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Panigrahi A, Kumar A, Gupta S, Grover DS, Gupta V. Outcomes of gonioscopy-assisted transluminal trabeculotomy in advanced pigmentary glaucoma. Br J Ophthalmol 2024:bjo-2024-325749. [PMID: 39317433 DOI: 10.1136/bjo-2024-325749] [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: 04/30/2024] [Accepted: 08/20/2024] [Indexed: 09/26/2024]
Abstract
PURPOSE To compare outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) over a 12-month period with trabeculectomy in patients with advanced pigmentary glaucoma (PG). METHODS This was a pilot randomised controlled trial of patients with advanced PG (mean deviation worse than -12 dB), undergoing either GATT or a fornix-based trabeculectomy. Absolute success (criterion A) was defined as a postoperative intraocular pressure (IOP) between 6 and 18 mm Hg, with a drop of at least 30% from the treated preoperative value without need of any IOP-lowering medication. Success (criterion B) was also defined as per the target IOP, with an upper limit of 15 mm Hg for eyes with mean deviation (MD) between -12 and -24 dB, and 12 mm Hg or lower for MD values worse than -24 dB. Qualified success was a similar IOP standard on the same or fewer antiglaucoma medications. RESULTS For GATT (n=10), mean preoperative IOP and number of glaucoma medications were 28.2±11.2 mm Hg and 4±0.8 that reduced to 11.8±2.5 mm Hg and 0.7 at 12 months postoperatively, while in the trabeculectomy (n=12) group, they were 27.3±5.5 mm Hg and 3.6±0.7 that reduced to 11.5±2.2 mm Hg and 0.5±0.9, respectively. All eyes (100%) achieved qualified success. Absolute success was 60% and 67.7% by criterion A and 50% and 58.3% by criterion B for GATT and trabeculectomy, respectively. Two eyes in the trabeculectomy group developed hypotony while none of the GATT group had any sight-threatening complications (p=0.4). CONCLUSIONS GATT alone demonstrated a significant reduction in IOP and number of glaucoma medications in patients with advanced PG.
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Affiliation(s)
- Arnav Panigrahi
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Anurag Kumar
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Shikha Gupta
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | | | - Viney Gupta
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Karapapak M, Olgun A. Comparison of GATT versus micropulse transscleral diode laser cyclophotocoagulation combined with GATT in patients with advanced glaucoma. Eur J Ophthalmol 2024; 34:1489-1496. [PMID: 38602018 DOI: 10.1177/11206721241247440] [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] [Indexed: 04/12/2024]
Abstract
PURPOSE To compare the efficacy of gonioscopy-assisted transluminal trabeculotomy (GATT) versus micropulse transscleral diode laser cyclophotocoagulation(MP-TDLC) combined with GATT in the treatment of advanced glaucoma. METHODS This retrospective comparative study study included 82 patients (82 eyes) with a diagnosis of advanced glaucoma: 36 patients underwent GATT, and 46 underwent GATT + MP-TDLC. Intraocular pressure (IOP) changes in patients who underwent GATT and GATT MP-TDLC were analyzed retrospectively at regular intervals during the 6-month follow-up period. RESULTS For the 82 patients included in this study, the mean ± SD IOPs before the procedures were 27.2 ± 8.5 mmHg in the GATT group and 26.6 ± 6.9 mmHg in the GATT + MP-TDLC group (p = 0.866), and the numbers of glaucoma medications used were 3.41 ± 0.5 in the GATT group and 3.36 ± 0.4 in the GATT + MP-TDLC group (p = 0.605). The mean IOP after GATT was 13.6 ± 3.9 mmHg at day 1, 13.9 ± 3.7 mmHg at week 1, 14.6 ± 4.0 mmHg at month 1, 15.3 ± 4.3 mmHg at month 3, and 14.7 ± 3.3 mmHg at month 6. In the GATT + MP-TDLC group, the postoperative day 1, week 1, month 1, month 3, and month 6 IOP values were 12.4 ± 2.5, 11.8 ± 1.8, 12.1 ± 2.0, 11.8 ± 1.09, and 11.8 ± 1.5 mmHg, respectively. CONCLUSION GATT was found to be effective in the treatment of patients with advanced glaucoma, and results closer to the targeted low teens IOP values were obtained with GATT + MP-TDLC.
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Affiliation(s)
- Murat Karapapak
- Department of Ophthalmology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Ali Olgun
- Department of Ophthalmology, West Eye Hospital, Erbil, Iraq
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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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Palan P, Senthil S. False Passage of 5-0 Polypropylene Suture into Episcleral Vein during Gonioscopy-Assisted Transluminal Trabeculotomy. J Glaucoma 2024; 33:e78-e80. [PMID: 38739495 DOI: 10.1097/ijg.0000000000002423] [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: 03/06/2024] [Accepted: 04/26/2024] [Indexed: 05/16/2024]
Abstract
Gonioscopy-assisted transluminal trabeculotomy (GATT) is a promising cost-effective minimally invasive glaucoma surgery (MIGS). The main advantage is safety with regards to low risk for hypotony and its related complications. However, the Schlemm's canal (SC) based procedures have a different set of complications, the most common being hyphema and transient intraocular pressure spike. The other rare complications being, the false passage of the suture by traversing the external wall of the SC into the suprachoroidal space or posterior chamber or breaching the internal wall of the SC into the anterior chamber. Although these complications are rare, knowledge about them is important not only for early identification but for prevention and management if they occur. Through this case report, we describe a rare complication where the suture had traversed through a dilated episcleral vein during GATT. To our knowledge, there has been no prior report of such a complication.
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Affiliation(s)
- Parth Palan
- Academy of Eye Care Education, L V Prasad Eye Institute, Hyderabad
| | - Sirisha Senthil
- VST Centre for Glaucoma Services, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India
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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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Khan A, Waldner D, Ford B, Docherty G, Gooi P. Efficacy of gonioscopy-assisted transluminal trabeculotomy in advanced-age glaucoma patients. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024; 59:e213-e219. [PMID: 37187356 DOI: 10.1016/j.jcjo.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 03/22/2023] [Accepted: 04/09/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND The prevalence and severity of many etiologies of glaucoma increase with age, often requiring surgery later in life. Surgery in the most aged demographic, however, poses multiple unique physiologic and psychosocial challenges with variable outcomes. In this study, we evaluate the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) in an advanced-age population (>85 years of age). METHODS This is a single-centre retrospective cohort study of consecutive patients who underwent GATT at or above 85 years of age. This included patients with GATT of any circumferential extent (90°-360°) with or without concurrent phacoemulsification cataract surgery. The primary outcome measure was proportion of successful surgeries at 1 year by the "complete success" criteria (intraocular pressure [IOP] <17 mm Hg on no medications 3 months after surgery with no additional interventions). Secondary outcomes included proportion of successful surgeries by alternative criteria, cross-sectional analyses of IOPs and medication use, and analyses of postoperative complications and interventions. RESULTS Forty eyes of 31 patients were included in the study. Mean baseline IOP was 16.75 ± 7.33 mm Hg on 1.60 ± 1.43 classes of medication. At 1 year, the cumulative survival by Kaplan-Meier analysis was 46.6%. There was a statistically significant reduction in IOP at all postoperative time points to a mean of 11.78 ± 3.07 mm Hg at the last follow-up. There were postoperative complications in 18 eyes, with hyphema and corneal edema accounting for the majority. CONCLUSIONS This study provides evidence that GATT is a safe and effective intervention in advanced-age glaucoma populations.
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Affiliation(s)
- Ammar Khan
- Division of Ophthalmology, Department of Surgery, University of Calgary, Calgary, AB.
| | - Derek Waldner
- Division of Ophthalmology, Department of Surgery, University of Calgary, Calgary, AB
| | - Bryce Ford
- Division of Ophthalmology, Department of Surgery, University of Calgary, Calgary, AB
| | - Gavin Docherty
- Department of Surgery, Ophthalmology, Kelowna General Hospital, Kelowna, BC
| | - Patrick Gooi
- Division of Ophthalmology, Department of Surgery, University of Calgary, Calgary, AB
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Bouhout S, Bachour K, Harasymowycz P, Jaworski L, Wang Q, Durr GM. Gonioscopy-Assisted Transluminal Trabeculotomy in Uveitis-Related Ocular Hypertension and Glaucoma. J Glaucoma 2024; 33:464-472. [PMID: 38506842 DOI: 10.1097/ijg.0000000000002376] [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: 10/23/2023] [Accepted: 02/16/2024] [Indexed: 03/21/2024]
Abstract
PRCIS Gonioscopy-assisted transluminal trabeculotomy (GATT) may be an effective first-line surgery for decreasing intraocular pressure (IOP) and medication burden in patients with uveitis-related ocular hypertension (OHT) or glaucoma. OBJECTIVE The purpose of the study is to determine the efficacy of GATT in lowering IOP in uveitis-related OHT or glaucoma. METHODS Retrospective case series that included patients with uveitis-related OHT or glaucoma who underwent GATT with or without concomitant cataract extraction and intraocular lens implantation at 2 Canadian academic centres from July 2018 to May 2022. Primary outcomes were: complete (no medications) and qualified success (with medication), and failure defined as (1) IOP >21 mm Hg with maximal medical therapy, (2) the need for additional glaucoma procedure, (3) loss of light perception secondary to glaucoma, and (4) IOP <6 mm Hg for 3 months. RESULTS Twenty-one eyes from 18 patients were included with a mean preoperative IOP of 26.2 ± 7.3 mm Hg on 4.3 ± 0.7 classes of glaucoma drops. The average follow-up was 29.2 ± 17.6 months and 76% of eyes (n = 16) had reached at least 12 months of follow-up. At the 12-month follow-up visit, there was a significant decrease in average IOP by 9.9 ± 7.9 mm Hg (38%, P = 0.005) and a decrease of 1.9 in glaucoma medication classes ( P = 0.002). Of eyes, 14% achieved complete success, whereas 80% of eyes achieved qualified success. Six eyes failed (29%) and 5 patients (24%) required additional glaucoma surgery. The most common postoperative complication was hyphema (n = 9; 43%). CONCLUSION This small case series suggests that GATT may be an effective first-line surgery for decreasing IOP and medication burden in patients with uveitis-related OHT or glaucoma. Further studies with longer follow-ups should be conducted to assess its long-term outcomes.
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Affiliation(s)
| | | | - Paul Harasymowycz
- Department of Ophthalmology, Montreal Glaucoma Institute and Bellevue Ophthalmology Clinics, University of Montreal, Maisonneuve-Rosemont Hospital, Montreal
| | - Laurence Jaworski
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal (CHUM), QC, Canada
| | - Qianqian Wang
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal (CHUM), QC, Canada
| | - Georges M Durr
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal (CHUM), QC, Canada
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Ayub G, De Francesco T, Costa VP. Bent ab interno needle goniotomy versus gonioscopy-assisted transluminal trabeculotomy in primary open-angle glaucoma: study protocol of a randomized clinical trial. Trials 2024; 25:300. [PMID: 38702810 PMCID: PMC11069271 DOI: 10.1186/s13063-024-08134-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 04/23/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Minimally invasive glaucoma surgery (MIGS) is a new class of surgeries, which combines moderate to high success rates and a high safety profile. Bent Ab interno Needle Goniotomy (BANG) and Gonioscopy-Assisted Transluminal Trabeculotomy (GATT) are two low-cost MIGS procedures that communicate the anterior chamber to Schlemm's canal. Most of the available publications on MIGS are either case series or retrospective studies, with different study protocols. The aim of this manuscript is to describe a randomized clinical trial (RCT) protocol to compare the long-term intraocular pressure (IOP) control and the safety of both procedures in eyes with primary open-angle glaucoma. METHODS This is a parallel, double-arm, single-masked RCT that includes pseudophakic primary open-angle glaucoma (POAG) eyes. After inclusion criteria, medications will be washed out to verify baseline IOP before surgery. Patients will be randomized to BANG or GATT using a sealed envelope. Follow-up visits will be 1, 7, 15, 30, 60, 90, 180, 330 and 360 days after surgery. On PO330, a new medication washout will be done. The main outcome is the IOP reduction following the procedures. Complimentary evaluation of functional and structural parameters, safety, and quality of life will be done after 30, 90, 180, and 360 days. DISCUSSION Our study was designed to compare the long-term efficacy and safety of two low-cost MIGS. Most of the published studies on this subject are case series or retrospective cohorts, with different study protocols, which included different types and severities of glaucomas, combined with cataract extraction. Our study only included mild to moderate POAG eyes, with previous successful cataract extraction. Moreover, it provides a standardized protocol that could be replicated in future studies investigating various types of MIGS. This would allow comparison between different techniques in terms of efficacy, safety, and patients' quality of life. TRIAL REGISTRATION Retrospectively registered at the Registro Brasileiro de Ensaios Clínicos (ReBEC) platform RBR-268ms5y . Registered on July 29, 2023. The study was approved by the Ethics Committee of the University of Campinas, Brazil.
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Affiliation(s)
- Gabriel Ayub
- Department of Ophthalmology, University of Campinas, 251 Vital Brazil St., Campinas, São Paulo, 13083-888, Brazil.
| | - Ticiana De Francesco
- Department of Ophthalmology, University of Campinas, 251 Vital Brazil St., Campinas, São Paulo, 13083-888, Brazil
| | - Vital Paulino Costa
- Department of Ophthalmology, University of Campinas, 251 Vital Brazil St., Campinas, São Paulo, 13083-888, Brazil
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9
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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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10
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Hallaj S, Wong JC, Shalaby WS, Ayres BD, Moster MR. Persistent Mydriasis Following Gonioscopy-Assisted Transluminal Trabeculotomy. J Glaucoma 2024; 33:55-58. [PMID: 37523651 DOI: 10.1097/ijg.0000000000002283] [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: 04/15/2023] [Accepted: 07/08/2023] [Indexed: 08/02/2023]
Abstract
Herein we describe 2 cases of persistent mydriasis after gonioscopy-assisted transluminal trabeculotomy for open angle glaucoma. Both surgeries were uneventful, but the patients experienced postoperative hyphema and intraocular pressure elevation. They then developed persistent fixed and dilated pupils resistant to pilocarpine that led to intolerable photosensitivity and glare. An iris cerclage pupilloplasty was performed with adequate relief of symptoms in one case.
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Affiliation(s)
- Shahin Hallaj
- Glaucoma Service, Will Eye Hospital
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Jae-Chiang Wong
- Glaucoma Service, Will Eye Hospital
- Westchester Medical Center Department of Ophthalmology, New York Medical College, Valhalla, NY
| | - Wesam Shamseldin Shalaby
- Glaucoma Service, Will Eye Hospital
- Tanta Medical School, Tanta University, Tanta, Gharbia, Egypt
| | - Brandon D Ayres
- Cornea Service, Wills Eye Hospital
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
- Tanta Medical School, Tanta University, Tanta, Gharbia, Egypt
| | - Marlene R Moster
- Glaucoma Service, Will Eye Hospital
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
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11
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Chan PPM, Larson MD, Dickerson JE, Mercieca K, Koh VTC, Lim R, Leung EHY, Samuelson TW, Larsen CL, Harvey A, Töteberg-Harms M, Meier-Gibbons F, Shu-Wen Chan N, Sy JB, Mansouri K, Zhang X, Lam DSC. Minimally Invasive Glaucoma Surgery: Latest Developments and Future Challenges. Asia Pac J Ophthalmol (Phila) 2023; 12:537-564. [PMID: 38079242 DOI: 10.1097/apo.0000000000000646] [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: 09/27/2023] [Accepted: 10/12/2023] [Indexed: 12/21/2023] Open
Abstract
The development of minimally invasive glaucoma surgeries (MIGSs) was intended to provide safe and modestly efficacious modalities for early intervention of mild-to-moderate glaucoma, with minimal trauma and rapid recovery. They were mainly ab interno procedures that reduce intraocular pressure by facilitating the aqueous outflow by bypassing the trabecular meshwork resistance, reinforcing the uveoscleral flow via the supraciliary space, and reducing aqueous production by the ciliary body. While the cumulating evidence helps shape the role of the available MIGS, the exponential new development and advancement in this field has expanded the territory of MIGS. Apart from developing subconjunctival MIGS filtration devices (Xen gel stent and PRESERFLO MicroShunt), there is a tendency to revisit the "traditional" MIGS for alternative use and to modify the procedures with consideration of the fundamental aqueous outflow physiology. Combined MIGS has also been suggested, based on the theory that their different mechanisms may provide additive or synergistic effects. The advancement of laser procedures is also promising and could supplement unmet needs along the glaucoma treatment algorithm. This review examines the broad array of MIGS, updates the recent findings, discusses their potential alternative applications, and explores future challenges.
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Affiliation(s)
- Poemen P M Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Department of Ophthalmology and Visual Sciences, Lam Kin Chung. Jet King-Shing Ho Glaucoma Treatment and Research Centre, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Jaime E Dickerson
- Sight Sciences, Menlo Park, CA, USA
- University of North Texas Health Science Center, North Texas Eye Research Institute, Fort Worth, TX, USA
| | | | - Victor Teck Chang Koh
- Department of Ophthalmology, National University Health System, Singapore
- Centre for Innovation and Precision Eye Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ridia Lim
- Department of Ophthalmology, Sydney Eye Hospital, Sydney, Australia
- Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Enne Hiu Ying Leung
- The C-MER Dennis Lam & Partners Eye Center, C-MER International Eye Care Group, Hong Kong, China
| | - Thomas W Samuelson
- Minnesota Eye Consultants, Bloomington, MN, US
- Department of Ophthalmology, University of Minnesota, MN, US
| | - Christine L Larsen
- Minnesota Eye Consultants, Bloomington, MN, US
- Department of Ophthalmology, University of Minnesota, MN, US
| | | | - Marc Töteberg-Harms
- Department of Ophthalmology, Augusta University, Medical College of Georgia, Augusta, GA, USA
| | | | | | - Jessica Belle Sy
- Department of Ophthalmology, Sydney Eye Hospital, Sydney, Australia
- Baguio General Hospital and Medical Center, Baguil City, Benguet, Philippines
| | - Kaweh Mansouri
- Glaucoma Center, Swiss Visio, Clinique de Montchoisi, Lausanne, Switzerland
| | - Xiulan Zhang
- State Key Laboratory of Ophthalmology, 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, China
| | - Dennis S C Lam
- The C-MER Dennis Lam & Partners Eye Center, C-MER International Eye Care Group, Hong Kong, China
- The International Eye Research Institute of The Chinese University of Hong Kong (Shenzhen), Shenzhen, China
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12
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Laroche D, Madu CT. Preventing Blindness with Early Cataract Surgery and Micro-Invasive Glaucoma Surgery in Patients Over 50: Guidance for Patients, Physicians and World Governments in Dealing with Glaucoma. Clin Ophthalmol 2023; 17:2929-2938. [PMID: 37814637 PMCID: PMC10560466 DOI: 10.2147/opth.s422415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/25/2023] [Indexed: 10/11/2023] Open
Abstract
Purpose To offer clinical guidance and address safety and efficacy concerns regarding the growing use of micro-invasive glaucoma surgery (MIGS) as an initial treatment for glaucoma in adult patients. Design Narrative literature review. Methods A review was conducted to assess outcomes and complications of MIGS in the treatment of glaucoma, both alone and in combination with lens replacement. These outcomes were compared with those of standard glaucoma surgery and/or glaucoma management with medication. Results MIGS are effective at lowering intraocular pressure (IOP) over long periods of follow-up. These techniques share a similarly high safety profile between one another. MIGS were found to have lower complication rates and to be more effective in reducing the total amount of medication needed to maintain control of intraocular pressure than standard surgery approaches. Conclusion MIGS techniques are growing in popularity and have been demonstrated to be a safe and effective alternative to standard glaucoma surgery. Guidance in the implementation of these procedures has been outlined.
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Affiliation(s)
- Daniel Laroche
- Department of Ophthalmology, New York Eye and Ear Infirmary, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Advanced Eye Care of New York, New York, NY, USA
| | - Chisom T Madu
- City University of New York School of Medicine, New York, NY, USA
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Parikh DA, Mellen PL, Kang T, Shalaby WS, Moster MR, Dunn JP. Gonioscopy-Assisted Transluminal Trabeculotomy for the Treatment of Glaucoma in Uveitic Eyes. Ocul Immunol Inflamm 2023; 31:1608-1614. [PMID: 35695409 DOI: 10.1080/09273948.2022.2087093] [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: 07/13/2021] [Accepted: 06/03/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) in adult eyes with uncontrolled uveitic glaucoma. METHODS We reviewed 16 eyes from 13 patients. Surgical success was defined as intraocular pressure (IOP) reduction >20% from baseline or IOP between 5 and 21 mmHg by the 3-month visit while on a stable number or fewer IOP-lowering agents and no need for additional glaucoma surgery. RESULTS At 12 months, the cumulative success rate was 81%. Mean IOP was 37.8 ± 13.0 mmHg at baseline and 12.2 ± 3.0 mmHg at 12 months (68% reduction; p < .0001). The average number of glaucoma medications was 4.6 ± 1.3 at baseline and 2.2 ± 0.7 at 12 months (52% reduction; p < .0001). Transient hyphema was seen in 44% of eyes at 1 week. CONCLUSIONS This small retrospective study suggests that GATT is effective and safe as an initial surgical treatment for medically refractory glaucoma in uveitic adult eyes.
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Affiliation(s)
- Devayu A Parikh
- Uveitis Unit, Retina Division, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Phoebe L Mellen
- Uveitis Unit, Retina Division, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Tony Kang
- Uveitis Unit, Retina Division, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | | | - Marlene R Moster
- Glaucoma Division, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - James P Dunn
- Uveitis Unit, Retina Division, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
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Dar N, Naftali Ben Haim L, Yehezkeli V, Sharon T, Belkin A. Gonioscopy-assisted transluminal trabeculotomy in patients with advanced glaucoma. Indian J Ophthalmol 2023; 71:3024-3030. [PMID: 37530276 PMCID: PMC10538851 DOI: 10.4103/ijo.ijo_2769_22] [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: 10/21/2022] [Revised: 04/07/2023] [Accepted: 06/05/2023] [Indexed: 08/03/2023] Open
Abstract
Purpose To evaluate the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with advanced glaucoma. Methods Records of 46 patients with advanced glaucoma were reviewed retrospectively in this single-center chart review. The main outcome measure was surgical success; intra-ocular pressure (IOP) and IOP lowering medication use were secondary outcome measures. Success was defined as an IOP of 18 mmHg or lower (criterion A) or 14 mmHg or lower (criterion B) and one of the following: IOP reduction >30% from baseline on the same or fewer medications or IOP ≤ of baseline on fewer medications as compared to baseline. Results Forty-seven eyes were included in the analysis. The average mean deviation was -17.5 ± 7.2 dB (range -8.0 to -33.0). The average follow-up was 6.8 months (range 3.2-22.3). Success at 6 months was 91% for criterion A and 75% for criterion B (n = 33). Mean IOP was reduced from 19.3 ± 6 mmHg (12-40) on 3.7 ± 1.4 medications to 13.2 ± 5.8 mmHg on 1.6 ± 1.4 medications at the 6th post-operative month (P < 0.001 for both IOP and medications). At the last follow-up visit, 37 patients (78%) had an IOP of 14 mmHg or lower, and ten of these patients were unmedicated. Transient hyphema and IOP spikes were the most prevalent adverse events following surgery. Three eyes required further surgery for IOP control. None of the patients lost vision because of surgery. Conclusions GATT is a viable surgical option in cases of advanced glaucoma. Careful patient selection and attentive post-operative management are imperative.
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Affiliation(s)
- Nimrod Dar
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liron Naftali Ben Haim
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Veronika Yehezkeli
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Sharon
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avner Belkin
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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15
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Liu WW, Petkovsek D, Shalaby WS, Arbabi A, Moster MR. Four-year Surgical Outcomes of Gonioscopy-assisted Transluminal Trabeculotomy in Patients with Open-Angle Glaucoma. Ophthalmol Glaucoma 2023; 6:387-394. [PMID: 36702382 PMCID: PMC10664355 DOI: 10.1016/j.ogla.2023.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/04/2023] [Accepted: 01/17/2023] [Indexed: 01/24/2023]
Abstract
PURPOSE To provide 4-year data on the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with open-angle glaucoma. DESIGN Retrospective case series. PARTICIPANTS Eyes of patients > 18 years of age who underwent GATT by a single surgeon at Wills Eye Hospital with at least 36 months follow-up. METHODS Postoperative changes in outcome measures including intraocular pressure (IOP), medication use and visual acuity were recorded. Failure was defined as IOP > 21 mmHg or less than 20% reduction below baseline at any postoperative visit after 3 months or need for further glaucoma surgery. MAIN OUTCOME MEASURES Main outcome measures were failure rate, IOP, number of glaucoma medications, and visual acuity at 4 years. RESULTS Fifty-nine patients (74 eyes), age 57.1 ± 18.5 years (37.8% female) underwent the GATT procedure. Average follow-up was 47.0 ± 6.7 months (range 35.6-76.5 months). Mean IOP was 27.0 ± 10.0 mmHg preoperatively and 14.8 ± 6.5 mmHg at 4 years (45% IOP decrease; P < 0.01). Mean number of medications decreased from 3.2 ± 1.0 preoperatively to 2.3 ± 1.0 at 4 years (P < 0.01). The cumulative failure rate at 4 years was 53.9%, and the cumulative reoperation rate was 42.0%. No significant differences between patients with primary open-angle glaucoma and other types of glaucoma were found. CONCLUSIONS Gonioscopy-assisted transluminal trabeculotomy can be a safe and effective conjunctival-sparing surgery for treating various forms of open-angle glaucoma at 4 years. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Wendy W Liu
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California; Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania.
| | - Daniel Petkovsek
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Wesam S Shalaby
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania; Tanta Medical School, Tanta University, Tanta, Gharbia, Egypt
| | | | - Marlene R Moster
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania
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Chen RI, Purgert R, Eisengart J. Gonioscopy-Assisted Transluminal Trabeculotomy and Goniotomy, With or Without Concomitant Cataract Extraction, in Steroid-Induced and Uveitic Glaucoma: 24-Month Outcomes. J Glaucoma 2023; 32:501-510. [PMID: 36795532 DOI: 10.1097/ijg.0000000000002183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 01/22/2023] [Indexed: 02/17/2023]
Abstract
PRCIS Gonioscopy-assisted transluminal trabeculotomy (GATT) and goniotomy with Kahook Dual Blade both achieved sustained reductions in intraocular pressure (IOP) and medication burden in eyes with steroid-induced or uveitic glaucoma at 24 months. Both procedures had favorable safety profiles. PURPOSE To characterize the 24-month surgical outcomes of GATT and excisional goniotomy in eyes with steroid-induced or uveitic glaucoma. PATIENTS AND METHODS A retrospective chart review was performed of eyes with steroid-induced or uveitic glaucoma that underwent GATT or excisional goniotomy, either standalone or combined with phacoemulsification cataract surgery, by a single surgeon at the Cole Eye Institute. IOP, number of glaucoma medications, and steroid exposure were recorded preoperatively and at multiple postoperative timepoints up to 24 months. Surgical success was defined as at least 20% IOP reduction or IOP <12, 15, or 18 mm Hg (Criterion A, B, or C). Surgical failure was defined as need for additional glaucoma surgery or loss of light perception vision. Intraoperative and postoperative complications were reported. RESULTS Forty eyes of 33 patients underwent GATT, and 24 eyes of 22 patients underwent goniotomy, of which 88% and 75%, respectively, had 24-months' follow-up. Concomitant phacoemulsification cataract surgery was performed in 38% (15/40) GATT eyes and 17% (4/24) goniotomy eyes. IOP and number of glaucoma medications were reduced at all postoperative timepoints in both groups. At 24 months, GATT eyes had mean IOP 12.9±3.5 mm Hg on 0.9±1.2 medications, and goniotomy eyes had mean IOP 14.3±4.1 mm Hg on 1.8±1.3 medications. Surgical failure was 8% for GATT and 14% for goniotomy at 24 months. Transient hyphema and transient IOP elevation were the most common complications, and 10% GATT eyes required surgical evacuation of hyphema. CONCLUSIONS Both GATT and goniotomy demonstrate favorable efficacy and safety in steroid-induced and uveitic glaucoma eyes. Both procedures achieved sustained reductions in IOP and glaucoma medication burden at 24 months.
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Affiliation(s)
- Rebecca I Chen
- Department of Ophthalmology and Vision Science, University of California, Davis, Sacramento, CA
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Patterson I, Avdagic E, Qiu M. Safety and Efficacy of Resident-Performed Gonioscopy-Assisted Transluminal Trabeculotomy. J Glaucoma 2023; 32:313-319. [PMID: 36634018 DOI: 10.1097/ijg.0000000000002171] [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: 02/28/2022] [Accepted: 12/14/2022] [Indexed: 01/13/2023]
Abstract
PRCIS GATT can be performed efficaciously and safely by PGY-3 and PGY-4 residents, with clinical outcomes and complication rates that mirror those of attending-performed GATT cohorts from the literature. PURPOSE Report outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) performed by PGY-3 and PGY-4 residents. METHODS A retrospective chart review was performed for patients undergoing resident-performed GATT. Eyes with previous traditional glaucoma surgery (trabeculectomy or aqueous shunt) or neovascular glaucoma were excluded from this analysis. The primary aim was to assess whether resident-performed GATTs demonstrated success rates comparable with the GATT literature. Surgical success was defined as intraocular pressure (IOP)<21 mmHg, and an IOP reduction of 20% from baseline, and no subsequent IOP-lowering surgery. The secondary and tertiary aims were to describe complication rates and operating times for resident-performed GATTs, respectively. RESULTS A total of 50 eyes from 40 patients with various types of glaucoma were included. Eyes either underwent resident-performed GATT-alone (N=9) or GATT+cataract extraction with intraocular lens implantation (CEIOL) (N=41). The surgical success rate at 6 months was 71% for GATT-alone and 42% for GATT+CEIOL. Three eyes required subsequent IOP-lowering surgery. The hyphema rate was 16% at postoperative week 1 and 6% at postoperative month 1. The IOP spike (>30 mmHg) rate was 18%. Mean surgical time for both GATT-alone and GATT+CEIOL was longer for PGY-4s than for PGY-3s, attributable to less attending assistance during PGY-4 cases and more resident-performed cataracts in PGY-4 GATT+CEIOL cases (85%) compared with PGY-3 cases (35%). CONCLUSIONS GATT can be performed efficaciously and safely by PGY-3 and PGY-4 residents, with clinical outcomes and complication rates that mirror those of attending-performed GATT cohorts from the literature.
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Affiliation(s)
- Ian Patterson
- Department of Ophthalmology and Visual Science, The University of Chicago Medicine, Chicago, IL
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18
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Wang Y, Zhang W, Xin C, Sang J, Sun Y, Wang H. Gonioscopy-assisted transluminal trabeculotomy for open-angle glaucoma with failed incisional glaucoma surgery: two-year results. BMC Ophthalmol 2023; 23:89. [PMID: 36879233 PMCID: PMC9987149 DOI: 10.1186/s12886-023-02830-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 02/27/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND To evaluate the safety and efficacy of gonioscopy-assisted transluminal trabeculotomy (GATT) in treating patients with open-angle glaucoma (OAG) who had failed prior incisional glaucoma surgery. METHODS A consecutive case series of OAG patients aged ≥ 18 who underwent GATT with previous failed glaucoma incision surgery was retrospectively analyzed. Main outcome measures included intraocular pressure (IOP), the number of glaucoma medications, surgical success rate, and occurrence of complications. Success was defined as an IOP of ≤ 21 mmHg and a reduction of IOP by 20% or more from baseline with (qualified success) or without (complete success) glaucoma medications. For eyes with preoperative IOP of < 21 mmHg on 3 or 4 glaucoma medications, postoperative IOP of ≤ 18 mmHg without any glaucoma medications was also defined as complete success. RESULTS Forty-four eyes of 35 patients (21 with juvenile-onset open-angle glaucoma and 14 with adult-onset primary open-angle glaucoma) with a median age of 38 years were included in this study. The proportion of eyes with 1 prior incisional glaucoma surgery was 79.5%, and the others had 2 prior surgeries. IOP decreased from 27.4 ± 8.8 mm Hg on 3.6 ± 0.7 medications preoperatively to 15.3 ± 2.7 mm Hg on 0.5 ± 0.9 medications at the 24-month visit (P < 0.001). The mean IOP and the number of glaucoma medications at each follow-up visit were lower than the baseline (all P < 0.001). At 24 months postoperatively, 82.1% of the eyes had IOP ≤ 18 mmHg (versus 15.9% preoperatively, P < 0.001), 56.4% reached IOP ≤ 15 mmHg (versus 4.6% preoperatively, P < 0.001), and 15.4% achieved IOP ≤ 12 mmHg (compared to none preoperatively, P = 0.009). While 95.5% of eyes took 3 or more medications preoperatively, 66.7% did not take glaucoma medication 24 months after GATT. Thirty-four (77.3%) eyes achieved IOP reduction greater than 20% on fewer medications. The complete and qualified success rates were 60.9% and 84.1%, respectively. No vision-threatening complications occurred. CONCLUSIONS GATT was safe and effective in treating refractory OAG patients who failed prior incisional glaucoma surgery.
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Affiliation(s)
- Yiwei Wang
- Department of Ophthalmology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, 450003, China.,Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Weijia 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.,Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, No.8 Chongwenmennei Street, Beijing, 100730, Dongcheng District, China
| | - Chen Xin
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.,Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, No.8 Chongwenmennei Street, Beijing, 100730, Dongcheng District, China
| | - Jinghong Sang
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, No.8 Chongwenmennei Street, Beijing, 100730, Dongcheng District, China
| | - Yang Sun
- Department of Ophthalmology, Stanford University, Palo Alto, CA, 94303, USA
| | - Huaizhou Wang
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, No.8 Chongwenmennei Street, Beijing, 100730, Dongcheng District, China.
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The case for standalone micro-invasive glaucoma surgery: rethinking the role of surgery in the glaucoma treatment paradigm. Curr Opin Ophthalmol 2023; 34:138-145. [PMID: 36373756 PMCID: PMC9894157 DOI: 10.1097/icu.0000000000000927] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE OF REVIEW To highlight progress in glaucoma therapy challenging the traditional medication-first approach and present evidence supporting early standalone surgery in the era of micro-invasive glaucoma surgery (MIGS). RECENT FINDINGS Medical therapy is limited by well documented poor adherence that compromises the quality of intraocular pressure reduction. Results from modern clinical trials demonstrate advantages of selective laser trabeculoplasty and MIGS procedures in terms of both IOP control and progression risk. SUMMARY The MIGS options for pseudophakic or precataractous patients are limited by regulatory rules that require the performance of some procedures only at the time of cataract surgery. These include the iStent/iStent Inject and the Hydrus implants. Nonbleb-forming procedures currently available for standalone use in eyes with mild-moderate primary open-angle glaucoma include gonioscopy-assisted transluminal trabeculotomy (which lowers IOP by 28-61% and medication use by 38-73% in various studies), trabecular ablation with the Trabectome (23-39% and 21-43%, respectively), excisional goniotomy with the Kahook Dual Blade (15-36% and 15-40%, respectively), ab interno canaloplasty (35% and 57%, respectively), and combined canaloplasty and trabeculotomy using the OMNI system (39-40% and 64-73%, respectively). For patients who would benefit from early standalone surgery, these procedures offer meaningful reductions in both IOP and medication burden.
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Ćwiklińska-Haszcz A, Żarnowski T, Wróbel-Dudzińska D, Kosior-Jarecka E. The Efficacy and Safety of the GATT Procedure in Open-Angle Glaucoma-6-Month Results. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2759. [PMID: 36768125 PMCID: PMC9914959 DOI: 10.3390/ijerph20032759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
AIM The aim of the study was to retrospectively evaluate the efficacy and safety of GATT during a 6-month observation period. MATERIAL AND METHODS The studied group consisted of 69 open-angle glaucoma patients treated with GATT as the only procedure or in combination with cataract surgery. Patients were assessed 1 day, 10 days, 1 month, 3 months, and 6 months after the surgery via standard ophthalmic examination including VF, IOP, and BCVA. The number of medications taken daily and possible complications were checked. Two criteria of success were established (S1: IOP decrease by 30% and S2: IOP lower than 18 mm Hg). RESULTS Before the surgery, the mean IOP was 26.94 mmHg and significantly decreased after GATT to 15.59 mmHg at 6M. BCVA did not significantly differ between the visits. The mean MD did not change significantly within the 6-month observation period (-8.20 dB vs. -8.16 dB, p = 0.9824), similar to the mean VFI (64.31% vs. 63.05%, p = 0.8571). A 30% IOP decrease at 6M visit was obtained in 95.6% of patients, and 37.7% needed medications to stabilize IOP. An IOP lower than 18 mmHg at 6M was obtained in 91.3% of studied patients after the GATT procedure, and in 58.0% without additional medications. The mean number of medications received daily decreased significantly at 6M compared to preoperative results (2.59 at inclusion vs. 0.76 at 6M, p = 0.0004). The most frequent complication after surgery was hyphema, which resolved spontaneously within 10 days. CONCLUSION The 6-month observation showed that GATT is a minimally invasive glaucoma-surgery technique that enables an effective and safe IOP decrease.
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Velamala IP, Bharathi M. Gonioscopy Assisted Transluminal Trabeculotomy:A Boon to Developing Nations-A Systematic Review. Semin Ophthalmol 2023; 38:178-182. [PMID: 35776682 DOI: 10.1080/08820538.2022.2094715] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To systematically review surgical procedure, safety and efficacy of Gonioscopy-Assisted Transluminal Trabeculotomy (GATT). METHODS A review of literature was done to analyze all suitable articles from two different databases. RESULTS GATT is effective in reducing intraocular pressure and mean number of medications from baseline. It is associated with minimal complications when compared to ab-externo procedures. It has shorter learning curve and can be performed as primary surgical procedure in moderate-to-severe case of open-angle glaucomas. CONCLUSION GATT is a minimally invasive surgical procedure for the management of primary and secondary open-angle glaucoma in both adults and children. The advantages of GATT are ab-interno approach, access to open entire natural drainage system, good safety profile and efficacy comparable to trabeculectomy. It can be performed with both illuminated micro-catheter and suture, out of which suture GATT is cost-effective, which is a boon to developing nations.
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Affiliation(s)
| | - Mahesh Bharathi
- Glaucoma Services, L V Prasad Eye Institute, Visakhapatnam, India
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22
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Rao A, Khan SM, Mukherjee S. Causes of Immediate and Early IOP Spikes After Circumferential Gonioscopy-Assisted Transluminal Trabeculotomy Using ASOCT. Clin Ophthalmol 2023; 17:313-320. [PMID: 36711260 PMCID: PMC9879041 DOI: 10.2147/opth.s397816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/05/2023] [Indexed: 01/23/2023] Open
Abstract
Purpose To report the early postoperative causes of intraocular pressure (IOP) spikes after complete circumferential gonioscopy-assisted transluminal trabeculotomy (GATT) using anterior segment optical coherence tomography (ASOCT). Methods This was retrospective interventional case series of patients who underwent circumferential GATT by a single surgeon (APR) from 2021 to 2022 at a tertiary eye care in East India and who developed IOP spikes at 1 day-2 weeks (immediate) or early (>2 weeks-2 months) after GATT. The intraocular pressure (IOP), glaucoma medications, and angle evaluation by ASOCT at 1 week, and 1 month were compared between the two groups. Results Thirty-two eyes of 32 consecutive patients, aged 40±20.1 years (20 exfoliation glaucoma, 9 juvenile open-angle, and 3 developmental glaucoma), that developed IOP spikes between immediate (n=20) or early (n=12) IOP spikes after GATT, were included. Immediate postoperative spikes were seen in 20 eyes due to retained viscoelastic (n=8), hyphema (n=8) in uncontrolled hypertension, and peripheral anterior synechiae (PAS) (n=6) of which only one eye required medication at 2 months. Causes of immediate IOP spikes on ASOCT included an inverted/reattached trabecular shelf, iris strands in eyes with abnormal iris in developmental glaucoma, and PAS in 1-2 quadrants. Causes of early IOP spikes included PAS >3 quadrants (n=8), and hyperreflective fibrotic tissue over TM (n=4) with 50% requiring medications at 2 months. The ASOCT features predicting the need for medications were PAS >3 quadrants (OR=8.4[2.2-14.3], p=0.03) and fibrotic TM closure (OR=5.4, [3.6-10.2], p=0.003). One eye with macrohyphema 3 days after surgery owing to uncontrolled hypertension (owing to the stoppage of medicines), required additional incisional trabeculectomy within 1 month of surgery. Conclusion Immediate IOP spikes are mostly self-resolving as opposed to early IOP spikes >2 weeks that require medications after GATT. Gonioscopic PAS >3 quadrants, and fibrotic TM closure were the main identifiable ASOCT causes predicting the need for medications after GATT.
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Affiliation(s)
- Aparna Rao
- Glaucoma Service, LV Prasad Eye Institute, Bhubaneswar, Odisha, 751024, India,Correspondence: Aparna Rao, Glaucoma Service, LV Prasad Eye Institute, MTC Campus, Bhubaneswar, Odisha, 751024, India, Tel +91 674 2653001, Fax +91 674 2653130, Email ;
| | - Sardar Mohd Khan
- Glaucoma Service, LV Prasad Eye Institute, Bhubaneswar, Odisha, 751024, India
| | - Sujoy Mukherjee
- Glaucoma Service, LV Prasad Eye Institute, Bhubaneswar, Odisha, 751024, India
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Asafali F, Rajamani M, Ramamurthy C, Chaya CJ, M V. Relationship of degrees of gonioscopy assisted transluminal trabeculotomy and trabecular shelf to success using a marker suture technique. Eye (Lond) 2023; 37:132-138. [PMID: 35031703 PMCID: PMC9829732 DOI: 10.1038/s41433-021-01838-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 10/05/2021] [Accepted: 11/01/2021] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To evaluate the safety and efficacy of gonioscopy-assisted transluminal trabeculotomy (GATT) using a marker suture which could be a viable low cost alternative to an illuminated micro catheter, by helping the surgeon identify obstruction to suture passage, and estimate the degree of Schlemm's canal cannulated. SUBJECT/METHODS Thirty four eyes with 360° of open angles with uncontrolled IOP despite maximal medical therapy, non-compliant to medical therapy or failed incisional glaucoma surgery underwent GATT. 5-0 or 6-0 Prolene® suture was used to cannulate Schlemm's canal. An 8-0 Vicryl® suture was tied around the trailing portion of the Prolene® suture and acted as a guide to estimate the length of Schlemm's canal negotiated. The degree of trabecular shelf seen was noted postoperatively. RESULTS Mean baseline IOP was 24.7 ± 8.8 mm Hg (range 13-54 mmHg). Six patients had appositional angle closure and the rest had open angles. Patients were followed up for a period of 45.0 ± 14.6weeks (range 6 weeks-2 years). The mean IOP 6 weeks after surgery was 13 ± 3.3 mm Hg, and at 1 year was 13.5 ± 2.6 mm Hg. Mean degrees of cannulation achieved was 264.5 ± 84.0˚ (90-360˚). The mean number of medications prior to surgery was 2.1 ± 1.0 and at 6 months review was 0.15 ± 0.3. The absolute success was 92.6% 1 year after surgery. Nine patients lost some of their trabecular shelf in the postoperative period, but this did not seem to affect the short term success rate. DISCUSSION Suture GATT is a safe and effective procedure to lower IOP even in patients with partial cannulation. Adding a marker suture is a useful adjunct to help identify the length of Schlemm's canal successfully cannulated and monitor progress of the Prolene® suture.
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Affiliation(s)
- Fasna Asafali
- Department of Glaucoma, The Eye Foundation, 582A, D.B.Road, R.S. Puram, Coimbatore, 641002, Tamilnadu, India
| | - Muralidhar Rajamani
- Department of Glaucoma, The Eye Foundation, 582A, D.B.Road, R.S. Puram, Coimbatore, 641002, Tamilnadu, India.
| | - Chitra Ramamurthy
- Department of Glaucoma, The Eye Foundation, 582A, D.B.Road, R.S. Puram, Coimbatore, 641002, Tamilnadu, India
| | - Craig J Chaya
- Department of Ophthalmology & Visual Sciences, University of Utah, Salt Lake City, USA
| | - Vaishnavi M
- Department of Glaucoma, The Eye Foundation, 582A, D.B.Road, R.S. Puram, Coimbatore, 641002, Tamilnadu, India
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Nagar AM, Maghsoudlou P, Wormald R, Barton K, Hysi P, Lim KS. Differences in the Surgical Outcomes of Glaucoma Surgery in Patients of African Caribbean Descent. Curr Eye Res 2022; 47:1567-1577. [PMID: 36214781 DOI: 10.1080/02713683.2022.2126859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE People of African Caribbean Descent (ACD) have a higher prevalence of glaucoma compared to people of European Descent (ED) and there is uncertainty if treatment outcomes are equivalent between the two groups. To assess surgical failure rates comparing ACD with ED focusing on trabeculectomy, aqueous shunt implantation, non-penetrating filtering surgery (NPFS), and minimally invasive glaucoma surgery (MIGS) by performing a systematic review in accordance with the PRISMA guidelines and to determine whether there is any evidence in to show a difference in success rates based on race. METHODS A systematic review of articles using the CENTRAL, Ovid MEDLINE, PubMed, EMBASE, and ClinicalTrials.gov databases was completed. Additional studies were identified by contacting clinical experts and searching bibliographies. All retrospective and prospective studies on trabeculectomy, aqueous shunt implantation, NPFS, and MIGS that included at least 20% ACD were included. Two review authors independently screened search results for eligibility and inclusion and extracted the data using pre-determined fields. RESULTS A total of 76 studies were identified for inclusion in the review. Glaucoma surgical outcomes in ACD appear to be poorer compared to ED overall, particularly for trabeculectomy. Data on NPFS are limited, but the studies completed thus far demonstrate surprisingly good results for ACD, particularly when compared to ED, who have significantly lower pre-operative IOPs. Evidence from studies investigating aqueous shunts does not suggest that ACD have poorer outcomes than ED. There is not enough data on MIGS to provide a significant conclusion. CONCLUSION In a population where trabeculectomy may no longer be the gold standard, sufficiently powered studies assessing surgical outcomes in aqueous shunts, NPFS, and MIGS are needed to guide clinicians.
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Affiliation(s)
- A M Nagar
- Department of Ophthalmology, St Thomas' Hospital, London, UK.,King's College London, London, UK
| | | | - R Wormald
- International Centre for Eye Health at the LSHTM and Institute of Ophthalmology UCL, London, UK
| | - K Barton
- Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - P Hysi
- King's College London, London, UK
| | - K S Lim
- Department of Ophthalmology, St Thomas' Hospital, London, UK.,King's College London, London, UK
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Minimally Invasive Glaucoma Surgery: Safety of Individual Devices. J Clin Med 2022; 11:jcm11226833. [PMID: 36431310 PMCID: PMC9696404 DOI: 10.3390/jcm11226833] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 10/30/2022] [Accepted: 11/11/2022] [Indexed: 11/22/2022] Open
Abstract
Primary open-angle glaucoma progression in those already on maximal medical therapy has traditionally been treated with trabeculectomy, a surgical procedure that carries a high degree of morbidity. In the last few decades, significant advances have been made in the field of minimally invasive glaucoma surgery (MIGS) devices, which aim to defer or prevent trabeculectomy via less arduous surgical techniques in certain types of glaucoma. Although reviews have been published examining the efficacy of various MIGS techniques, no article synthesises the comparative safety of all available devices. We performed a literature review examining the safety of MIGS devices. Fifteen devices were included, variously attempting to increase aqueous outflow through the trabecular meshwork or the suprachoroidal space, shunting into the subconjunctival space, or reducing aqueous production through ciliary body ablation. Notably, the earliest product attempting to increase outflow to the suprachoroidal space, Alcon's CyPass Micro-Stent, was withdrawn from the market due to concerns regarding increased corneal endothelial cell loss at five years post-implantation. All other devices were described as well-tolerated, with the most common adverse effects including hyphaema, intraocular pressure spikes, and device migration or obstruction. MIGS devices are purported to be uniformly safe, and many studies report no statistically significant increased complications beyond those associated with cataract surgery alone. It is important to note, however, the generally poor quality of current studies, with a dearth of randomised, or even prospective, data, and a large proportion of studies funded by device producers.
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Chang EL, Apostolopoulos N, Mir TA, Freedman IG, Teng CC. Large Hyphema following Femtosecond Laser-assisted Cataract Surgery (FLACS) and Trabectome Resulting in Endocapsular Hematoma. J Curr Glaucoma Pract 2022; 16:195-198. [PMID: 36793266 PMCID: PMC9905881 DOI: 10.5005/jp-journals-10078-1372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 03/30/2022] [Indexed: 01/25/2023] Open
Abstract
Aim To report a large hyphema following femtosecond laser-assisted cataract surgery (FLACS) and trabectome resulting in endocapsular hematoma. Background Hyphema has previously been described following trabectome, however, no cases have been reported following FLACS or FLACS combined with microinvasive glaucoma surgery (MIGS). We report a case of a large hyphema following FLACS combined with MIGS that resulted in an endocapsular hematoma. Case description A 63-year-old myopic female with exfoliation glaucoma underwent FLACS with a trifocal intraocular lens implant and Trabectome in the right eye. Significant intraoperative bleeding ensued following the trabectome and was treated with viscoelastic tamponade, anterior chamber (AC) washout, and cautery. The patient developed a large hyphema with intraocular pressure (IOP) rise that was treated with multiple AC taps, paracentesis, and eye drops. The hyphema took approximately 1 month to completely clear, leaving an endocapsular hematoma. This was treated successfully with Neodymium:Yttrium-Aluminum-Garnet (Nd:YAG) laser posterior capsulotomy. Conclusion Hyphema may occur with angle-based MIGS in combination with FLACS and may cause endocapsular hematoma. An increase in episcleral venous pressure during the docking and suction phase of the laser may predispose to bleeding. Endocapsular hematoma is an uncommon finding after cataract surgery and may be treated with Nd:YAG posterior capsulotomy. How to cite this article Chang EL, Apostolopoulos N, Mir TA, et al. Large Hyphema following Femtosecond Laser-assisted Cataract Surgery (FLACS) and Trabectome Resulting in Endocapsular Hematoma. J Curr Glaucoma Pract 2022;16(3):195-198.
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Affiliation(s)
- Eileen L Chang
- Department of Ophthalmology & Visual Science, Yale University, Yale, New Haven, Connecticut, United States
| | - Nicholas Apostolopoulos
- Department of Ophthalmology & Visual Science, Yale University, Yale, New Haven, Connecticut, United States
| | - Tahreem A Mir
- Department of Ophthalmology & Visual Science, Yale University, Yale, New Haven, Connecticut, United States
| | - Isaac G Freedman
- Department of Ophthalmology & Visual Science, Yale University, Yale, New Haven, Connecticut, United States
| | - Christopher C Teng
- Department of Ophthalmology & Visual Science, Yale University, Yale, New Haven, Connecticut, United States
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Seif R, Jalbout NDE, Sadaka A, Szigiato AA, Harasymowycz P. Size Matters: Ab Interno Canaloplasty Revision with Suture Trabeculotomy. J Curr Glaucoma Pract 2022; 16:152-157. [PMID: 36793263 PMCID: PMC9905871 DOI: 10.5005/jp-journals-10078-1387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/28/2022] [Indexed: 01/25/2023] Open
Abstract
Aim To report the efficacy of the revision of failed ab interno canaloplasty with micro-invasive suture trabeculotomy (MIST) over a follow-up period of 24 months. Materials and methods A retrospective analysis was performed on 23 eyes with open-angle glaucoma (OAG), on whom an ab interno canaloplasty revision with MIST was performed for glaucoma progression. The primary outcome was the proportion of eyes with a significant intraocular pressure (IOP) reduction at 12 months post trabeculotomy, defined as an IOP ≤ 18 mm Hg or ≥20% reduction in IOP without any secondary intervention (SI), and with the same or fewer number of glaucoma medications (NGM). All parameters, including best corrected visual acuity (BCVA), IOP, NGM, and SI, were evaluated at 1, 6, 12, 18, and 24 months. Results At 12 months, eight out of 23 eyes (36.4%) achieved complete success, maintained in six eyes (27.3%) at 24 months. A significantly lower mean IOP was recorded at all visits [14.3 ± 4.0 mm Hg at 24 months vs 23.1 ± 6.8 mm Hg at baseline (BL)] with a percent IOP change of up to 27.3% at 24 months postoperatively. NGM and BCVA did not significantly decrease from BL. A total of 11 eyes (47.8%) needed an SI throughout the follow-up period. Conclusion Ab interno trabeculotomy in patients with failed canaloplasty was not shown to be effective in providing a satisfactory control of IOP in OAG patients, possibly due to the small suture gauge used in the initial canaloplasty. Clinical significance Further research is needed to optimize the surgical outcome. How to cite this article Seif R, Jalbout NDE, Sadaka A, et al. Size Matters: Ab Interno Canaloplasty Revision with Suture Trabeculotomy. J Curr Glaucoma Pract 2022;16(3):152-157.
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Affiliation(s)
- Roland Seif
- Department of Ophthalmology, Lebanese American University (LAU) Medical Center-Rizk Hospital, Beirut, Lebanon
| | - Nahia Dib El Jalbout
- Department of Ophthalmology, Lebanese American University (LAU) Medical Center-Rizk Hospital, Beirut, Lebanon
| | - Ama Sadaka
- Department of Ophthalmology, Lebanese American University (LAU) Medical Center-Rizk Hospital, Beirut, Lebanon
| | | | - Paul Harasymowycz
- Department of Ophthalmology, Université de Montréal, Montreal, Quebec, Canada
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Guo Y, Kratky V, Xie H, Shentu X, Man X, Wang Y, Wen W, Rokohl AC, Heindl LM. Grand Challenges and Opportunities in Surgical Ophthalmology: Together for a Shared Future. FRONTIERS IN OPHTHALMOLOGY 2022; 2:922240. [PMID: 38983527 PMCID: PMC11182242 DOI: 10.3389/fopht.2022.922240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 06/06/2022] [Indexed: 07/11/2024]
Affiliation(s)
- Yongwei Guo
- Eye Center, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang University Eye Hospital, Hangzhou, China
- Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
| | - Vladimir Kratky
- Department of Ophthalmology, Queen's University, Kingston, ON, Canada
| | - Huatao Xie
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xingchao Shentu
- Eye Center, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang University Eye Hospital, Hangzhou, China
- Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
| | - Xiaofei Man
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yanling Wang
- Department of Ophthalmology, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing, China
| | - Wen Wen
- Department of Ophthalmology and Visual Science, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Alexander C Rokohl
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
- Center for Integrated Oncology (CIO) Aachen-Bonn-Cologne-Duesseldorf, Cologne, Germany
| | - Ludwig M Heindl
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
- Center for Integrated Oncology (CIO) Aachen-Bonn-Cologne-Duesseldorf, Cologne, Germany
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Glaucoma Treatment Outcomes in Open Angle Glaucoma Patients of African Descent. J Glaucoma 2022; 31:479-487. [PMID: 35353787 PMCID: PMC9246921 DOI: 10.1097/ijg.0000000000002027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/19/2022] [Indexed: 01/31/2023]
Abstract
Open angle glaucoma (OAG), characterized by structural changes to the optic nerve head and retinal nerve fiber layer, is a progressive multifactorial optic neuropathy and a leading cause of irreversible blindness globally. Currently, intraocular pressure is the only modifiable risk factor; however, others have been identified, including genetics and race. Importantly, OAG is much more prevalent in persons of African descent (AD) compared with those of European descent (ED). OAG patients of AD are also known to have a more severe course of the disease, a finding potentially explained by structural and/or vascular differences within eye tissues. In addition, disparities in treatment outcomes have been identified in OAG patients of AD. Specifically, prostaglandin analogues have been suggested to be more effective in patients of AD than in those ED, while beta-adrenergic receptors have been suggested to be less effective, although the evidence is inconsistent. AD has also been identified as a risk factor for trabeculectomy failure while laser trabeculoplasty has been conversely found to be very effective in lowering intraocular pressure in patients of AD. Alternative surgical options, including Ex-Press shunt implantation, viscocanalostomy, and canaloplasty are promising in equivalence but require further research to evaluate disparity in outcome properly. In addition to treatment outcomes, social disparities affecting clinical care also exist for AD persons in the form of reduced adherence, access, and choice. Overall, data suggest the need for properly designed prospective trials with AD populations as a primary focus to identify the potential mechanisms driving disparities in treatment and address overall potential bias in glaucoma management.
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Outcomes of Prolene Gonioscopy-assisted Transluminal Trabeculotomy in Primary Open-angle Glaucoma and Pseudoexfoliative Glaucoma: A Comparative Study. J Glaucoma 2022; 31:751-756. [PMID: 35696703 DOI: 10.1097/ijg.0000000000002063] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 05/15/2022] [Indexed: 11/26/2022]
Abstract
PRCIS Gonioscopy-assisted transluminal trabeculotomy (GATT) provides greater intraocular pressure (IOP) reduction in pseudoexfoliative glaucoma (PXG) than in primary open-angle glaucoma (POAG) in the first years of surgery; however, the difference between groups equalizes in the long-term. PURPOSE To compare outcomes of GATT in eyes with POAG and PXG. METHODS Single-center, retrospective, comparative case series. A total of 202 eyes (91 eyes of POAG; 111 eyes of PXG) were included. GATT was performed as a standalone procedure or in combination with cataract extraction (CE). Outcome measures were change in IOP and number of medications at all time points (1, 3, 6, 9, 12, 18, 24, and 36 mo after surgery), success rate (IOP reduction ≥20% from baseline or IOP between 6-21 mmHg, without further glaucoma surgery), and complication rate. Cumulative success probabilities were compared using Kaplan-Meier survival analyses. RESULTS The mean IOP decreased by 8.8 mmHg (34.4%) in the POAG group with a mean decrease of 2 glaucoma medications at final visit. In the PXG group, the mean IOP decreased by 12.8 mm Hg (44.6%) on 2.3 fewer medications. Mean IOP reduction was significantly higher in PXG than POAG at all time points up to 2-year visit (P<0.05 for all), after which the difference was not significant. Cumulative success probability during the first year was significantly higher in PXG (97.6%) than in POAG (86.8%) (P=0.01); no significant difference was found at 2-year (P=0.07) and 3-year visits (P=0.24). CONCLUSION GATT was safe and effectively reduced the IOP and medication burden in patients with POAG and PXG. In the first year following GATT, a significantly higher success rate was noted in PXG compared to POAG, however, in subsequent years, the success rate was similar at ~ 75%.
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Hu K, Vemulapalli K, Gandhewar R, Shah A, Virgili G, Bunce C, Gazzard G. Minimally invasive trabecular meshwork surgery for open-angle glaucoma. Hippokratia 2022. [DOI: 10.1002/14651858.cd015186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kuang Hu
- Glaucoma Service; Moorfields Eye Hospital NHS Foundation Trust; London UK
- UCL Institute of Ophthalmology; London UK
| | | | | | - Anupa Shah
- Cochrane Eyes and Vision, Centre for Public Health; Queen's University Belfast; Belfast UK
| | - Gianni Virgili
- Cochrane Eyes and Vision, Centre for Public Health; Queen's University Belfast; Belfast UK
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA); University of Florence; Florence Italy
| | - Catey Bunce
- The Royal Marsden NHS Foundation Trust; London UK
| | - Gus Gazzard
- Glaucoma Service; Moorfields Eye Hospital NHS Foundation Trust; London UK
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Faria BM, Costa VP, Melillo GHL, Daga FB, Scoralick ALB, Paranhos A, Kanadani FN, Prata TS. Gonioscopy-Assisted Transluminal Trabeculotomy for Glaucoma: 1-Year Outcomes and Success Predictors. J Glaucoma 2022; 31:443-448. [PMID: 35353767 DOI: 10.1097/ijg.0000000000002025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/17/2022] [Indexed: 11/25/2022]
Abstract
PRCIS Our results suggest gonioscopy-assisted transluminal trabeculotomy (GATT) as an effective and safe option for the surgical management of open-angle glaucoma (OAG). Older age was the only risk factor for failure in our analysis. PURPOSE To report 12-month clinical outcomes, safety profile and success predictors of GATT in patients with OAG. PATIENTS AND METHODS A retrospective study of patients (18 y old and above) with medically uncontrolled OAG who underwent GATT as a solo procedure or combined with phacoemulsification (PHACO-GATT) between January 2018 and January 2020. Success at 12 months (primary outcome) was defined as intraocular pressure (IOP) <15 mm Hg, with an IOP reduction of at least 20%, OR a reduction of at least 2 glaucoma medications, compared with baseline. Secondary outcomes were success predictors and safety parameters. RESULTS A total of 73 eyes (GATT=38; PHACO-GATT=35) from 58 patients with a mean age of 54.8±11.6 years were included. Overall, after 12 months of follow-up, the mean IOP was reduced from 24.9±8.5 to 12.1±2.1 mm Hg (P<0.001). The mean number of glaucoma medications was reduced from 3.5±0.7 to 1.2±1.2 (P<0.001). The success rate was 87% at 12 months, with no significant differences between GATT (85%) and PHACO-GATT (91%) eyes (P=0.330). Age was the only factor significantly associated with surgical success (hazard ratio=1.35; P=0.012; after adjusting for preoperative IOP and number of glaucoma medications). Patients older than 60 years had a significant greater chance of failure (hazard ratio=10.96; P=0.026) compared with those younger than 60 years. The most common postoperative complication was transient hyphema (39%; median duration, 5 d). No sight-threatening adverse event was documented. CONCLUSIONS GATT was effective and safe at lowering IOP with or without cataract extraction in OAG. Patients 60 years or older had a higher risk of failure compared with those younger in age.
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Affiliation(s)
- Bruno M Faria
- Department of Ophthalmology, Federal University of Rio Grande do Norte, Natal
| | | | - Gustavo H L Melillo
- College of Medicine & Veterinary Medicine, The University of Edinburgh, Edinburgh, Scotland
| | - Fabio B Daga
- Department of Ophthalmology, Federal University of São Paulo, São Paulo
| | - Ana L B Scoralick
- Department of Ophthalmology, Federal University of São Paulo, São Paulo
- Glaucoma Institute, Belo Horizonte, Brazil
| | - Augusto Paranhos
- Department of Ophthalmology, Federal University of São Paulo, São Paulo
| | - Fábio N Kanadani
- Department of Ophthalmology, Federal University of São Paulo, São Paulo
- Glaucoma Institute, Belo Horizonte, Brazil
- Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida
| | - Tiago S Prata
- Department of Ophthalmology, Federal University of São Paulo, São Paulo
- Glaucoma Institute, Belo Horizonte, Brazil
- Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida
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Aboalazayem F, Elhusseiny AM, El Sayed YM. Gonioscopy-Assisted Transluminal Trabeculotomy; A Review. Curr Eye Res 2022; 48:329-338. [PMID: 35634789 DOI: 10.1080/02713683.2022.2084113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
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.
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Affiliation(s)
- Fayrouz Aboalazayem
- Department of Ophthalmology, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt
| | - Abdelrahman M. Elhusseiny
- Department of Ophthalmology, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Yasmine M. El Sayed
- Department of Ophthalmology, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt
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Quan AV, Chen J, Wang YE, Vanner EA, Grajewski AL, Hodapp EA, Chang TC. Factors Associated With Gonioscopy-Assisted Transluminal Trabeculotomy (GATT) Complications and Failure in Children. Am J Ophthalmol 2022; 241:168-178. [PMID: 35551908 DOI: 10.1016/j.ajo.2022.04.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/01/2022] [Accepted: 04/29/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To identify the factors associated with the complications and failure of gonioscopy-assisted transluminal trabeculotomy (GATT) in children. DESIGN Retrospective case series. METHODS This study was conducted in an institutional setting in a pediatric population (aged <18 years) who had undergone GATT. Records were reviewed, and pre- and postoperative intraocular pressures (IOP), extent of angle treated, medications, complications, and failure were recorded. Failure was defined as IOP >21 mm Hg or <5 mm Hg, absence of at least 20% IOP reduction, performance of additional IOP-lowering surgery, or loss of light perception vision. RESULTS A total of 74 eyes of 57 patients were included (mean age, 7.1 years). Over a median follow-up period of 28.5 months, 36 eyes (48.6%) failed. IOP spikes occurred in 25 eyes (33.8%) and were a significant risk factor for failure (hazard ratio [HR] = 2.17; P = .0207). Postoperative hyphema was a significant risk factor for IOP spike (HR = 4.13, P = .003) but not for failure (HR = 0.7, P = .2977). The risk of IOP spike was lowest in eyes treated with nonsteroidal anti-inflammatory drugs (NSAIDs; HR = 0.27, P = .0016). The risk of failure increased significantly in eyes that received topical corticosteroids (compared to NSAIDs; HR = 5.72, P = .0005), in eyes with <360○ incisions (HR = 4.69, P < .0001), and in younger children. CONCLUSIONS GATT is a reasonably effective procedure in childhood glaucoma. Postoperatively, the use of topical NSAIDs (without corticosteroid) may decrease the risk of failure. Eyes with IOP spikes without hyphema are at the highest risk for failure.
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Affiliation(s)
- Ann V Quan
- From Scripps Health (A.V.Q.), Department of Ophthalmology, San Diego, California, USA
| | - Jenny Chen
- UC Davis Eye Center (J.C.), University of California Davis Medical Center, Sacramento, California, USA
| | - Ye Elaine Wang
- Harvard Eye Associates (Y.E.W.), Laguna Hills, California, USA
| | - Elizabeth A Vanner
- Bascom Palmer Eye Institute (E.A.V., A.L.G., E.A.H., T.C.C.), University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Alana L Grajewski
- Bascom Palmer Eye Institute (E.A.V., A.L.G., E.A.H., T.C.C.), University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Elizabeth A Hodapp
- Bascom Palmer Eye Institute (E.A.V., A.L.G., E.A.H., T.C.C.), University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ta Chen Chang
- Bascom Palmer Eye Institute (E.A.V., A.L.G., E.A.H., T.C.C.), University of Miami Miller School of Medicine, Miami, Florida, USA.
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Gallardo MJ, Pyfer MF, Vold SD, Sarkisian SR, Campbell A, Singh IP, Flowers B, Dhamdhere K. Canaloplasty and Trabeculotomy Combined with Phacoemulsification for Glaucoma: 12-Month Results of the GEMINI Study. Clin Ophthalmol 2022; 16:1225-1234. [PMID: 35493971 PMCID: PMC9039153 DOI: 10.2147/opth.s362932] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/12/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose To report 12-month efficacy outcomes of 360° canaloplasty and 180° trabeculotomy using the OMNI surgical system in combination with phacoemulsification in patients with mild-moderate open-angle glaucoma (OAG) and visually significant cataract. Setting Fifteen multi-subspecialty ophthalmology practices and surgery centers located in 14 US states. Design Prospective, multicenter, IRB approved study of patients treated with canaloplasty (360°) and trabeculotomy (180°). Eligible patients had cataract and mild-moderate OAG with intraocular pressure (IOP) ≤33 mmHg on 1 to 4 hypotensive medications. Unmedicated post-washout mean diurnal IOP (DIOP) ≥21 and ≤36 mmHg. Methods Medication washout preoperatively and prior to month 12 DIOP. Effectiveness outcomes were IOP and IOP lowering medication use. Safety outcomes included adverse events and secondary surgical interventions (SSIs). Evaluations at 1, 3, 6, and 12 months. Results A total of 149 subjects underwent surgery and 120 were included in the final effectiveness analysis. Mean (standard deviation) unmedicated diurnal IOP was reduced from 23.8 (3.1) mmHg at baseline to 15.6 (4.0) at month 12 (−35%) and medications (before washout) were reduced from 1.8 (0.9) at baseline to 0.4 (0.9) at month 12 (−80%). At month 12, 84.2% of eyes achieved IOP reductions >20% from baseline, 80% of eyes were medication-free, and 76% of eyes achieved IOP between 6–18 mmHg inclusive. Adverse events were uncommon. Most were mild and self-limited including transient hyphema (9 of 149; 6%) and transient IOP elevations (3 of 149; 2.0%). No eyes required SSIs or experienced loss of VA that was attributable to the device or procedure. Conclusion Canaloplasty and trabeculotomy performed with the OMNI surgical system at the time of phacoemulsification significantly reduces unmedicated mean diurnal IOP and medication use 12 months postoperatively, with an excellent safety profile. This procedure should be considered for eyes with mild-moderate OAG to reduce IOP, medication burden, or both.
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Affiliation(s)
| | - Mark F Pyfer
- Northern Ophthalmic Associates, Jenkintown, PA, USA
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Kan JT, Betzler BK, Lim SY, Ang BCH. Anterior segment imaging in minimally invasive glaucoma surgery - A systematic review. Acta Ophthalmol 2022; 100:e617-e634. [PMID: 34250742 DOI: 10.1111/aos.14962] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 06/17/2021] [Indexed: 12/13/2022]
Abstract
Minimally invasive glaucoma surgery (MIGS) has grown in popularity over the past decade. This systematic review explores the peri-operative and intraoperative application of anterior segment imaging to maximize the efficacy and safety of MIGS. A review of the PubMed, EMBASE and CINAHL databases was conducted, with inclusion criteria restricted to MIGS that had received United States Food and Drug Administration (FDA) premarket approval, FDA 510(K) premarket notification, or were listed as a class 1 device exempt from FDA approval or notification. 21 manuscripts from 21 unique studies were identified pertaining to MIGS devices including the XEN Gel Stent, Trabectome, iStent Inject, 1st-generation iStent and the Kahook Dual Blade (KDB). Anterior segment imaging modalities included anterior segment optical coherence tomography (AS-OCT), ultrasound biomicroscopy (UBM), aqueous angiography, OCT volumetric scans and in vivo confocal microscopy. Identification and evaluation of aqueous outflow pathways before and after MIGS have potential for improving patient preoperative patient selection and postoperative outcomes. Intraoperative imaging potentially provides the resolution needed for good visualization of angle anatomy and accurate evaluation of surgical endpoints in angle-based MIGS. Anterior segment imaging has been used to identify procedural complications, provide objective information on implant location in relation to surrounding anatomy, assess the post-implantation structural impact of MIGS devices and manage bleb failure and scarring. Technical difficulties in incorporating imaging modalities into the surgical microscope, variable quality of images and optical interference from ocular structures or surgical instruments are remaining barriers, which discourage the widespread clinical use of this technology.
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Affiliation(s)
- John Tsia‐Chuen Kan
- Department of Ophthalmology Tan Tock Seng Hospital National Healthcare Group Eye Institute Singapore Singapore
| | - Bjorn Kaijun Betzler
- Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore
| | - Sheng Yang Lim
- Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore
| | - Bryan Chin Hou Ang
- Department of Ophthalmology Tan Tock Seng Hospital National Healthcare Group Eye Institute Singapore Singapore
- Department of Ophthalmology Woodlands Health Campus National Healthcare Group Eye Institute Singapore Singapore
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Shi Y, Wang H, Oatts JT, Xin C, Yin P, Zhang L, Tian J, Zhang Y, Cao K, Han Y, Wang N. A Prospective Study of Intraocular Pressure Spike and Failure After Gonioscopy-Assisted Transluminal Trabeculotomy in Juvenile Open-Angle Glaucoma: A Prospective Study of GATT in JOAG. Am J Ophthalmol 2022; 236:79-88. [PMID: 34695398 DOI: 10.1016/j.ajo.2021.10.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/30/2021] [Accepted: 10/09/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To identify risk factors for surgical failure after gonioscopy-assisted transluminal trabeculotomy (GATT) in juvenile open-angle glaucoma (JOAG). DESIGN Prospective, interventional case series. METHODS GATT was the initial surgery in 70 eyes of 70 patients with JOAG. Surgical success was defined as a postoperative intraocular pressure (IOP) of ≤21 mm Hg with at least a 20% reduction from preoperative IOP, with or without the use of antiglaucoma medication (qualified and complete success, respectively) at each postoperative visit. IOP spike was defined as IOP >30 mm Hg and an increase of at least 10 mm Hg from IOP before the spike, and then reduced to ≤21 mm Hg. RESULTS The median age at the time of surgery was 19.3 years (range, 4.9-37.5 years) with a visual field mean deviation of -17.4 ± 10.6 dB. Mean IOP decreased from 31.3 ± 9.5 mm Hg preoperatively to 15.8 ± 2.7 at 12 months postoperatively. The complete and qualified success rates were 74.3% and 91.4%, respectively. An IOP spike occurred in 52 eyes (74%), with a median spike duration of 3.5 days (range, 1-21 days). Longer duration of IOP spike (P = .009) and older age at the time of surgery (P = .025) were both associated with worse surgical outcomes. Advanced disease was associated with prolonged IOP spike (P = .007). CONCLUSIONS GATT provided excellent outcomes in patients with severe JOAG. Older age and longer duration of postoperative IOP spike are risk factors for failure. Severe cases are more likely to have longer durations of IOP spike. Frequent IOP monitoring during the early postoperative period is needed to detect IOP spikes in these patients.
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Abdelrahman AM, Amin RH. Combined nasal goniotomy - temporal trabeculotomy (NGTT) for circumferential angle surgery in primary congenital glaucoma. Eur J Ophthalmol 2022; 32:3470-3475. [PMID: 35253454 DOI: 10.1177/11206721221085395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess the safety and efficacy of combining nasal goniotomy with temporal trabeculotomy in the management of primary congenital glaucoma. DESIGN Case series. METHODS Fifteen eyes of eleven children (3-12 months old at presentation) were enrolled in this study after the establishment of PCG diagnosis based on the criteria placed by the World Glaucoma Association. Combined nasal goniotomy and temporal trabeculotomy were done on each eye in an attempt to perform almost 360 degrees circumferential angle surgery without disturbing the superior 180 degrees of conjunctiva to preserve it for future filtering glaucoma surgeries. RESULTS By first month, average IOP was 10.5 ± 4.3 mmHg with a 65.3% reduction from average pre-operative IOP. Almost the same percentage of reduction was maintained at 3rd,6th and 12th months postoperative visits with average IOP of 11.9 ± 4.65, 11.8 ± 2.77 and 13 ± 2.82 mmHg (60.7%, 61.1% and 57.2% reduction from pre-operative average). According to success rates, complete success has been achieved in all eyes but one (93.3%), with minor complications in 4 out of 15 eyes (26.6%) that did not affect IOP outcome. Nine out of fifteen eyes completed 18 months post-operative follow-up visits with a successfully, maintained target average IOP of 13.3 ± 3.0 mmHg (57.2% reduction). All of the mean IOP readings during post-operative follow-up period were significantly lower when compared to pre-operative IOP (p < 0.0001). Only one eye had persistently elevated IOP of 26 mmHg at 1st and 3rd months post-operatively that necessitated a subsequent subscleral trabeculectomy which succeeded in controlling the pressure bringing it down to 15 mmHg on topical medications. CONCLUSION Nasal goniotomy - temporal trabeculotomy (NGTT) is the combination of two well established surgeries that exploits the advantages of circumferential angle surgery while sparing the superior conjunctiva completely for future surgeries if needed. This new procedure was safe and effective in lowering IOP by an average of 60% from pre-operative IOP with a sustained effect till 18 months post-operatively. We believe that this surgery might be added to the armentarium of the surgical management of infantile glaucomas with other circumferential angle surgeries.
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Bolletta E, Iannetta D, Moramarco A, Fontana L. Malignant glaucoma following gonioscopy-assisted transluminal trabeculotomy: a case report. BMC Ophthalmol 2022; 22:59. [PMID: 35135528 PMCID: PMC8822788 DOI: 10.1186/s12886-022-02276-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 01/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To report a case of malignant glaucoma that developed after gonioscopy-assisted transluminal trabeculotomy (GATT). CASE PRESENTATION An 85-year-old male pseudophakic patient affected by pseudoexfoliative glaucoma (PEXG), unresponsive to medical glaucoma treatment, underwent uneventful GATT surgery. On the first day after surgery, the eye showed a shallow central and peripheral anterior chamber (AC) with a raised intraocular pressure (IOP) measured at 55 mmHg. Optical coherence tomography and ultrasound biomicroscopy confirmed the diagnosis of malignant glaucoma. Laser iridotomy, posterior capsulotomy and hyaloidotomy were performed, and the patient was treated with atropine sulphate 1%, maximum topical and systemic ocular hypotensive drugs with no improvement in the IOP. Subsequently, the patient underwent pars plana anterior vitrectomy, resulting in deepening of the AC with opening of the iridocorneal angle and decrease of the IOP. No further postoperative complications were recorded, and the IOP remained controlled 12 months after surgery without antiglaucoma medications. CONCLUSIONS Despite the minimally invasive profile of GATT, malignant glaucoma may develop after this procedure. Early recognition and prompt treatment are mandatory for preventing permanent visual loss.
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Affiliation(s)
- Elena Bolletta
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Viale Risorgimento 80, Reggio Emilia, Italy
| | - Danilo Iannetta
- Ophthalmology Unit, DIMES, Alma Mater Studiorum, University of Bologna and S. Orsola-Malpighi Teaching Hospital, 40138, Bologna, Italy
| | - Antonio Moramarco
- Ophthalmology Unit, DIMES, Alma Mater Studiorum, University of Bologna and S. Orsola-Malpighi Teaching Hospital, 40138, Bologna, Italy
| | - Luigi Fontana
- Ophthalmology Unit, DIMES, Alma Mater Studiorum, University of Bologna and S. Orsola-Malpighi Teaching Hospital, 40138, Bologna, Italy.
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Conventional Trabeculotomy versus Gonioscopy-Assisted Transluminal Trabeculotomy: A Retrospective Cohort Study. J Clin Med 2021; 11:jcm11010046. [PMID: 35011786 PMCID: PMC8745353 DOI: 10.3390/jcm11010046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/15/2021] [Accepted: 12/21/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Conventional trabeculotomy (CT) is performed in an ab-externo manner with at most 120 degrees of incision area of Schlemm’s canal (SC). Recently, gonioscopy-assisted transluminal trabeculotomy (GATT), which makes possible a 360-degree incision area of SC in an ab-interno manner, is introduced. The purpose of this study was to compare surgical outcomes for CT and GATT with and without simultaneous phacoemulsification over 24 months and to identify factors associated with surgical success. Results: Patients’ baseline characteristics were not significantly different between two groups. The surgical success rate in CT and GATT with phacoemulsification groups were 40.4% and 96.6% and were significantly higher in the GATT group than in the CT group (p < 0.001). However, the surgical success rate in CT and GATT without phacoemulsification groups were 40.8% and 54.2%, and there were no significant differences between two groups without phacoemulsification (p = 0.55). Similarly, the postoperative IOP was significantly lower in the GATT group than in the CT group only in eyes with simultaneous phacoemulsification. There were no significant differences in the numbers of glaucoma medications between the two groups. Additional glaucoma surgery was needed in 13.2% and 25.9% of patients in the GATT and CT groups, respectively (p = 0.157). The multivariate logistic regression analysis revealed that the surgical success of trabeculotomy was significantly associated with combined phacoemulsification and the type of glaucoma surgery (GATT). Conclusion: Although both groups without phacoemulsification had a similar surgical success and IOP-lowering effect, GATT combined with phacoemulsification had a higher surgical success rate and a greater IOP-lowering effect compared with combined CT and phacoemulsification. Multivariate logistic regression analysis showed that the factors associated with higher surgical success at one year and two years postoperatively were the combined phacoemulsification procedure and the GATT.
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Zhang W, Wang Y, Xin C, Sun Y, Cao K, Wang H, Wang N. Ab Interno vs. Ab Externo Microcatheter-Assisted Circumferential Trabeculotomy in Treating Patients With Primary Open-Angle Glaucoma. Front Med (Lausanne) 2021; 8:795172. [PMID: 34988099 PMCID: PMC8720850 DOI: 10.3389/fmed.2021.795172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Circumferential trabeculotomy have evolved from ab externo to ab interno approach. Both procedures may lower IOP, but it is unclear which maybe a superior approach.Purpose: To compare the outcomes of ab interno and ab externo circumferential trabeculotomy in patients with primary open-angle glaucoma.Design: Retrospective, comparative case series.Participants: Primary open angle glaucoma patients undergoing ab interno (40 patients in Group 1) or ab externo (54 patients in Group 2) circumferential trabeculotomy, with about one half of them having prior incisional glaucoma surgery.Methods: Outcomes including intraocular pressure (IOP), glaucoma medications and surgical complications were analyzed.Main Outcome Measures: IOP, medications and surgical success defined as an IOP of ≤ 21 mmHg and a reduction of IOP ≥20% from baseline (criterion A) or IOP ≤ 18 mmHg and a reduction of IOP 20% from baseline (criterion B) with (qualified success) or without (complete success) medications.Results: At 1 year, IOP decreased by 37.1% (26.0–14.8 mmHg) in Group 1 and 39.5% (28.5–15.1 mmHg) in Group 2. Medications decreased from 3.5 in Group 1 and 3.6 in Group 2 pre-operatively to 0.6 ± 1.0 and 0.3 ± 0.6 post-operatively, respectively. Success rates did not differ significantly between groups based on criterion A (complete and qualified success: 68.7 and 81.9% in Group 1, and 75.3 and 90.4% in Group 2, respectively) or criterion B (complete and qualified success: 58.2 and 79.3%in Group 1, and 69.5 and 88.4% in Group 2, respectively). For eyes with prior filtration surgeries, the mean percent reduction of IOP (41.7 ± 32.7% in Group 1, 39.7 ± 27.8% in Group 2, P = 0.724) and the mean medication reduction (2.9 ± 1.6 in Group 1, 3.4 ± 1.0 in Group 2, P = 0.454) were not significantly different.Conclusions: Ab interno circumferential trabeculotomy achieved comparable outcomes to ab externo trabeculotomy and may be an effective surgical option for patients with primary open-angle glaucoma.
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Affiliation(s)
- Weijia Zhang
- Department of Ophthalmology, Beijing Tongren Eye Centre, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Yiwei Wang
- Department of Ophthalmology, Henan Provincial People's Hospital, Zhengzhou, China
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Centre, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Chen Xin
- Department of Ophthalmology, Beijing Tongren Eye Centre, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Yang Sun
- Byers Eye at Stanford, Palo Alto, CA, United States
| | - Kai Cao
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Centre, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Huaizhou Wang
- Department of Ophthalmology, Beijing Tongren Eye Centre, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
- *Correspondence: Huaizhou Wang
| | - Ningli Wang
- Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Centre, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Belkin A, Chaban YV, Waldner D, Samet S, Ahmed IIK, Gooi P, Schlenker MB. Gonioscopy-assisted transluminal trabeculotomy is an effective surgical treatment for uveitic glaucoma. Br J Ophthalmol 2021; 107:690-697. [PMID: 34930723 DOI: 10.1136/bjophthalmol-2021-320270] [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: 08/14/2021] [Accepted: 12/02/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND To assess the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) in uveitic glaucoma (UG). METHODS A retrospective interventional case series in which 33 eyes of 32 patients with UG underwent GATT with or without concomitant cataract extraction and intraocular lens implantation (CE/IOL) at three Canadian treatment centres from October 2015 to 2020. The main outcome measure was surgical success defined as an intraocular pressure (IOP) ≤18 mm Hg and at least one of the following: IOP within one mm Hg of baseline on fewer glaucoma medications as compared with baseline or a 30% IOP reduction from baseline on the same or fewer medications. Secondary outcome measures were IOP, medication usage and surgical complications. RESULTS Mean patient age (mean±SD) was 49±16 years (range: 18-79) and 44% were female. GATT was performed as a standalone procedure in 52% of cases and the remainder were combined with CE/IOL. Surgical success was achieved in 71.8% (SE: 8.7%) of cases. Mean preoperative IOP (±SD) was 31.4±10.8 mm Hg on a median of 4 medications. 59% of patients were on oral carbonic anhydrase inhibitors (CAIs) prior to surgery. After 1 year, average IOP was 13.8 mm Hg on a median 1 medication, with 6% of patients being on oral CAIs. No sight threatening complications occurred during surgery or follow-up. CONCLUSION GATT is an effective surgical strategy in the management of UG. This microinvasive conjunctival-sparing procedure should be considered early in these patients.
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Affiliation(s)
- Avner Belkin
- Meir Medical Center, Kfar Saba, Israel .,Department of Ophthalmology, Tel Aviv University, Tel Aviv, Israel
| | - Yuri Valere Chaban
- University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Derek Waldner
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Saba Samet
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Iqbal Ike K Ahmed
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Gooi
- Department of Ophthalmology, University of Calgary, Calgary, Alberta, Canada
| | - Matthew B Schlenker
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
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Qiao Y, Tan C, Chen X, Sun X, Chen J. Gonioscopy-assisted transluminal trabeculotomy versus goniotomy with Kahook dual blade in patients with uncontrolled juvenile open-angle glaucoma: a retrospective study. BMC Ophthalmol 2021; 21:395. [PMID: 34781914 PMCID: PMC8594178 DOI: 10.1186/s12886-021-02159-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 11/02/2021] [Indexed: 12/21/2022] Open
Abstract
Background To compare the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) and Kahook Dual Blade (KDB) excisional goniotomy in patients with uncontrolled juvenile open-angle glaucoma (JOAG). Methods Thirty-three patients (46 eyes) were included in this single-center, retrospective, comparative study and treated with GATT (36 eyes) or KDB goniotomy (13 eyes). Intraocular pressure (IOP), number of glaucoma medications, adverse events, and additional anti-glaucoma procedures were collected during pre- and postoperative visits. Surgical success was defined as 6 mmHg ≤ IOP ≤ 18 mmHg and ≥ 20% IOP reduction from baseline with (partial success) or without (complete success) IOP-lowering medications. Results The mean ± SD preoperative IOP was 30.48 ± 12.9 mmHg and 26.08 ± 13.1 mmHg (P = 0.164) on 3.71 ± 0.46 and 3.08 ± 0.86 (P = 0.023) glaucoma medications in GATT and KDB group, respectively. At 3 months, the mean ± SD IOP was 15.48 ± 5.93 mmHg and 20.0 ± 10.8 mmHg after GATT and KDB, respectively (P = 0.072). The percentage of IOP lowering from baseline was 44.4 in the GATT group and 14.1 in the KDB group (P = 0.011). The mean reduction in medications was 2.6 ± 1.7 and 0.8 ± 1.2 three months after GATT and KDB, respectively (P < 0.001). Cumulative proportion of partial and complete success were 65.6 and 44.7% in the GATT group, 30.8 and 15.4% in the KDB group at 6 months. Additional procedures were required in 13.9% of cases after GATT and in 61.5% after KDB (P = 0.001). Patients in the GATT group with prior anti-glaucoma procedures and postoperative IOP spikes were more likely to fail, while those with complete trabeculotomy had a better prognosis. Conclusions Reduction of IOP and medications were greater after GATT in uncontrolled JOAG eyes. Whereas, more additional IOP-lowering procedures were required after KDB goniotomy. Trial registration This study was registered under the Chinese Clinical Trial Registry (ChiCTR2000034172, 27/06/2020). Supplementary Information The online version contains supplementary material available at 10.1186/s12886-021-02159-z.
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Affiliation(s)
- Yunsheng Qiao
- Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, 83 Fenyang Rd, Shanghai, 200031, China
| | - Chen Tan
- Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, 83 Fenyang Rd, Shanghai, 200031, China
| | - Xueli Chen
- Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, 83 Fenyang Rd, Shanghai, 200031, China.,State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, 200032, China.,NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, 200031, China
| | - Xinghuai Sun
- Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, 83 Fenyang Rd, Shanghai, 200031, China.,State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, 200032, China.,NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, 200031, China
| | - Junyi Chen
- Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, 83 Fenyang Rd, Shanghai, 200031, China. .,State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, 200032, China. .,NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, 200031, China.
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Yang SA, Mitchell W, Hall N, Elze T, Lorch AC, Miller JW, Zebardast N. Trends and Usage Patterns of Minimally Invasive Glaucoma Surgery in the United States: IRIS® Registry Analysis 2013-2018. Ophthalmol Glaucoma 2021; 4:558-568. [PMID: 33831643 DOI: 10.1016/j.ogla.2021.03.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/20/2021] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Understanding trends and patterns in the use of minimally invasive glaucoma surgery (MIGS) and patient profiles undergoing each procedure is important given their relative expense and unknown long-term safety and effectiveness. DESIGN Retrospective analysis. PARTICIPANTS Minimally invasive glaucoma surgeries and standard glaucoma surgeries recorded in the American Academy of Ophthalmology Intelligent Research in Sight (IRIS®) Registry. METHODS We used the data from IRIS Registry between 2013 and 2018 (inclusive) to measure the annual number of MIGS and standard surgical techniques (trabeculectomy or glaucoma drainage device [GDD] placement) performed in the United States, stratified by demographic characteristics. Secondary analyses of concurrent surgeries and of subsequent surgeries for MIGS and standard surgical technique also were conducted. MAIN OUTCOME MEASURES Trends and sociodemographic characteristics of MIGS use in the United States. RESULTS Two hundred three thousand three hundred thirty-two eyes and 232 537 unique procedures had associated, documented International Statistical Classification of Diseases and Related Health Problems (ICD), Ninth or Tenth Revision, codes for glaucoma and were included in final analyses. Among eyes with documented glaucoma diagnoses, a substantial increase in annual MIGS procedures occurred over the study period (from 7586 in 2013 to 39 677) and a smaller decrease in standard glaucoma procedures (from 16 215 to 13 701). The proportion of iStent procedures almost tripled during the study period (from 14% to 40%), and by 2017 accounted for almost half (43.7%) of all glaucoma surgeries in the United States. Twenty-one thousand twenty-five of all eyes (10.3%) underwent multiple procedures: 7638 (36.3%) on the same day and 13 387 (63.7%) on subsequent days. Endocyclophotocoagulation and iStent placement were the most common concurrent procedures (55.4% of all concurrent procedures). Trabeculectomy and GDD placement were most commonly followed by another standard glaucoma surgery, but when followed by sequential MIGS, endocyclophotocoagulation and goniotomy were the most common procedures performed (33.0% and 21.9%, respectively). CONCLUSIONS A significant increase in MIGS use occurred over the recent 6-year period, despite limited evidence of their long-term safety or effectiveness, highlighting the need for trials comparing safety and outcomes of novel MIGS versus traditional surgical treatments for glaucoma.
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Affiliation(s)
- Shuang-An Yang
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts
| | - William Mitchell
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Nathan Hall
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts; Schepens Eye Research Institute of Massachusetts Eye and Ear, Boston, Massachusetts
| | - Tobias Elze
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts; Glaucoma Service, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Alice C Lorch
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts; Glaucoma Service, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Joan W Miller
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts; Glaucoma Service, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Nazlee Zebardast
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts; Glaucoma Service, Massachusetts Eye and Ear, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
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Wang Y, Wang H, Han Y, Shi Y, Xin C, Yin P, Li M, Cao K, Wang N. Outcomes of gonioscopy-assisted transluminal trabeculotomy in juvenile-onset primary open-angle glaucoma. Eye (Lond) 2021; 35:2848-2854. [PMID: 33262477 PMCID: PMC8452612 DOI: 10.1038/s41433-020-01320-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 11/03/2020] [Accepted: 11/11/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To report the outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) for juvenile-onset primary open-angle glaucoma (JOAG). METHODS A consecutive case series of JOAG patients who underwent GATT was reviewed with follow-up period of up to 18 months. Intraocular pressure (IOP), number of glaucoma medications and success rate were compared between eyes with and without prior glaucoma surgery, and between mild-to-moderate and severe cases defined based on Humphrey Visual Field mean deviation. RESULTS In total, 59 eyes of 48 patients were included. Overall, IOP was reduced from 26.5 ± 9.0 mmHg on 3.7 ± 0.9 medications preoperatively to 14.7 ± 3.0 mmHg on 0.7 ± 1.2 medications at 12 months and to 14.1 ± 2.3 mmHg on 0.4 ± 0.8 medications at 18 months postoperatively (P < 0.001). The complete and qualified success rates were 70.8% and 81.2% at 12 months, and 58.6% and 81.2% at 18 months, respectively. Eyes with and without prior glaucoma surgery did not differ significantly in terms of postoperative IOP, glaucoma medication and success rate. In addition, GATT was effective for both mild-to-moderate and severe cases; the latter achieved a surgical success of 79.1%. CONCLUSIONS GATT is effective for JOAG. In particular, this case series suggests that GATT is promising in treating severe JOAG and those with prior glaucoma surgery.
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Affiliation(s)
- Yiwei Wang
- grid.24696.3f0000 0004 0369 153XBeijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, 100730 Beijing, China
| | - Huaizhou Wang
- grid.24696.3f0000 0004 0369 153XDepartment of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, 100730 Beijing, China
| | - Ying Han
- grid.266102.10000 0001 2297 6811Department of Ophthalmology, University of California San Francisco, San Francisco, CA USA
| | - Yan Shi
- grid.24696.3f0000 0004 0369 153XDepartment of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, 100730 Beijing, China
| | - Chen Xin
- grid.24696.3f0000 0004 0369 153XBeijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, 100730 Beijing, China
| | - Peng Yin
- grid.24696.3f0000 0004 0369 153XBeijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, 100730 Beijing, China ,Department of Ophthalmology, Beijing Puren Hospital, Beijing, China
| | - Meng Li
- grid.24696.3f0000 0004 0369 153XBeijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, 100730 Beijing, China
| | - Kai Cao
- grid.24696.3f0000 0004 0369 153XBeijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, 100730 Beijing, China
| | - Ningli Wang
- grid.24696.3f0000 0004 0369 153XBeijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, 100730 Beijing, China
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Outcomes of Gonioscopy-assisted Transluminal Trabeculotomy in Vitrectomized Patients With Secondary Glaucoma After Silicone Oil Removal. J Glaucoma 2021; 30:e114-e118. [PMID: 33177367 DOI: 10.1097/ijg.0000000000001738] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/24/2020] [Indexed: 11/27/2022]
Abstract
PRCIS The present study demonstrates that surgical success rates of gonioscopy-assisted transluminal trabeculotomy (GATT) with a target intraocular pressure (IOP)≤21 mm Hg are 93.3% (for qualified success) and 26.7% (for complete success) in vitrectomized patients exhibiting secondary open-angle glaucoma (SOAG) after silicone oil (SO) removal, for an average follow-up of 37.5 months. PURPOSE To report the long-term outcomes of GATT in vitrectomized patients exhibiting SOAG after SO removal. SETTING Retrospective case-series study. PATIENT POPULATION This retrospective case-series study enrolled vitrectomized patients who underwent uneventful GATT surgery between May 2014 and May 2019 at Gazi University Hospital for the treatment of medically uncontrolled SOAG after SO removal. MAIN OUTCOME MEASURES At baseline and at each postoperative visit, a detailed ophthalmic examination consisting of slit-lamp biomicroscopy, indirect ophthalmoscopy, macular optical coherence tomography, and Goldmann applanation tonometry was performed in all patients. Baseline demographic and clinical characteristics, duration between pars plana vitrectomy and SO removal, duration between SO removal and onset of SOAG, follow-up time, need for antiglaucoma medication, visual acuity, and IOP measurements were noted. Surgical success was defined as an IOP≤21 and ≥6 mm Hg with (qualified success) and without (complete success) IOP-lowering medication. RESULTS A total of 15 patients had a history of pars plana vitrectomy with 1000 centistoke SO tamponade before the GATT surgery. GATT was performed in all patients with SOAG after SO removal. The mean age and follow-up of the patients were 53.6±11.8 years (range, 34 to 72 y) and 37.5±15.1 months (range, 12 to 61 mo), respectively. The average duration of SO tamponade in the vitreous cavity was 7.5±1.6 months (range, 5 to 10 mo). The average duration between the SO removal and the development of SOAG was 14.1±13.2 months (range, 2 to 46 mo). The mean IOP decreased from 31.0±4.1 mm Hg at baseline to 15.6±4.6 mm Hg at final visit. The mean final logMAR BCVA was 0.92±0.58 (range, 2 to 0.045). Qualified surgical success was achieved in 14 (93.3%) patients, whereas complete success was achieved in only 4 (26.7%) patients (P<0.001). CONCLUSIONS GATT seems to be safe and successful procedure for controlling IOP in patients exhibiting SOAG after SO removal. However, most patients may require antiglaucoma medication during the follow-up, particularly within the first 2 postoperative years.
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Abstract
Micro- or minimally invasive glaucoma surgeries (MIGS) have been the latest addition to the glaucoma surgical treatment paradigm. This term refers not to a single surgery, but rather to a group of distinct procedures and devices that aim to decrease intraocular pressure. Broadly, MIGS can be categorized into surgeries that increase the trabecular outflow [Trabectome, iStent (first and second generations), Hydrus microstent, Kahook Dual Blade and gonioscopy-assisted transluminal trabeculotomy], surgeries that increase suprachoroidal outflow (Cypass microstent and iStent Supra), and conjunctival bleb-forming procedures (Xen gel stent and InnFocus microshunt). Compared to traditional glaucoma surgeries, such as trabeculectomy and glaucoma drainage device implantation (Ahmed, Baerveldt, and Molteno valves), MIGS are touted to have less severe complications and shorter surgical time. MIGS represent an evolving field, and the efficacy and complications of each procedure should be considered independently, giving more importance to high-quality and longer-term studies.
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Affiliation(s)
- David J Mathew
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario M5T 2S8, Canada;
| | - Yvonne M Buys
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario M5T 2S8, Canada;
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Bektas C, Aktas Z, Ucgul AY, Karamert SS. Prognostic factors affecting the surgical success of gonioscopy-assisted transluminal trabeculotomy. Indian J Ophthalmol 2021; 69:1425-1429. [PMID: 34011713 PMCID: PMC8302281 DOI: 10.4103/ijo.ijo_2035_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: To investigate the prognostic factors affecting gonioscopy-assisted transluminal trabeculotomy (GATT) surgical success. Methods: Fifty-three eyes were retrospectively enrolled. Open-angle glaucoma patients with at least 6-month follow-up were included. At baseline, demographic characteristics, intraocular pressure (IOP), number of anti-glaucomatous medications (AG), and glaucoma type were recorded. Postoperatively, IOP, complications, and number of AG were noted. The effects of these parameters on surgical success were investigated. Results: The median follow-up time was 13.7 months. The mean IOP decreased from 25.6 ± 6.2 mm Hg at baseline to 14.6 ± 3.5 mm Hg at final, and the number of AG decreased from 3.2 ± 0.78 to 1.2 ± 1.3. When target IOP was considered as 18 mm Hg and 15 mm Hg, surgical success rates were 81.1% and 60.4%, respectively. When target IOP was considered as 18 mm Hg, a positive effect of the combination with cataract surgery and a negative effect of postoperative macrohyphema on success rates were observed. Other factors did not show any association with the success rates for both target IOP values when analyzed by the Cox proportional hazards regression analysis. Conclusion: Postoperative macrohyphema may affect surgical success rates negatively. The contribution of the combination with cataract surgery is controversial. Glaucoma stage does not seem to affect surgical success.
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Affiliation(s)
- Caglar Bektas
- Department of Ophthalmology, Can State Hospital, Can, 17400, Canakkale, Turkey
| | - Zeynep Aktas
- Department of Ophthalmology, Gazi University Medical School, Besevler, 06500, Ankara, Turkey
| | - Ahmet Yucel Ucgul
- Department of Ophthalmology, Training and Research Hospital, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Selin Sahin Karamert
- Department of Ophthalmology, Dr Sami Ulus Maternity and Children Research and Training Hospital, Ankara, Turkey
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Hamze H, Mohite AA, Pandey P, Sung VCT, Masood I. Comparison of 1-year surgical outcomes of combined cataract surgery and gonioscopy-assisted transluminal trabeculotomy (GATT) versus cataract surgery and iStent Inject. Graefes Arch Clin Exp Ophthalmol 2021; 259:3035-3044. [PMID: 34014384 DOI: 10.1007/s00417-021-05133-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/11/2021] [Accepted: 02/16/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE Evaluate the efficacy, safety, and complication rates of phacoemulsification cataract surgery when combined with either gonioscopy-assisted transluminal trabeculotomy (GATT) or iStent Inject. METHODS This is a retrospective case-control study to compare the surgical outcomes of combined phacoemulsification cataract surgery with either GATT (phaco-GATT) or iStent Inject (phaco-iStent). Both groups had at least 1-year follow-up. The primary outcome measures were IOP and number of glaucoma medications (NGMs) at 1 year. Secondary outcomes measures were best corrected visual acuity (BCVA) and intra- or postoperative complications within the first year of follow-up. Success was defined as intraocular pressure (IOP) < 21 mmHg and ≥ 20% reduction in IOP at 1 year regardless of the NGM. RESULTS Each group included 37 patients. The median baseline IOP (24 vs 17) and NGM (3 vs 2) were higher in the phaco-GATT group (p < 0.001). Phaco-GATT achieved a 38% (p < 0.0001) reduction in IOP compared to 13.2% (p < 0.001) in the phaco-iStent group at 1-year follow-up. The reduction in IOP and NGM was significantly higher in the phaco-GATT group (p < 0.01). After adjusting for baseline IOP, the reduction in IOP at 12 months was still significantly higher in the phaco-GATT group (p = 0.042). At 1 year, 86.4% of patients in the phaco-GATT group met the success criteria compared to 35.1% in the phaco-iStent group. Safety outcomes were slightly favourable in the phaco-iStent group. CONCLUSION Phaco-GATT and phaco-iStent showed a significant reduction in IOP and NGM, with phaco-GATT having a significantly higher reduction. Phaco-iStent appears to have a higher safety profile and is probably preferable in monocular patients and those with a high risk of bleeding.
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Affiliation(s)
- Hisham Hamze
- Birmingham and Midland Eye Centre, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Dudley Road, Birmingham, B18 7QH, UK
| | - Abhijit Anand Mohite
- New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton Rd, Heath Town, Wolverhampton, WV10 0QP, UK
| | - Pravin Pandey
- Birmingham and Midland Eye Centre, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Dudley Road, Birmingham, B18 7QH, UK
| | - Velota C T Sung
- Birmingham and Midland Eye Centre, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Dudley Road, Birmingham, B18 7QH, UK
| | - Imran Masood
- Birmingham and Midland Eye Centre, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Dudley Road, Birmingham, B18 7QH, UK.
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Vez S, Müller L, Bochmann F. Surgical Outcomes of Gonioscopy-Assisted Transluminal Trabeculotomy (GATT) in Patients with Open-Angle Glaucoma - A Retrospective Case Series. Klin Monbl Augenheilkd 2021; 238:391-395. [PMID: 33930918 DOI: 10.1055/a-1425-6888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the outcome of gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with open-angle glaucoma (OAG). PARTICIPANTS AND METHODS A retrospective case series of patients with uncontrolled OAG treated by GATT at the cantonal Hospital Lucerne, a tertiary referral center, between October 2018 and July 2019 with a minimal 6-month follow-up period. Main outcome measures were intraocular pressure (IOP), number of antiglaucoma medications, and complications. RESULTS Thirty-one eyes of 29 patients with a mean age of 70.9 years and a minimal follow-up period of 6 months were included in this study. Twenty eyes were treated for pseudoexfoliation (64.5%), seven for primary open-angle (22.6%), three for pigmentary (9.7%), and one for traumatic (3.2%) glaucoma. Twenty-six eyes had data at the 6-month follow-up and 12 eyes at the 12-month follow-up. Twenty-two eyes (70.9%) were pseudophakic prior to the operation. Mean preoperative IOP was 33 mmHg (standard deviation [SD] 8.0 mmHg). The postoperative IOP was 13.9 mmHg [SD 2.2] at the 6- and 13.9 mmHg [SD 3.1] at the 12-month follow-up. The postoperative IOP evolution translated into a 58% decrease between 6 and 12 months (p < 0.001). Thirteen patients (41.9%) were treated with oral Diamox prior to GATT. The number of antiglaucoma medications decreased from a preoperative average of 2.9 [SD 1.2] to postoperative 1 [SD 1] drug (p < 0.001). The most frequent adverse event was the occurrence of postoperative hyphema. Hyphema was observed in 21 (68.0%), 7 (22.6%), and 2 (6.4%) eyes at days 1, 7, and 30 after GATT, respectively. Intraocular hypertension over 25 mmHg was seen in eight eyes (25.8%), and in four of them, a steroid response was suspected. One patient developed an anterior uveitis and a macular edema. CONCLUSION GATT is an effective and safe intervention for OAG, particularly in pseudoexfoliation glaucoma (PEX). The advantages of GATT compared to filtration surgery are the low rate of long-term complications and that the intervention is feasible even when difficult conjunctival conditions are encountered.
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Affiliation(s)
- Sarah Vez
- Augenklinik, Luzerner Kantonsspital, Luzern, Switzerland
| | - Luzia Müller
- Augenklinik, Luzerner Kantonsspital, Luzern, Switzerland
| | - Frank Bochmann
- Augenklinik, Luzerner Kantonsspital, Luzern, Switzerland
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