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Comment
. 2023 Apr;37(6):1258-1263.
doi: 10.1038/s41433-022-02087-2. Epub 2022 May 24.

Gonioscopy-assisted Transluminal Trabeculotomy (GATT) combined phacoemulsification surgery: Outcomes at a 2-year follow-up

Yue Wan  1 , Kai Cao  1 , Jin Wang  1 , Yunxiao Sun  2 , Rong Du  1 , Ziyi Wang  1 , Jidi Zhang  1 , Huaizhou Wang  2 , Ningli Wang  3
Affiliations
Comment

Gonioscopy-assisted Transluminal Trabeculotomy (GATT) combined phacoemulsification surgery: Outcomes at a 2-year follow-up

Yue Wan et al. Eye (Lond). 2023 Apr.

Abstract

Background/objectives: This study aimed to provide a 24-month follow-up on the surgical success and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) combined with phacoemulsification and intraocular lens (IOL) implantation in the treatment of patients with primary open-angle glaucoma (POAG) combined cataract.

Subjects/methods: We included 124 consecutive cases of POAG with microcatheter-assisted GATT or GATT combined with phacoemulsification and IOL implantation at Beijing Tongren Eye Centre between October 2019 and November 2020. Main outcome measures included surgical success rate, changes in IOP, number of antiglaucoma medications, best corrected visual acuity (BCVA), postoperative complications at baseline, and follow-up period of up to 24 months.

Results: In total, 58 eyes received GATT combined with phacoemulsification surgery and 66 eyes received GATT alone. The overall qualified success rate was 86.21% for eyes with GATT combined with phacoemulsification surgery, and 83.48% for eyes with GATT only at 24 months. IOP was reduced from 26.40 ± 6.37 mmHg on 3.12 ± 0.80 medications preoperatively to 14.61 ± 2.28 mmHg on 0.27 ± 0.71 medications at 12 months and 16.08 ± 2.38 mmHg on 0.45 ± 0.96 medications at 24 months after combined surgery. Additionally, mean BCVA improved from 0.75 ± 0.43 logMAR units preoperatively to 0.22 ± 0.18 logMAR units 24 months after combined surgery. No vision-threatening complications occurred during the 24-month follow-up.

Conclusions: The 24-month follow-up results of our study suggest that GATT combined with cataract surgery is a safe and effective treatment for decreasing IOP and number of medications in patients with POAG combined cataract.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Comparison of Preoperative versus postoperative IOP and prescribed glaucoma medications for eyes that underwent GATT combined phacoemulsification surgery (Group1) and those that underwent GATT surgery only (Group2).
Compared to baseline, IOP and glaucoma medication burden decreased significantly at all postoperative visits (mixed-effect model, ****P < 0.0001, **P < 0.01, *P < 0.05). The two groups did not differ significantly in terms of the mean IOP and number of prescribed glaucoma medications at each follow-up visit (mixed-effect model, P > 0.05).
Fig. 2
Fig. 2. Kaplan–Meier analysis of the cumulative probabilities of surgical success.
Success was defined as: an IOP of ≤18 mmHg and a reduction of IOP by 20% or more from baseline with (qualified success) or without (complete success) glaucoma medications; or for eyes with preoperative IOP of <21 mmHg on 3 or 4 glaucoma medications but intolerant to the medications, postoperative IOP of ≤18 mmHg without any glaucoma medications. Neither complete (A) nor qualified (B) success rate differed significantly between the eyes that underwent GATT combined phacoemulsification surgery or GATT only (P > 0.05). The difference between qualified (C) and complete success rate (D) between mild-to-moderate and advanced cases was not statistically significant. The differences between the groups were analysed by the log-rank test.
Fig. 3
Fig. 3. Preoperative versus postoperative BCVA in eyes that underwent GATT combined phacoemulsification surgery (Group 1) and those that underwent GATT surgery only (Group 2).
Compared to baseline, BCVA improved significantly at last postoperative visits in eyes that underwent GATT combined phacoemulsification surgery (Mann–Whitney U test, ****P < 0.0001). The eyes that underwent GATT surgery only did not differ significantly between preoperative BCVA and postoperative BCVA (Mann–Whitney U test).
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