Two-Year Results of Gonioscopy-Assisted Transluminal Trabeculotomy in Primary Congenital Glaucoma.

Abstract

Prcis: Gonioscopy-assisted transluminal trabeculotomy yielded a 45% reduction in intraocular pressure in primary congenital glaucoma, with a success rate of 86.6%. Hyphema was the most common complication. We did not encounter any vision-threatening complications.

Background: To assess the outcome of gonioscopy-assisted transluminal trabeculotomy (GATT) in primary congenital glaucoma (PCG) and identify the potential prognostic factors for adverse outcomes.

Methods: This prospective study included patients aged <14 years, presenting with PCG from November 2019 till November 2021. We excluded eyes with hazy cornea, secondary glaucoma, peripheral anterior synechiae ≥90 degrees, and eyes in which the extent of GATT was <270 degrees. Success was defined as a final intraocular pressure (IOP) <18 mm Hg with IOP reduction >20%. Primary outcomes were reduction in IOP and medications, secondary outcomes were complications and correlation of IOP reduction and surgical success with possible risk factors.

Results: We included 60 eyes of 50 patients aged 1-156 months (mean: 25.5±36.5). A 353±21 degrees incision was created, with 85% achieving a 360-degree incision. There was a significant reduction in IOP and medications at all follow-up intervals up to 2 years, with a mean of 45% IOP reduction. The final success rate was 86.6%, with 76.7% being controlled without medications. There was a significant positive correlation between the preoperative cup-to-disc ratio (CDR) and failure rates ( P =0.03) and between the incision extent and the IOP reduction (r=0.4, P =0.001). Hyphema was the most common complication, affecting 33%, and resolved spontaneously in all cases. No vision-threatening complications occurred.

Conclusions: GATT is a safe and effective procedure in eyes with PCG and clear cornea, including eyes that had previous failed glaucoma surgery. Circumferential GATT is associated with more favorable outcomes, while eyes with a larger CDR are at a higher risk for failure.