Early outcomes of 5-0 prolene gonioscopy-assisted transluminal trabeculotomy in juvenile open-angle glaucoma

Abstract

Purpose: To study the early postoperative efficacy and safety of 5-0 prolene gonioscopy-assisted transluminal trabeculotomy (GATT) in juvenile open-angle glaucoma (JOAG).

Methods: This was a prospective, interventional study. Patients with JOAG planned for GATT were included. All patients were evaluated on postoperative days 1, 15, and 30 as well as 3 months and 6 months postoperatively. Baseline and follow-up visits were compared to determine the significant difference in intraocular pressure (IOP), number of antiglaucoma medications (AGMs), and best-corrected visual acuity. Other outcome measures included surgical success, complications, and interventions.

Results: Thirty eyes (28 patients) were included, of which 11 eyes had mild-to-moderate and 19 eyes had severe JOAG. Mean IOP reduced from preoperative 23.43 ± 9.65 mmHg to 12.7 ± 5.2 mmHg (P < 0.001) at the end of 1 week and 14.52 ± 7.3 mmHg, 13.83 ± 6.29 mmHg, and 14.00 ± 7.23 mmHg at the end of 1, 3, and 6 months, respectively (P < 0.001). The mean number of AGM reduced from 2.93 ± 0.87 to 0.5 at the end of 1 week and 0.69 ± 1.17, 0.83 ± 0.15, 0.80 ± 0.96, and 0.80 ± 0.96 at the end of 1, 3, and 6 months, respectively (P < 0.001). The cumulative probability of overall success at the end of 6 months was 72.7% in the mild to moderate group and 73.7% in the advanced group (using both criteria 1 IOP ≥6 and ≤21 mmHg or a 20% reduction and criteria 2 IOP ≥6 and ≤18 mmHg or a 25% reduction). Hyphema was the most common complication. Macrohyphema (>1 mm) was seen in one patient, out of which two patients required anterior chamber wash. IOP spikes (>30 mmHg) were seen in two patients.

Conclusion: GATT is efficacious and safe with good surgical outcomes in JOAG patients.

Keywords: Advanced glaucoma; glaucoma; gonioscopy-assisted transluminal trabeculotomy; juvenile open angle glaucoma.

Figure 1

Steps of GATT (a) Blunting of tip of 5-0 prolene suture. (b) 2mm nasal goniotomy. (c) Passing the blunted tip in Schlemm’s canal (d) Retrieving the tip from the other end of the goniotomy after a successful 360-degree passage

Figure 2

Line graph showing the preoperative and postoperative comparison of IOP (primary axis-solid lines) and number of AGMs (secondary axis-dash lines) between mild/moderate and severe eyes

Figure 3

(a): Kaplan–Meier graph showing the cumulative probability of overall (complete and qualified) success between the mean deviation severity (mild/moderate and severe) groups (P = 0.969, log-rank test) by criteria 1. (b): Kaplan–Meier graph showing the cumulative probability of overall (complete and qualified) success between the mean deviation severity (mild/moderate and severe) groups (P = 0.973, log-rank test) by criteria 2