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Gepstein R, Laytman Klein T, Naftali Ben Haim L, Belkin A. Uveitic Flare-Ups After Gonioscopy-Assisted Transluminal Trabeculotomy ( GATT) in Patients with Uveitic Glaucoma. Ocul Immunol Inflamm 2024:1-7. [PMID: 38470999 DOI: 10.1080/09273948.2024.2316760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 02/05/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE To assess the risk of gonioscopy-assisted transluminal trabeculotomy (GATT) inducing an uveitic flare-up in patients with uveitic glaucoma (UG). METHODS This retrospective study included consecutive UG patients who underwent GATT at a single medical center between June 2020 and September 2022. The main outcome measure was the occurrence of a surgery-related uveitic complication defined as either an uveitic flare-up defined by the Standardization of Uveitis Nomenclature (SUN) criteria, or the appearance of cystoid macular edema (CME) from 2 weeks to 3 months after surgery. RESULTS A total of 25 eyes of 22 patients were included in the study. Age ranged from 10-78 and 64% were women. The most common uveitic etiologies were juvenile idiopathic arthritis (JIA, 24%) and herpetic infection (24%). A total of 48%of the patients were on systemic immunosuppressants prior and unrelated to surgery. Eight eyes (32%) had severe glaucomatous damage prior to surgery, and 20% of the patients had undergone previous glaucoma surgery. Two cases (8%) demonstrated uveitic flare-up in the early postoperative period: a case of mild anterior chamber reaction and a case of CME with persistent edema prior to surgery. Average intraocular pressure (IOP) was reduced from 26.7 mm Hg on four medications to 12.2 on 1.1 after 1 year. One patient required reoperation for IOP control. CONCLUSIONS With careful pre and postoperative care, GATT seems to be a low-risk procedure for uveitic flare-ups in patients with UG.
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Affiliation(s)
- Raz Gepstein
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamar Laytman Klein
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liron Naftali Ben Haim
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avner Belkin
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Tanenbaum RE, Xiao J, Qiu M. Reflux hyphema from transient hypotony after Ozurdex® in eyes with prior GATT. Am J Ophthalmol Case Rep 2023; 32:101939. [PMID: 37869267 PMCID: PMC10585214 DOI: 10.1016/j.ajoc.2023.101939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/20/2023] [Accepted: 10/01/2023] [Indexed: 10/24/2023] Open
Abstract
Purpose To report on delayed-onset hyphema following intravitreal injection of dexamethasone implant Ozurdex® in eyes with a history of gonioscopy-assisted transluminal trabeculotomy (GATT). Observations We describe two cases of hyphema occurring within one day following Ozurdex® implantation in eyes that had undergone GATT at least one year prior. One case responded well to medical management, while the other required anterior chamber paracentesis for intraocular pressure (IOP) control. Both patients achieved normalization of IOP following resolution of the hyphema, and have not had recurrence. Conclusions and importance We propose that transient hypotony immediately after Ozurdex® injection may lead to a reflux of blood from the episcleral venous network into the anterior chamber in eyes with prior ab interno trabeculotomy. Glaucoma and retina specialists should be aware of this potential complication to guide follow up and management in the post-injection period for these patients.
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Affiliation(s)
- Rebecca E. Tanenbaum
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, IL, USA
| | - Jason Xiao
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Mary Qiu
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, IL, USA
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Xing W, Yao L. Hong Kong as a separate customs territory: Past, present and prospect. Heliyon 2023; 9:e20486. [PMID: 37822632 PMCID: PMC10562786 DOI: 10.1016/j.heliyon.2023.e20486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 09/19/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023] Open
Abstract
This article reviews the journey of Hong Kong attaining and retaining the General Agreement on Tariffs and Trade (GATT) and the World Trade Organization (WTO) membership as a separate customs territory, and examines the present challenges for the Hong Kong Special Administrative Region (HKSAR) to maintain its status within the multilateral trade system. By exploring the related facts and laws, the article concludes that Hong Kong has been a separate customs territory member of the GATT and WTO by virtue of the multilateral trade rules, and other countries are not entitled to revoke the HKSAR's separate customs territory status through unilateral measures. Given the past journey and present challenges with the separate customs territory status of Hong Kong, the following prospects can be drawn. The HKSAR remains qualified to possess full autonomy when conducting external commercial relations. A malfunctioning Appellate Body of the Dispute Settlement Body (DSB) may be incapable to safeguard the interests of HKSAR as a separate customs territory.
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Affiliation(s)
- Wangwang Xing
- Walther Schücking Institute for International Law, Kiel University, 24118, Kiel, Germany
- Southern Marine Science and Engineering Guangdong Laboratory (Zhuhai), 519000, Zhuhai, China
| | - Li Yao
- English Seminar, Faculty of Arts and Humanities, Kiel University, 24118, Kiel, Germany
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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. Int J Environ Res 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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Espinoza G, Pedraza-Concha A, Tello A, Galvis V, Rangel CM, Castellanos YA. Cystoid Macular Edema after an uncomplicated Gonioscopy- Assisted Transluminal Trabeculotomy on a previously vitrec- tomized patient. Clin Ter 2022; 173:198-202. [PMID: 35612329 DOI: 10.7417/ct.2022.2417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE The main purpose of this study was to report a case of cystoid macular edema (CME) after gonioscopy-assisted transluminal trabeculotomy (GATT). METHODS We describe the case of a 73-year-old woman with ocular hypertension and history of cataract surgery combined with posterior vitrectomy and epiretinal membrane peeling 2 years before, who developed CME after uncomplicated GATT procedure. RESULTS Uneventful GATT surgery was performed in an eye with ocular hypertension. A month after GATT surgery, the patient com-plained of blurry vision. Best corrected visual acuity had deteriorated from 20/20 on Snellen chart, to 20/70. The patient was diagnosed with CME. Treatment with topical non-steroidal anti-inflammatory drug (NSAID) and topical corticosteroids for one month, and oral carbonic anhydrase inhibitor for one week achieved a total CME regression with recovery of a normal macular and foveal architecture. CONCLUSIONS Surgery-induced CME may occur following stand-alone microinvasive glaucoma surgery (MIGS) such as GATT. It would be worthwhile to conduct studies to explore whether the prophylactic use of NSAID and corticosteroids is justified.
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Affiliation(s)
- G Espinoza
- Centro Oftalmologico Virgilio Galvis, Floridablanca, Colombia
- Fundacion Oftalmológica de Santander FOSCAL, Floridablanca, Colombia
| | - A Pedraza-Concha
- Fundacion Oftalmológica de Santander FOSCAL, Floridablanca, Colombia
- Universidad Industrial de Santander UIS, Bucaramanga, Colombia
| | - A Tello
- Centro Oftalmologico Virgilio Galvis, Floridablanca, Colombia
- Fundacion Oftalmológica de Santander FOSCAL, Floridablanca, Colombia
- Universidad Autonoma de Bucaramanga UNAB
| | - V Galvis
- Universidad Autonoma de Bucaramanga UNAB
- Fundacion Oftalmológica de Santander FOSCAL, Floridablanca, Colombia
- Centro Oftalmologico Virgilio Galvis, Floridablanca, Colombia
| | - C M Rangel
- Centro Oftalmologico Virgilio Galvis, Floridablanca, Colombia
- Fundacion Oftalmológica de Santander FOSCAL, Floridablanca, Colombia
- Universidad Autonoma de Bucaramanga UNAB
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Sharkawi E, Artes PH, Lindegger DJ, Dari ML, Wardani ME, Pasquier J, Guarnieri A. Gonioscopy-assisted transluminal trabeculotomy in primary angle-closure glaucoma. Graefes Arch Clin Exp Ophthalmol 2021; 259:3019-3026. [PMID: 34155560 DOI: 10.1007/s00417-021-05244-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE This study aims to report on outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) in eyes with primary angle-closure glaucoma (PACG). METHODS This study is a prospective, interventional, non-comparative case series. A total of 103 eyes from 88 patients with PACG underwent an ab interno trabeculotomy, using either a 5.0 polypropylene suture or an illuminated microcatheter, with up to 24 months of follow-up. The main outcome measures were intraocular pressure (IOP), number of antiglaucoma medications, success rate (IOP reduction ≥ 20% from baseline or IOP between 6 and 21 mmHg, without further glaucoma surgery) and complication rate. RESULTS The mean preoperative IOP was 21.4 (SD 7.4) mmHg using 2.5 (SD 1.1) glaucoma medications. These decreased postoperatively to 12.1 (SD 2.4) mmHg and 0.8 (SD 1.2) medications, at 24 months (P < 0.05). Success rate was 78% at 24 months of follow-up, and complication rate was 4.8%. CONCLUSION At 24 months of follow-up, our results for GATT in PACG demonstrate that this procedure effectively lowers IOP in this subtype of glaucoma, with a low complication rate.
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Affiliation(s)
- Eamon Sharkawi
- Swiss Eye Centre, Avenue de Rumine 64, Lausanne, 1005, Switzerland.
| | - Paul H Artes
- University of Plymouth, Plymouth, UK
- Southwest Eye Institute, Tavistock, UK
| | | | - Maria Laura Dari
- Swiss Eye Centre, Avenue de Rumine 64, Lausanne, 1005, Switzerland
| | | | - Jérôme Pasquier
- Center for Primary Care and Public Health, Unisanté, University of Lausanne, Lausanne, Switzerland
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Bozkurt E, Yenihayat F, Olgun A, Yazıcı AT, Şahbaz İ. The efficacy of gonioscopy-assisted transluminal trabeculectomy combined with phacoemulsification. Int Ophthalmol 2021; 41:35-43. [PMID: 32869109 DOI: 10.1007/s10792-020-01550-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/16/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To investigate the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) with or without cataract extraction (CE) in primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PEX) patients. METHODS A retrospective, non-randomized study included 108 eyes of 108 patients, with a mean age of 65.96 ± 14.84 years, who underwent GATT to treat open-angle glaucoma. We have compared two groups, GATT alone or GATT combined with CE and followed-up minimum for 12 months. Preoperative intraocular pressure (IOP), best-corrected visual acuity (BCVA) compared with final IOP, medication numbers, and BCVA levels. Surgical success was determined as IOP reduction > 20% from baseline, IOP between 5-21 mmHg, if surgery was done for intolerance to medications, preoperative < 21 mmHg with medications, postoperatively < 21 mmHg without medications, and no need for further glaucoma surgery. Also, we defined success with medications and success without medications. High success is defined as IOP < 16 mmHg without medications. RESULTS Success percentiles were found 87.5% for GATT and 83.8% for GATT with CE group (P = 0.811). IOP percentile changes were - 44.25 ± 21.32 in GATT group, - 32.29 ± 23.41 in GATT with CE group, statistically higher change observed in GATT group (P = 0.009). Final IOP levels were found statistically indifferent for comparing GATT and GATT with CE groups and between PEX and POAG groups (respectively, P = 0.412, P = 0.335). CONCLUSION We observed GATT alone has a superior lowering effect on IOP than combined surgery. Final IOP values and success percentiles show us combined surgery is also effective.
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Lehmann-Clarke L, Sadeghi Y, Guarnieri A, Sharkawi E. Gonioscopy-assisted transluminal trabeculotomy using an illuminated catheter for infantile primary congenital glaucoma. Case series. Am J Ophthalmol Case Rep 2020; 19:100733. [PMID: 32462099 DOI: 10.1016/j.ajoc.2020.100733] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 11/22/2022] Open
Abstract
Purpose To describe our experience of Gonioscopy-Assisted Transluminal Trabeculotomy (GATT) in four eyes with infantile primary congenital glaucoma (PCG). Observations We report the first two GATT procedures performed in six-month-old infants with PCG. We also report the same procedure in two eyes of a two-year-old boy with PCG who had previous goniotomies with subsequent peripheral anterior synechiae formation. In all four eyes, the IOP remained under 20 mmHg at years three and four postoperatively, without glaucoma medication or conjunctival surgery. Conclusions and importance Our cases confirm that GATT is an alternative to traditional ab externo glaucoma surgery in PCG and can be successfully performed within the first months of life, or in infants with failed or partially functioning goniotomies, avoiding the need for invasive conjunctival or scleral surgery.
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Hirabayashi MT, Lee D, King JT, Thomsen S, An JA. Comparison Of Surgical Outcomes Of 360° Circumferential Trabeculotomy Versus Sectoral Excisional Goniotomy With The Kahook Dual Blade At 6 Months. Clin Ophthalmol 2019; 13:2017-2024. [PMID: 31686776 PMCID: PMC6800543 DOI: 10.2147/opth.s208468] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/27/2019] [Indexed: 12/12/2022] Open
Abstract
Purpose To compare reductions in intraocular pressure (IOP) and IOP-lowering medication use following sectoral excisional goniotomy with the Kahook Dual Blade (KDB) or 360° trabeculotomy (via either Trab360 or gonioscopy-assisted transluminal trabeculotomy [GATT]) in eyes with open-angle glaucoma (OAG) undergoing phacoemulsification cataract surgery. Methods A retrospective review was conducted to collect data from adult subjects with early to advanced primary or secondary OAG undergoing phacoemulsification combined with either KDB or 360° trabeculotomy (Trab360 or GATT) between August 1, 2016 and July 30, 2018 for which 6-month follow-up was available. Data collected included IOP, glaucoma medications, adverse events, and additional IOP-lowering procedures. The primary outcome measure was surgical success (≥20% IOP or ≥1 medication reduction without additional IOP-lowering procedures) at 6 months. Results Data were collected from 74 eyes of 61 subjects undergoing KDB excisional goniotomy and 27 eyes of 25 subjects undergoing 360° trabeculotomy (19 eyes of 17 subjects undergoing Trab360 and 8 eyes of 8 subjects undergoing GATT). At 6 months, 81.7% (58/71) of KDB eyes and 84.6% (22/26) of 360° trabeculotomy eyes achieved surgical successes (P=0.737). Mean IOP reductions and medication reductions were similar between groups at 6 months. However, more eyes undergoing KDB than Trab360/GATT achieved target IOP ≤18 mmHg (80.0% [56/70] vs 59.3% [16/27], P=0.040) and ≤15 mmHg (61.4% [43/70] vs 25.9% [7/27], P=0.003) without further IOP-lowering interventions at 6 months. The nature and frequency of adverse events were similar between groups. Conclusions Both KDB and Trab360 or GATT procedures similarly lowered both IOP and the need for IOP-lowering medications during the first 6 postoperative months. More eyes undergoing KDB excisional goniotomy than 360° trabeculotomy attained target IOP ≤18 mmHg and ≤15 mmHg at 6 months. A full 360° trabecular bypass may not be necessary to achieve maximal efficacy from this class of micro-invasive glaucoma procedures.
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Affiliation(s)
| | - Dayeong Lee
- University of Missouri Columbia School of Medicine, Columbia, MO, USA
| | - Joshua T King
- University of Missouri Columbia School of Medicine, Columbia, MO, USA
| | - Samuel Thomsen
- University of Missouri Columbia School of Medicine, Columbia, MO, USA.,Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, MO, USA
| | - Jella A An
- University of Missouri Columbia School of Medicine, Columbia, MO, USA.,Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, MO, USA
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