Gonioscopy-assisted transluminal trabeculotomy as an option after failed trabeculectomy

Purpose To evaluate the safety and efficacy profile of gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with open-angle glaucoma with a history of previous failed trabeculectomy surgery. Method This case-series study included 26 eyes of 26 consecutive patients with a mean age of 64....

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Bibliographic Details
Published in:International ophthalmology 2020-08, Vol.40 (8), p.1923-1930
Main Authors: Cubuk, Mehmet Ozgur, Ucgul, Ahmet Yucel, Unsal, Erkan
Format: Article
Language:English
Subjects:
Acuity
Eye (anatomy)
Eye surgery
Glaucoma
Medicine
Medicine & Public Health
Ophthalmology
Original Paper
Surgery
Surgical outcomes
Thickness
Visual acuity
Visual field
Visual fields
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Summary:Purpose To evaluate the safety and efficacy profile of gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with open-angle glaucoma with a history of previous failed trabeculectomy surgery. Method This case-series study included 26 eyes of 26 consecutive patients with a mean age of 64.1 ± 4.5 (56–78) years who underwent GATT using the 5/0 prolene suture to treat medically uncontrolled moderate to advanced glaucoma despite the previous trabeculectomy surgery. At baseline and each visit, Snellen best-corrected visual acuity (BCVA), IOP values, cup-to-disc ( C / D ) ratio, retinal nerve-fiber layer thickness and mean deviation values in visual field test were recorded. Need for medication or further glaucoma surgery were noted. Surgical success was defined as final IOP ≤ 15 mmHg and ≥ 20% IOP reduction from baseline without any further glaucoma surgery. Results Twelve (46.2%) patients with primary open angle glaucoma (POAG) and fourteen (53.8%) patients with pseudoexfoliative glaucoma (PEXG) underwent GATT. Average baseline IOP was 25.3 ± 5.4 (16–45) mmHg. Mean follow-up time was 17.8 ± 4.1 (12–26) months. Mean baseline BCVA was 0.47 ± 0.25. Surgical success was achieved in 16 of 26 (61.5%). In ten of patients, medically uncontrolled glaucoma persisted after GATT surgery and they underwent further glaucoma surgery. PEXG patients showed a higher IOP reduction than POAG patients did at last follow-up (45.6% vs 34.8%). Conclusion The present study revealed that GATT was an effective procedure as a second IOP-lowering surgery in PEXG patients having previous failed trabeculectomy. However, in POAG patients having previous failed trabeculectomy, GATT seems to have a limited efficacy.
ISSN:0165-5701
1573-2630
DOI:10.1007/s10792-020-01364-x