Surgical Outcomes of 180-degree Gonioscopy-Assisted Transluminal Trabeculotomy: Comparison of Nasal Versus Temporal Incisions.

Abstract

Prcis: Performing 180-degree gonioscopy-assisted transluminal trabeculotomy for primary open-angle glaucoma and pseudoexfoliation glaucoma patients can be expected to be equally effective with either a nasal or temporal incision at 12-months postoperative.

Purpose: Anatomically, there are more collector channels on the nasal-side (NS) than on the temporal-side (TS) of the eye. This study aimed to clarify the differences in efficacy between NS and TS incisions for lowering intraocular pressure (IOP) in glaucoma patients who underwent 180-degree gonioscopy-assisted transluminal trabeculotomy (hemi-GATT).

Patients and methods: This multicenter retrospective cohort study was conducted on 423 consecutive eyes with primary open-angle glaucoma and pseudoexfoliation glaucoma that underwent hemi-GATT between April 2016 and March 2022 at Kyoto Prefectural University of Medicine Hospital, Kyoto, Japan and three affiliated medical facilities. Only the patients who had the same type of glaucoma in both eyes and underwent the same surgical procedure were included. Hemi-GATT was performed with an NS incision in the right eye (NS group) and a TS incision in the left eye (TS group). IOP and medication scores were retrospectively investigated.

Results: This study involved 100 eyes of 50 patients. Median IOP (NS group/TS group) (mmHg) at before surgery and at 1-day and 1-, 3-, 6-, and 12-months postoperative was 17.0 (interquartile range, 15.0-19.8)/16.0 (15.0-19.8), 11.0 (9.0-12.8)/11.0 (10.0-13.0), 14.0 (11.8-16.0)/13.0 (11.8-15.3), 13.0 (11.0-14.0)/11.0 (11.0-13.0), 13.5 (11.3-15.0)/12.5 (11.3-14.0), and 13.0 (11.0-15.0)/12.0 (11.0-14.0), respectively, thus showing a significant postoperative decrease of IOP. The median medication scores (NS group/TS group) were 3.0 (interquartile range, 2.0-4.0)/3.0 (2.0-4.0) at preoperative and 0.0 (0.0-2.0)/0.0 (0.0-1.0) at 12-months postoperative, thus showing a significant postoperative reduction. No significant differences were observed between the NS and TS groups at any point.

Conclusions: Our findings revealed no significant difference in efficacy between NS and TS incisions for lowering IOP in glaucoma patients who underwent hemi-GATT.