Pattern of Long Term Intraocular Pressure Variation following Gonioscopy-assisted Transluminal Trabeculotomy: Two-year Outcomes.

Abstract

Prcis: Patients with clinically uncontrolled open-angle glaucoma submitted to isolated gonioscopy-assisted transluminal trabeculotomy or combined with phacoemulsification not only achieved low mean IOPs, but also demonstrated stable IOP patterns during a 24-month follow-up.

Purpose: To assess the impact of gonioscopy-assisted transluminal trabeculotomy (GATT) on long term intraocular pressure (IOP) variation.

Patients and methods: An unicentric retrospective study including 169 consecutive patients who had undergone standalone GATT or combined with phacoemulsification (PHACOGATT) due to clinically uncontrolled open-angle glaucoma, with at least 12 months of follow-up was conducted. Long term mean IOP, long term IOP peak, long term IOP fluctuation, coefficient of variation, mean-positive IOP variation, sustained clinically significant positive IOP variation and number of follow-up visits with IOP ≥15 mmHg were investigated.

Results: 169 eyes from 169 patients were included (GATT group=101 patients; PHACOGATT group=68 patients). Mean long term IOP (12.0±1.8 vs. 11.2±2.0 mmHg), mean long term IOP peak (12.9±2.6 vs. 11.8±3.5 mmHg) and mean coefficient of variation (0.07±0.08 vs. 0.05±0.09) were lower in the PHACOGATT group, while mean IOP fluctuation (1.0±3.7 mmHg vs. 1.2±1.8 mmHg) was lower in the GATT group. Additionally, overall mean-positive IOP variation was 0.79±1.64 mmHg. Finally, only 6.5% of the patients presented sustained clinically significant positive IOP variation and IOP was ≥15 mmHg in 5.9% of the follow-up visits.

Conclusions: Patients with clinically uncontrolled open-angle glaucoma submitted to GATT or PHACOGATT achieved low mean IOPs and demonstrated stable IOP patterns. Our results provide additional evidence supporting GATT and PHACOGATT as viable options for the treatment of medically uncontrolled glaucoma patients requiring low and stable IOPs.