Gonioscopy-assisted transluminal trabeculotomy in patients with advanced glaucoma

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.

Gonioscopy-assisted transluminal trabeculotomy for secondary high intraocular pressure after vitrectomy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the clinical efficacy of gonioscopy-assisted transluminal trabeculotomy(GATT)for secondary high intraocular pressure after vitrectomy.METHODS: A retrospective study was conducted on 10 patients(15 eyes)with secondary high intraocular pressure(IOP)after vitrectomy treated with GATT in Department of Ophthalmology, Chengdu First People's Hospital from January 2019 to May 2022. The best-corrected visual acuity(BCVA), IOP, number of IOP-lowering drugs, and complications before operation and at 1d, 1wk, 1, 3 and 6mo after operation were recorded, and the surgical success rate was analyzed.RESULTS:There was no difference in BCVA before and 6mo after operation(Z=0, P=1). The mean IOP decreased from 28.33±9.48mmHg to 17.47±3.78(1d), 18.8±3.29(1wk), 19.13±3.62(1mo), 20.31±3.66(3mo)and 18.03±3.23mmHg(6mo; all P&#x003C;0.05). The average medication used before surgery was 2(2, 4), and the average medication used 6mo after surgery was 1(0, 2), which was significantly decreased(P&#x003C;0.001). The total success rate of surgery at 1d, 1wk, 1, 3 and 6mo after surgery was 87%(13 eyes), 93%(14 eyes), 87%(13 eyes), 73%(11 eyes)and 93%(14 eyes)respectively. The main postoperative complications were transient hyphema(10 eyes, 67%)and transient elevated IOP(5 eyes, 33%). No complications seriously affecting the vision occurred.CONCLUSION: GATT is safe and effective in the treatment of secondary high intraocular pressure after vitrectomy.

Gonioscopy-assisted transluminal trabeculotomy: Passing the right way decoding suture

Background: Trabeculectomy is still the most frequently performed glaucoma surgery. But being an invasive procedure, it has numerous vision?threatening complications along with bleb?related complications like cystic bleb, overhanging bleb blebitis, or endophthalmitis. The choice of therapy between medical laser and filtering surgery is now bridged by minimally invasive glaucoma surgeries (MIGS), which are conjunctiva?sparing procedures with adequate intraocular pressure (IOP)?lowering effects and good safety profiles. Among the armamentarium of MIGS procedures, gonioscopy?assisted transluminal trabeculotomy (GATT) is a frontrunner safe procedure. The procedure is a blebless and sutureless procedure in which a readily available Prolene suture is used to cleave the entire trabecular meshwork. An ab interno approach also allows direct visualization of a so?called trabecular shelf that, when present, indicates an open, cleaved collector system commonly associated with a positive postoperative outcome. Thus, it not only saves the eye from various postoperative complications of other previous penetrating procedures, but is also an effective glaucoma surgery that can be performed with very low costs, which would have big economic implications for glaucoma carein developing countries. Purpose: The purpose of this video is to illustrate transluminal novel trabeculotomy technique and video?based skill transfer to a novice surgeon. Synopsis: This video depicts detailed steps of GATT surgery in a patient with primary open angle glaucoma and in a case of silicon oil induced secondary open angle glaucoma. The authors also share their experience regarding possible intraoperative problems and solutions with some tips and tricks to make the surgery easy. Highlights: GATT can be performed with cataract surgery with minimal patient morbidity and a short recovery time with preserving healthy conjunctiva. There is no risk of post op hypotony or bleb related complications, with a short surgical learning curve

Surgical outcomes of combined gonioscopy-assisted transluminal trabeculotomy and cataract surgery

Purpose: To evaluate the success, safety, and complication rates of gonioscopy-assisted transluminal trabeculotomy (GATT) combined with cataract surgery. Methods: A retrospective study was conducted for 32 patients who underwent GATT combined with phacoemulsification and intraocular lens implantation. Patients with primary open-angle glaucoma were enrolled. The primary outcome measures were visual acuity, intraocular pressure (IOP), the number of antiglaucoma medications used, and complications. Results: The average preoperative visual acuity of the patients was logMAR 1.57 ± 1.2, and the average postoperative visual acuity was logMAR 0.39 ± 0.38. A significant increase in visual acuity was observed post-surgery (P < 0.05). The average preoperative IOP was 34.2 ± 10.6 mmHg. In the 3rd postoperative month, the average IOP was 10.5 ± 2.2 mmHg, and in the 6th postoperative month, the average IOP was 11.2 ± 2.4 mmHg. In all postoperative follow-ups, IOP was significantly lower than that during the preoperative period (P < 0.05). A decrease of 2.7 ± 0.6 on average was detected in the number of glaucoma medications used in the postoperative period compared to the preoperative period, and the average decrease in the number of active ingredients post-surgery was 3.5 ± 0.8. The most frequent complication was hyphaema (31.2%). In only one patient (3.1%), the surgery was considered to have failed due to the development of deep hypotony. Conclusion: Performing GATT in the same session as cataract surgery does not reduce the efficacy of GATT, yet this procedure reduces the incidence of the most frequent complication of GATT, i.e. hyphaema. Therefore, in convenient cases, combined surgery can safely be performed.