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Gonioscopy-assisted transluminal trabeculotomy as an option after failed trabeculectomy

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Abstract

Purpose

To evaluate the safety and efficacy profile of gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with open-angle glaucoma with a history of previous failed trabeculectomy surgery.

Method

This case-series study included 26 eyes of 26 consecutive patients with a mean age of 64.1 ± 4.5 (56–78) years who underwent GATT using the 5/0 prolene suture to treat medically uncontrolled moderate to advanced glaucoma despite the previous trabeculectomy surgery. At baseline and each visit, Snellen best-corrected visual acuity (BCVA), IOP values, cup-to-disc (C/D) ratio, retinal nerve-fiber layer thickness and mean deviation values in visual field test were recorded. Need for medication or further glaucoma surgery were noted. Surgical success was defined as final IOP ≤ 15 mmHg and ≥ 20% IOP reduction from baseline without any further glaucoma surgery.

Results

Twelve (46.2%) patients with primary open angle glaucoma (POAG) and fourteen (53.8%) patients with pseudoexfoliative glaucoma (PEXG) underwent GATT. Average baseline IOP was 25.3 ± 5.4 (16–45) mmHg. Mean follow-up time was 17.8 ± 4.1 (12–26) months. Mean baseline BCVA was 0.47 ± 0.25. Surgical success was achieved in 16 of 26 (61.5%). In ten of patients, medically uncontrolled glaucoma persisted after GATT surgery and they underwent further glaucoma surgery. PEXG patients showed a higher IOP reduction than POAG patients did at last follow-up (45.6% vs 34.8%).

Conclusion

The present study revealed that GATT was an effective procedure as a second IOP-lowering surgery in PEXG patients having previous failed trabeculectomy. However, in POAG patients having previous failed trabeculectomy, GATT seems to have a limited efficacy.

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References

  1. Allen L, Burian HM (1962) Trabeculotomy ab externo. A new glaucoma operation: technique and results of experimental surgery. Am J Ophthalmol 53:19–26

    Article  CAS  PubMed  Google Scholar 

  2. Harms H, Dannheim R (1970) Epicritical consideration of 300 cases of trabeculotomy 'ab externo'. Trans Ophthalmol Soc UK 89:491–499

    CAS  PubMed  Google Scholar 

  3. McPherson SD Jr, McFarland D (1980) External trabeculotomy for developmental glaucoma. Ophthalmology 87(4):302–305

    Article  PubMed  Google Scholar 

  4. Smith R (1960) A new technique for opening the canal of Schlemm. Preliminary report. Br J Ophthalmol 44:370–373

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Beck AD, Lynch MG (1995) 360 degrees trabeculotomy for primary congenital glaucoma. Arch Ophthalmol 113(9):1200–1202

    Article  CAS  PubMed  Google Scholar 

  6. Ikeda H, Ishigooka H, Muto T, Tanihara H, Nagata M (2004) Long-term outcome of trabeculotomy for the treatment of developmental glaucoma. Arch Ophthalmol 122(8):1122–1128

    Article  PubMed  Google Scholar 

  7. Girkin CA, Marchase N, Cogen MS (2012) Circumferential trabeculotomy with an illuminated microcatheter in congenital glaucomas. J Glaucoma 21(3):160–163

    Article  PubMed  Google Scholar 

  8. Lim ME, Dao JB, Freedman SF (2017) 360-Degree trabeculotomy for medically refractory glaucoma following cataract surgery and juvenile open-angle glaucoma. Am J Ophthalmol 175:1–7

    Article  PubMed  Google Scholar 

  9. Chin S, Nitta T, Shinmei Y et al (2012) Reduction of intraocular pressure using a modified 360-degree suture trabeculotomy technique in primary and secondary open-angle glaucoma: a pilot study. J Glaucoma 21(6):401–407

    Article  PubMed  Google Scholar 

  10. Tanihara H, Negi A, Akimoto M et al (1993) Surgical effects of trabeculotomy ab externo on adult eyes with primary open angle glaucoma and pseudoexfoliation syndrome. Arch Ophthalmol 111(12):1653–1661

    Article  CAS  PubMed  Google Scholar 

  11. Dao JB, Sarkisian SR Jr, Freedman SF (2014) Illuminated microcatheter-facilitated 360-degree trabeculotomy for refractory aphakic and juvenile open-angle glaucoma. J Glaucoma 23(7):449–454

    Article  PubMed  Google Scholar 

  12. Grover DS, Godfrey DG, Smith O, Feuer WJ, Montes de Oca I, Fellman RL (2014) Gonioscopy-assisted transluminal trabeculotomy, ab interno trabeculotomy: technique report and preliminary results. Ophthalmology 121(4):855–861

    Article  PubMed  Google Scholar 

  13. Aktas Z, Ucgul AY, Bektas C, Sahin KS (2019) Surgical outcomes of prolene gonioscopy-assisted transluminal trabeculotomy in patients with moderate to advanced open-angle glaucoma. J Glaucoma 28(10):884–888

    Article  PubMed  Google Scholar 

  14. 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(8):1092–1096

    Article  PubMed  Google Scholar 

  15. Rahmatnejad K, Pruzan NL, Amanullah S et al (2017) Surgical outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with open-angle glaucoma. J Glaucoma 26(12):1137–1143

    Article  PubMed  Google Scholar 

  16. Grover DS, Godfrey DG, Smith O, Shi W, Feuer WJ, Fellman RL (2017) Outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) in eyes with prior incisional glaucoma surgery. J Glaucoma 26(1):41–45

    Article  PubMed  Google Scholar 

  17. Hirunpatravong P, Reza A, Romero P et al (2016) Same-site trabeculectomy revision for failed trabeculectomy: outcomes and risk factors for failure. Am J Ophthalmol 170:110–118

    Article  PubMed  Google Scholar 

  18. Moster MR (2017) Gonioscopy-assisted transluminal trabeculotomy as an option in a young myopic patient with progressive glaucoma. EC Ophthalmol 6:178–183

    Google Scholar 

  19. Bussel II, Kaplowitz K, Schuman JS, Loewen NA, Trabectome Study Group (2015) Outcomes of ab interno trabeculectomy with the trabectome after failed trabeculectomy. Br J Ophthalmol 99(2):258–262

    Article  PubMed  Google Scholar 

  20. 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(5):393–401

    Article  PubMed  Google Scholar 

  21. Sato T, Kawaji T, Hirata A (2019) Transient ciliochoroidal detachment after 360-degree suture trabeculotomy ab interno for open-angle glaucoma: 12-month follow-up. Eye (Lond) 33(7):1081–1089

    Article  Google Scholar 

  22. Nazarali S, Damji F, Damji KF (2018) What have we learned about exfoliation syndrome since its discovery by John Lindberg 100 years ago? Br J Ophthalmol 102(10):1342–1350

    Article  PubMed  Google Scholar 

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Funding

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Authors and Affiliations

  1. Department of Ophthalmology, Istanbul Training and Research Hospital, Istanbul, Turkey

    Mehmet Ozgur Cubuk & Erkan Unsal

  2. Department of Ophthalmology, Training and Research Hospital, Abant Izzet Baysal University, Kılıçarslan Mah. 144. Sk No: 7, 6 Merkez, Bolu, Turkey

    Ahmet Yucel Ucgul

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  1. Mehmet Ozgur Cubuk
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  2. Ahmet Yucel Ucgul
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  3. Erkan Unsal
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Correspondence to Ahmet Yucel Ucgul.

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All procedures performed in studies involving human participants were inaccordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included inthe study.

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Cubuk, M.O., Ucgul, A.Y. & Unsal, E. Gonioscopy-assisted transluminal trabeculotomy as an option after failed trabeculectomy. Int Ophthalmol 40, 1923–1930 (2020). https://doi.org/10.1007/s10792-020-01364-x

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  • DOI: https://doi.org/10.1007/s10792-020-01364-x

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