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 3 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) (mm Hg) 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.