior and inferior quadrants at all time points (p > 0.05). No significant differences of mean IOP levels were observed between patients who developed PAS and who did not develop PAS at postoperative 1 month (p = 0.72), 3 months (p = 0.21) and 6 months (p = 0.59). The mean IOP and mean number of antiglaucoma medications decreased from 31.5 ± 7.2 mmHg and 3.6 ± 0.6 at baseline to 13.8 ± 3.1 mmHg and 1.6 ± 1.3 at postoperative 6 months, respectively (p < 0.001, for both). Cumulative success rate (95% confidence interval) was 74.3% (69.9-78.6%) at the end of the study. Mild to moderate degrees of hyphema occurred in all cases postoperatively. CONCLUSION Although PAS formation was observed to be relatively higher in nasal quadrant, PAS frequency was not statistically different between the angle quadrants.
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Affiliation(s)
- Murat Gunay
- Department of Ophthalmology, Faculty of Medicine, Karadeniz Technical University, Tip Fakultesi, Goz Hastaliklari Klinigi, Farabi Caddesi, 61080, Trabzon, Turkey.
| | - Adem Turk
- Department of Ophthalmology, Faculty of Medicine, Karadeniz Technical University, Tip Fakultesi, Goz Hastaliklari Klinigi, Farabi Caddesi, 61080, Trabzon, Turkey
| | - Hilal Ozturk
- Department of Ophthalmology, Faculty of Medicine, Karadeniz Technical University, Tip Fakultesi, Goz Hastaliklari Klinigi, Farabi Caddesi, 61080, Trabzon, Turkey
| | - Fatma Tugba Bulanik
- Department of Ophthalmology, Faculty of Medicine, Karadeniz Technical University, Tip Fakultesi, Goz Hastaliklari Klinigi, Farabi Caddesi, 61080, Trabzon, Turkey
| | - Dilek Uzlu
- Department of Ophthalmology, Faculty of Medicine, Karadeniz Technical University, Tip Fakultesi, Goz Hastaliklari Klinigi, Farabi Caddesi, 61080, Trabzon, Turkey
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Meshksar A, Razeghinejhad MR, Azimi A. Ab-interno Trabeculotomy Procedures: A Review. J Curr Ophthalmol 2023; 35:110-124. [PMID: 38250496 PMCID: PMC10795813 DOI: 10.4103/joco.joco_45_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 07/02/2023] [Accepted: 07/05/2023] [Indexed: 01/23/2024] Open
Abstract
Purpose To discuss the safety and efficacy of various forms of ab-interno trabeculotomy procedures. Methods A comprehensive search in PubMed and Google Scholar was done using the keywords "glaucoma", "microinvasive glaucoma surgery", "complications", "goniotomy", and "trabeculotomy". Publications discussing ab-interno trabeculotomy procedures were selected; furthermore, the relevant references in these articles were gathered and the search was updated during the article preparation. Since gonioscopy-assisted transluminal trabeculotomy was first introduced in 2014, we had no time restriction. Results Ab-interno trabeculotomy procedures, as a type of minimally invasive glaucoma surgeries, facilitate the natural trabecular outflow and lower the intraocular pressure (IOP) while preserving the conjunctiva for possible future glaucoma surgeries. It can be done alone or in combination with cataract surgery and effectively lowers the IOP and the number of antiglaucoma medications in various forms of glaucoma. Conclusion By appropriate patient selection, ab-interno trabeculotomy could be selected as a safe and effective procedure in the management of various forms of glaucoma either as an isolated procedure or in combination with cataract extraction.
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Affiliation(s)
- Aidin Meshksar
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Reza Razeghinejhad
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Glaucoma Service, Wills Eye Hospital, Philadelphia, PA, USA
| | - Ali Azimi
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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