Gonioscopy-assisted transluminal trabeculotomy reduces IOP in open-angle glaucoma
Minimally invasive gonioscopy-assisted transluminal trabeculotomy significantly reduced both IOP and the number of medications needed for patients with glaucoma.
Patients with open-angle glaucoma due to inadequately controlled IOP or intolerance to medication experienced a mean decrease in IOP of 44% and a mean reduction in glaucoma medications of 65%, Kamran Rahmatnejad, MD, told Ocular Surgery News.
“Both IOP and number of medications decreased significantly following the surgery. No significant differences between patients with primary open-angle glaucoma and other types of glaucoma were found. Hyphema was the most common postoperative complication, which resolved after 1 month,” Rahmatnejad said.
GATT successful in majority
In a retrospective study, Rahmatnejad and colleagues evaluated 66 patients with open-angle glaucoma who underwent gonioscopy-assisted transluminal trabeculotomy (GATT). Two groups, consisting of 48 patients with primary open-angle glaucoma (POAG) and 18 patients with “other” glaucoma, or non-POAG, were further separated as GATT only, GATT with cataract extraction or GATT with prior cataract extraction, for a total of six groups.
The researchers collected postoperative data at 1 day, 1 week, 1 month, 3 months, 6 months and greater than 1 year.
The overall success rate of GATT was 63%. GATT was successful in 69% of white patients and 42% of black patients, which was a statistically significant difference (P < .05).
At baseline, the mean preoperative IOP for all participants was 26.1 mm Hg, and at 12 months, it was 14.6 mm Hg, a statistically significant 44% decrease (P < .001).
The mean number of medications decreased from 3.1 medications at baseline to 1.2 medications at 12 months, a statistically significant decrease (P < .001).
“As a minimally invasive glaucoma surgery, GATT is a viable option in adult patients with open-angle glaucoma, which fills the gap between medication/laser and more invasive glaucoma surgeries,” Rahmatnejad said.
Reductions in IOP, medications
In the POAG group, IOP decreased an average of 10.4 mm Hg at 6 months and 9.3 mm Hg at 1 year. Phakic POAG patients who underwent concurrent cataract extraction did not have different changes in IOP levels or number of medications compared with phakic POAG patients who underwent GATT only.
Patients with non-POAG experienced statistically significant IOP decreases of 16.6 mm Hg at 6 months and 18.6 mm Hg at 1 year. These patients also experienced a statistically significant drop in number of medications used, from 3.1 preoperative medications to 1.4 medications at 1 year (P = .009).
Phakic patients with non-POAG who underwent concurrent cataract extraction did not experience statistically significant reductions in IOP or number of medications needed when compared with phakic patients with non-POAG who underwent GATT only.
There were no statistically significant IOP differences between patients with POAG or other types of glaucoma.
According to Rahmatnejad, the most common adverse event was transient hyphema. The rate of hyphema at 1 week postoperatively was 38% and at 1 month was 6%. – by Robert Linnehan
- Rahmatnejad K, et al. J Glaucoma. 2017;doi:10.1097/IJG.0000000000000802.
- For more information:
- Kamran Rahmatnejad, MD, can be reached at Glaucoma Research Center, Wills Eye Hospital, 840 Walnut St., Suite 1140, Philadelphia, PA 19107; email: firstname.lastname@example.org.
Disclosure: Rahmatnejad reports no relevant financial disclosures.