Clinical significance of episcleral venous fluid wave in gonioscopy-assisted transluminal trabeculotomy

Three-year outcomes of gonioscopy-assisted transluminal trabeculotomy for juvenile-onset primary open-angle glaucoma: a retrospective study

OBJECTIVES

This retrospective study evaluates the three-year efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with juvenile-onset primary open-angle glaucoma (JOAG).

METHODS

A total of 26 patients (35 eyes) with juvenile-onset primary open-angle glaucoma (JOAG) were included in this single-center, retrospective study. Clinical records of patients who underwent gonioscopy-assisted transluminal trabeculotomy (GATT) were analyzed to assess intraocular pressure (IOP), the number of glaucoma medications, and complications, while anterior chamber angle changes were observed by gonioscopy. The follow-up period was up to 36 months.

RESULTS

At the time of surgery, the median age of the cohort was 26 years (range: 4-35 years), with a mean visual field deviation (MD) of -17.03 ± 8.67 dB. The mean intraocular pressure (IOP) was reduced from 29.89 ± 9.43 mmHg preoperatively (on 2.7 ± 0.7 glaucoma medications) to 15.70 ± 4.39 mmHg at 12 months (on 0.4 ± 0.9 medications), 15.27 ± 3.24 mmHg at 24 months (on 0.3 ± 0.6 medications), and 17.33 ± 3.37 mmHg at 36 months (on 0.5 ± 0.7 medications). Gonioscopic examinations indicated that peripheral anterior synechiae (PAS) primarily formed within the first 1-3 months and were fully established by 6 months, after which the extent of peripheral anterior synechiae (PAS) remained relatively stable. Kaplan-Meier survival analysis revealed complete and qualified success rates of 73.7% and 82.6% at 12 months, 73.7% and 76.7% at 24 months, 60.3% and 69.1% at 30 months, and 51.7% and 69.1% at 36 months, respectively. The cumulative total success proportion were 90.6% at 12 months, 96.7% at 18 months, 92.3% at 24 months, 86.4% at 30 months and 73.3% at 36 months.

CONCLUSIONS

GATT is a safe and effective surgical option for JOAG, achieving sustained IOP reduction and favorable long-term success rates.

Comparison of efficacy and safety between gonioscopy-assisted transluminal trabeculotomy and trabeculectomy for primary open-angle glaucoma treatment: a retrospective cohort study

BACKGROUND

Trabeculectomy (TRAB) traditionally has been the gold-standard surgical treatment for primary open-angle glaucoma (POAG), while gonioscopy-assisted transluminal trabeculotomy (GATT) is an emerging minimally invasive surgery used for the treatment of various open-angle glaucoma (OAG) types. In this study, we aimed to compare the efficacy and safety between GATT and TRAB for the treatment of POAG.

METHODS

This cohort study included eyes with POAG that underwent a single GATT (30 eyes) or TRAB (34 eyes). Follow-up was conducted at 1 day, 1 week, and 1, 3, 6, and 12 months postoperatively. Intraocular pressure (IOP), the numbers of glaucoma medication, visual field mean deviation, peripapillary retinal nerve fiber layer thickness, surgical time, and complications were analyzed. Success criteria were defined as IOP ≤ 21 mmHg and ≥ 20% IOP reduction from baseline. Qualified and complete surgical success rates were also compared.

RESULTS

IOP and antiglaucoma drug use decreased significantly at 12 months postoperatively in the both groups (P < 0.001), with no significant differences between the two groups pre- and postoperatively (P > 0.05). The success rates at 12 months were 70% (95% confidence interval [CI] = 52.6-87.4%) in the GATT group and 76.5% (95% CI = 61.4-91.5%) in the TRAB group (P = 0.559).Visual field loss remained unchanged at 12 months postoperatively compared with preoperative levels in both groups (P > 0.05); however, peripapillary retinal nerve fiber layer thickness decreased significantly at 12 months postoperatively compared with preoperative levels in the GATT group (P < 0.001). The most frequent complications after TRAB and GATT were bleb-related complications and hyphema, respectively.

CONCLUSIONS

GATT demonstrated an efficacy comparable to that of TRAB for the treatment of POAG with regards to lowering IOP, reducing medication use, and preserving visual fields. Thus, GATT is a minimally invasive technique that enables an effective and safe decrease in IOP.