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Hemi-GATT combined with phacoemulsification in patients with moderate-severe primary open-angle glaucoma: 2-year outcomes

  • Glaucoma
  • Published:
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Abstract

Purpose

To describe the outcomes of inferior hemisphere 180° gonioscopy-assisted transluminal trabeculotomy (hemi-GATT) in patients with moderate-severe stage primary open-angle glaucoma (POAG).

Methods

This single center, retrospective study identified patients with POAG who had undergone combined inferior hemi-GATT with phacoemulsification. Patients with moderate-severe staged POAG were included in the study. Outcome measures included surgical success, intraocular pressure (IOP), number of topical IOP-lowering drops, best-corrected visual acuity (BCVA), visual field mean deviation (MD) and complications. Success was defined using two criteria: Criterion A (IOP <17 mmHg and >20% reduction) and Criterion B (IOP <12 mmHg and >20% reduction).

Results

One hundred-twelve eyes of 112 patients were included in this study. Of these, 91 patients were followed for 24 months or greater to assess endpoint surgical success. Kaplan-Meier survival analysis for Criterion A demonstrated a 64.8% probability of success without topical IOP-lowering therapy (complete success) and a 93.4% probability of success with or without topical IOP-lowering therapy (qualified success). Probabilities of complete and qualified success using Criterion B were 26.4% and 30.8%, respectively. IOP reduction from baseline (21.9 ± 5.8 mmHg) to 24-month follow-up (13.6 ± 3.9 mmHg) was 37.9% for the overall cohort. The most common complication was transient hyphema, which occurred in 25.9% (29 of 112) of patients. All cases of hyphema resolved spontaneously.

Conclusions

Combined hemi-GATT with phacoemulsification was associated with favorable outcomes and a low complication rate in this study of patients with moderate-severe POAG. Further studies are required comparing hemi-GATT to the 360° approach.

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References

  1. Resnikoff S, Pascolini D, Mariotti SP, Pokharel GP (2008) Global magnitude of visual impairment caused by uncorrected refractive errors in 2004. Bull World Health Organ 86:63–70. https://doi.org/10.2471/blt.07.041210

    Article  PubMed  PubMed Central  Google Scholar 

  2. Weinreb RN, Khaw PT (2004) Primary open-angle glaucoma. Lancet 363:1711–1720. https://doi.org/10.1016/s0140-6736(04)16257-0

    Article  PubMed  Google Scholar 

  3. Rafuse PE (2014) The optimal trabeculectomy: patient and procedure. Can J Ophthalmol 49:523–527. https://doi.org/10.1016/j.jcjo.2014.08.008

    Article  PubMed  Google Scholar 

  4. Mansouri K, Guidotti J, Rao HL et al (2018) Prospective evaluation of standalone XEN gel implant and combined phacoemulsification-XEN gel implant surgery: 1-year results. J Glaucoma 27:140–147. https://doi.org/10.1097/ijg.0000000000000858

    Article  PubMed  Google Scholar 

  5. Richter GM, Coleman AL (2016) Minimally invasive glaucoma surgery: current status and future prospects. Clin Ophthalmol 10:189–206. https://doi.org/10.2147/opth.s80490

    Article  PubMed  PubMed Central  Google Scholar 

  6. Sato T, Kawaji T (2021) 12-month randomized trial of 360° and 180° Schlemm’s canal incisions in suture trabeculotomy ab interno for open-angle glaucoma. Br J Ophthalmol 105:1094–1098. https://doi.org/10.1136/bjophthalmol-2020-316624

    Article  PubMed  Google Scholar 

  7. Grover DS, Smith O, Fellman RL et al (2015) Gonioscopy assisted transluminal trabeculotomy: an ab interno circumferential trabeculotomy for the treatment of primary congenital glaucoma and juvenile open angle glaucoma. Br J Ophthalmol 99:1092–1096. https://doi.org/10.1136/bjophthalmol-2014-306269

    Article  PubMed  Google Scholar 

  8. Al Habash A, Nagshbandi AA (2020) Quality of life after combined cataract and minimally invasive glaucoma surgery in glaucoma patients. Clin ophthalmol 14:3049–3056. https://doi.org/10.2147/opth.s276124

    Article  PubMed  PubMed Central  Google Scholar 

  9. Grover DS, Smith O, Fellman RL et al (2018) Gonioscopy-assisted transluminal trabeculotomy: an ab interno circumferential trabeculotomy: 24 months follow-up. J Glaucoma 27:393–401. https://doi.org/10.1097/ijg.0000000000000956

    Article  PubMed  Google Scholar 

  10. Aktas Z, Ucgul AY, Bektas C, Sahin Karamert S (2019) Surgical outcomes of prolene gonioscopy-assisted transluminal trabeculotomy in patients with moderate to advanced open-angle glaucoma. J Glaucoma 28:884–888. https://doi.org/10.1097/ijg.0000000000001331

    Article  PubMed  Google Scholar 

  11. Fontana L, De Maria M, Caristia A et al (2021) Comparison of gonioscopy-assisted transluminal trabeculotomy versus trabeculectomy with mitomycin C in patients with open-angle glaucoma. J Glaucoma 30:101–108. https://doi.org/10.1097/ijg.0000000000001696

    Article  PubMed  Google Scholar 

  12. Wan Y, Cao K, Wang J et al (2023) Gonioscopy-assisted transluminal trabeculotomy (GATT) combined phacoemulsification surgery: outcomes at a 2-year follow-up. Eye 37:1258–1263. https://doi.org/10.1038/s41433-022-02087-2

    Article  PubMed  Google Scholar 

  13. Guo CY, Qi XH, Qi JM (2020) Systematic review and meta-analysis of treating open angle glaucoma with gonioscopy-assisted transluminal trabeculotomy. Int J Ophthalmol 13:317–324. https://doi.org/10.18240/ijo.2020.02.17

    Article  PubMed  PubMed Central  Google Scholar 

  14. Waldner DM, Chaban Y, Penny MD et al (2023) Segmental suture gonioscopy-assisted transluminal trabeculotomy: comparison of superior versus inferior hemisphere outcomes. J Glaucoma 32:396–406. https://doi.org/10.1097/ijg.0000000000002169

    Article  PubMed  Google Scholar 

  15. Aktas Z, Ozmen MC, Atalay HT, Ucgul AY (2019) Evaluation of episcleral venous fluid wave during gonioscopy assisted transluminal trabeculotomy in patients with advanced glaucoma. Eye 33:668–673. https://doi.org/10.1038/s41433-018-0254-5

    Article  PubMed  Google Scholar 

  16. Aktas Z, Ucgul AY, Ozdek S, Boluk CE (2021) Outcomes of gonioscopy-assisted transluminal trabeculotomy in vitrectomized patients with secondary glaucoma after silicone oil removal. J Glaucoma 30:114–118. https://doi.org/10.1097/ijg.0000000000001738

    Article  Google Scholar 

  17. Sharkawi E, Lindegger DJ, Artes PH et al (2021) Outcomes of gonioscopy-assisted transluminal trabeculotomy in pseudoexfoliative glaucoma: 24-month follow-up. Br J Ophthalmol 105:977–982. https://doi.org/10.1136/bjophthalmol-2020-315954

    Article  PubMed  Google Scholar 

  18. Wang Y, Wang H, Han Y et al (2021) Outcomes of gonioscopy-assisted transluminal trabeculotomy in juvenile-onset primary open-angle glaucoma. Eye 35:2848–2854. https://doi.org/10.1038/s41433-020-01320-0

    Article  PubMed  Google Scholar 

  19. Loayza-Gamboa W, Martel-Ramirez V, Inga-Condezo V, Valderrama-Albino V, Alvarado-Villacorta R, Valera-Cornejo D (2020) Outcomes of combined prolene gonioscopy assisted transluminal trabeculotomy with phacoemulsification in open-angle glaucoma. Clin Ophthalmol 14:3009–3016. https://doi.org/10.2147/opth.s272298

    Article  PubMed  PubMed Central  Google Scholar 

  20. Bozkurt E, Yenihayat F, Olgun A, Yazıcı AT, Şahbaz İ (2021) The efficacy of gonioscopy-assisted transluminal trabeculectomy combined with phacoemulsification. Int Ophthalmol 41:35–43. https://doi.org/10.1007/s10792-020-01550-x

    Article  PubMed  Google Scholar 

  21. Issa SA, Pacheco J, Mahmood U, Nolan J, Beatty S (2005) A novel index for predicting intraocular pressure reduction following cataract surgery. Br J Ophthalmol 89:543–546. https://doi.org/10.1136/bjo.2004.047662

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Meyer MA, Savitt ML, Kopitas E (1997) The effect of phacoemulsification on aqueous outflow facility. Ophthalmology 104:1221–1227. https://doi.org/10.1016/s0161-6420(97)30154-7

    Article  CAS  PubMed  Google Scholar 

  23. Luo H, Xu Y, Zhang X (2017) Kaplan-Meier curve of retrospective study: do not misuse it! Int J Cardiol 247:28. https://doi.org/10.1016/j.ijcard.2017.04.043

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors would like to thank Dr. Patrick Gooi for providing images of the Hemi-GATT technique for inclusion in this study.

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Authors and Affiliations

  1. Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada

    Sunil Ruparelia, Darcie Wilson & Nir Shoham-Hazon

  2. Miramichi EyeNB Centre of Excellence, Miramichi, New Brunswick, Canada

    Nir Shoham-Hazon

Authors
  1. Sunil Ruparelia
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  2. Darcie Wilson
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  3. Nir Shoham-Hazon
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Corresponding author

Correspondence to Sunil Ruparelia.

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Ethics approval

This research was conducted in accordance with the Declaration of Helsinki. The study received full approval from the Horizon Health Network Research Ethics Board of Saint John Regional Hospital, Saint John, New Brunswick, Canada.

Consent to participate

Informed consent was obtained for all care and procedures included in this study. Waiver of consent for participation in this study was obtained from the Horizon Health Network Research Ethics Board of Saint John Regional Hospital, Saint John, New Brunswick, Canada

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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest, or non-financial interest in the subject matter or materials discussed in this manuscript.

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Ruparelia, S., Wilson, D. & Shoham-Hazon, N. Hemi-GATT combined with phacoemulsification in patients with moderate-severe primary open-angle glaucoma: 2-year outcomes. Graefes Arch Clin Exp Ophthalmol 261, 3257–3262 (2023). https://doi.org/10.1007/s00417-023-06166-2

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  • DOI: https://doi.org/10.1007/s00417-023-06166-2

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