Comparative analysis of efficacy and safety between partial and complete gonioscopy-assisted transluminal trabeculotomy for open-angle glaucoma.

Purpose: To compare the surgical efficacy and safety of partial and complete gonioscopy-assisted transluminal trabeculotomy (GATT) in open-angle glaucoma.

Methods: This retrospective comparative study included 206 eyes with primary open-angle glaucoma (POAG) or pseudoexfoliation glaucoma (PEXG) who underwent partial GATT (superior 180°, inferior 180°, or 270°) or complete GATT (360°) at a tertiary centre with at least 12 months of follow-up. Surgical success (qualified and complete) was defined across three intraocular pressure (IOP) criteria: A (<18 mmHg), B (<15 mmHg), and C (<12 mmHg), each requiring a ≥30% reduction from baseline. Additional outcomes included best-corrected visual acuity (BCVA), number of anti-glaucoma medications (AGMs), extent of episcleral venous fluid wave (EVFW) and postoperative complications.

Results: Mean follow-up was 19.7 ± 9.6 months. Baseline demographics, glaucoma type and surgical indications were comparable between groups. At final follow-up, all GATT variants resulted in significant IOP and AGM reductions (p < 0.001), with no statistically significant differences in IOP, BCVA, success rates, or complications among the four groups (p > 0.05). EVFW extent and safety profiles were similar across groups.

Conclusion: Partial GATT (superior 180°, inferior 180°, or 270°) provides similar surgical outcomes and safety as complete 360° GATT. Hemi-GATT may serve as a time-efficient and effective alternative to circumferential GATT in appropriate patients.