Trabectome-Initiated Gonioscopy-Assisted Transluminal Trabeculotomy

Smith, Brett Lowell; Ellyson, Austin C; Kim, Won I.

doi:10.1093/milmed/usx174

Cited by 9 publications

(5 citation statements)

References 10 publications

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“…In all cases it resolved spontaneously within a week. The incidence of reported hyphemas varies from 12.5% [26] up to 80% of cases [27], with 50% observed in our group. Previous studies on this technique described hyphema as an inevitable event that occurs as a result of tearing the vascularized-angle structures [28].…”

Section: Discussioncontrasting

confidence: 42%

The Efficacy and Safety of the GATT Procedure in Open-Angle Glaucoma—6-Month Results

Ćwiklińska-Haszcz

Żarnowski

Wróbel-Dudzińska

et al. 2023

IJERPH

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AIM. The aim of the study was to retrospectively evaluate the efficacy and safety of GATT during a 6-month observation period. MATERIAL AND METHODS. The studied group consisted of 69 open-angle glaucoma patients treated with GATT as the only procedure or in combination with cataract surgery. Patients were assessed 1 day, 10 days, 1 month, 3 months, and 6 months after the surgery via standard ophthalmic examination including VF, IOP, and BCVA. The number of medications taken daily and possible complications were checked. Two criteria of success were established (S1: IOP decrease by 30% and S2: IOP lower than 18 mm Hg). RESULTS. Before the surgery, the mean IOP was 26.94 mmHg and significantly decreased after GATT to 15.59 mmHg at 6M. BCVA did not significantly differ between the visits. The mean MD did not change significantly within the 6-month observation period (−8.20 dB vs. −8.16 dB, p = 0.9824), similar to the mean VFI (64.31% vs. 63.05%, p = 0.8571). A 30% IOP decrease at 6M visit was obtained in 95.6% of patients, and 37.7% needed medications to stabilize IOP. An IOP lower than 18 mmHg at 6M was obtained in 91.3% of studied patients after the GATT procedure, and in 58.0% without additional medications. The mean number of medications received daily decreased significantly at 6M compared to preoperative results (2.59 at inclusion vs. 0.76 at 6M, p = 0.0004). The most frequent complication after surgery was hyphema, which resolved spontaneously within 10 days. CONCLUSION. The 6-month observation showed that GATT is a minimally invasive glaucoma-surgery technique that enables an effective and safe IOP decrease.

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Section: Discussioncontrasting

confidence: 42%

The Efficacy and Safety of the GATT Procedure in Open-Angle Glaucoma—6-Month Results

Ćwiklińska-Haszcz

Żarnowski

Wróbel-Dudzińska

et al. 2023

IJERPH

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“…The cumulative observed reduction in pre to postoperative IOPs in this study is the smallest yet reported, with a median reduction of only 2-3 mm Hg compared with the mean reduction of ~10 mm Hg in previous reports. 23,29,30 However, the baseline IOP in this study is-to the author's knowledge-also the lowest ever reported, > 4 mm Hg less than the next lowest in the literature, Sato et al 31 Almost all published reports to date have preoperative IOPs > 21 mm Hg, and therefore this analysis represents a novel addition to the literature both in data for this specific surgical technique and indication for GATT. In the subset of patients with baseline IOPs > 21 mm Hg, the observed reduction in IOPs (11 mm Hg) was similar to other reports.…”

Section: Discussionmentioning

confidence: 51%

Segmental Suture Gonioscopy-Assisted Transluminal Trabeculotomy: Comparison of Superior Versus Inferior Hemisphere Outcomes

Waldner

Chaban

Penny

et al. 2022

Journal of Glaucoma

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Précis: Analysis of efficacy, safety, and risk factors for failure of superior versus inferior 180-degree segmental gonioscopy-assisted transluminal trabeculectomy showed no significant difference between approaches, with novel risk factors for failure identified.Purpose: Compare the efficacy, safety, and risk factors for failure of superior versus inferior 180-degree segmental suture gonioscopyassisted transluminal trabeculotomy (GATT).Design: Multicenter, retrospective interventional cohort study of 297 eyes of 243 glaucomatous patients, which underwent superior or inferior 180-degree suture hemi-GATT surgery combined with phacoemulsification at one of 3 Canadian ophthalmological surgical centres in Calgary, Alberta or Toronto, Ontario Main Outcome Measures: The primary outcome measure was the hazard ratio (HR) of failure for the "primary success" criteria. "Primary success" was defined as an intraocular pressure (IOP) <18 mm Hg and either 1) IOP reduced by ≥ 20% from baseline on the same number of IOP-lowering medications or 2) IOP ≤ baseline on fewer medications. Secondary outcome measures included HRs of failure for alternative criteria ("complete success", "qualified success" and "20% IOP reduction"), cross-sectional analysis, and Cox proportional hazard analysis for risk factors associated with increased failure for the complete cohort.Results: Baseline characteristics were similar between groups. The crude and adjusted HR of failure for the "primary success" criteria for superior surgeries relative to inferior surgeries were 1.27 (95% CI = 0.86-1.88) and 1.50 (95% CI = 0.91-2.46), with no statistically significant difference between approaches. Of the secondary criteria, there was statistical significance in favor of inferior surgeries only for crude analysis of the "20% reduction" criteria (1.40/ 1.27 (95% CI = 1.01-1.92). Increased risk of failure by the "primary success" measure for either intervention was seen with primary open angle glaucoma, advanced disease, and age below 70 years. There were no significant differences in the frequency of postoperative complications between cohorts, which were present in 72 superior (44.4%) and 67 inferior (49.6%; P value = 0.41) eyes; mostly early postoperative hyphema, iritis, and corneal edema.Conclusions: This retrospective study showed no difference in inferior versus superior 180 degrees of hemi-GATT/phacoemulsification cataract surgeries through the majority of analyses. Nonmodifiable factors including glaucoma type, advanced disease, and younger age were associated with a significantly higher risk of failure in this cohort. Further study is warranted.

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“…Then, an intracameral miotic agent can be injected, especially in phakic eyes to protect the lens. 17 The anterior chamber is then filled with viscoelastic agents, preferably cohesive to limit blood influx into the anterior chamber, 18 and by tilting the patient’s head and microscope, the surgeon can have a clear view of the nasal angle structures by using a direct goniolens.…”

Section: R Esultsmentioning

confidence: 99%

“…As the initial TM incision may cause bleeding and obscure the view of the surgeon, performing TM ablation can provide a clear view of the lumen and the outer wall of Schlemm’s canal, and the possibility of wound reapproximation following tissue ablation is minimized in the trabectome-treated part of the angle. 17 Jared et al . started with a Kahook dual blade (KDB) to excise 2 clock hours of the TM and then proceeded with GATT in a case of uveitis and the subsequent steroid-induced glaucoma.…”

Section: R Esultsmentioning

confidence: 99%

Ab-interno Trabeculotomy Procedures: A Review

Meshksar,

Razeghinejhad,

Azimi

2023

Journal of Current Ophthalmology

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Purpose: To discuss the safety and efficacy of various forms of ab-interno trabeculotomy procedures. Methods: A comprehensive search in PubMed and Google Scholar was done using the keywords “glaucoma”, “microinvasive glaucoma surgery”, “complications”, “goniotomy”, and “trabeculotomy”. Publications discussing ab-interno trabeculotomy procedures were selected; furthermore, the relevant references in these articles were gathered and the search was updated during the article preparation. Since gonioscopy-assisted transluminal trabeculotomy was first introduced in 2014, we had no time restriction. Results: Ab-interno trabeculotomy procedures, as a type of minimally invasive glaucoma surgeries, facilitate the natural trabecular outflow and lower the intraocular pressure (IOP) while preserving the conjunctiva for possible future glaucoma surgeries. It can be done alone or in combination with cataract surgery and effectively lowers the IOP and the number of antiglaucoma medications in various forms of glaucoma. Conclusion: By appropriate patient selection, ab-interno trabeculotomy could be selected as a safe and effective procedure in the management of various forms of glaucoma either as an isolated procedure or in combination with cataract extraction.

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Trabectome-Initiated Gonioscopy-Assisted Transluminal Trabeculotomy

Cited by 9 publications

References 10 publications

The Efficacy and Safety of the GATT Procedure in Open-Angle Glaucoma—6-Month Results

The Efficacy and Safety of the GATT Procedure in Open-Angle Glaucoma—6-Month Results

Segmental Suture Gonioscopy-Assisted Transluminal Trabeculotomy: Comparison of Superior Versus Inferior Hemisphere Outcomes

Ab-interno Trabeculotomy Procedures: A Review

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