Background To assess the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) in uveitic glaucoma (UG).
Methods A retrospective interventional case series in which 33 eyes of 32 patients with UG underwent GATT with or without concomitant cataract extraction and intraocular lens implantation (CE/IOL) at three Canadian treatment centres from October 2015 to 2020. The main outcome measure was surgical success defined as an intraocular pressure (IOP) ≤18 mm Hg and at least one of the following: IOP within one mm Hg of baseline on fewer glaucoma medications as compared with baseline or a 30% IOP reduction from baseline on the same or fewer medications. Secondary outcome measures were IOP, medication usage and surgical complications.
Results Mean patient age (mean±SD) was 49±16 years (range: 18–79) and 44% were female. GATT was performed as a standalone procedure in 52% of cases and the remainder were combined with CE/IOL. Surgical success was achieved in 71.8% (SE: 8.7%) of cases. Mean preoperative IOP (±SD) was 31.4±10.8 mm Hg on a median of 4 medications. 59% of patients were on oral carbonic anhydrase inhibitors (CAIs) prior to surgery. After 1 year, average IOP was 13.8 mm Hg on a median 1 medication, with 6% of patients being on oral CAIs. No sight threatening complications occurred during surgery or follow-up.
Conclusion GATT is an effective surgical strategy in the management of UG. This microinvasive conjunctival-sparing procedure should be considered early in these patients.
- treatment surgery
Data availability statement
Data are available on reasonable request. Data are available on reasonable request where legally and ethically possible.
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Contributors AB, MBS, PG, IIKA and YVC: study design, planning and manuscript preparation. DW: study planning, data collection and manuscript preparation. SS: manuscript preparation. As the Corresponding Author, AB took full responsibility as the guarantor for the finished work and conduct of the study.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests C: Consultant/Speaking Fees; S: Speakers Honoraria; R: Research Grant/Support. AB—Ioptima: C. IIKA—Aequus: C; Aerie Pharmaceuticals: C, R; Akorn: C; Alcon: C,S,R; Allergan: C,S,R; Aquea Health, Inc: C; ArcScan: C; Bausch Health: C; Beaver Visitec: C; Beyeonics: C; Carl Zeiss Meditec: C,S; Centricity Vision, Inc: C; CorNeat Vision: CELT Sight: C; ElutiMed: C; Equinox: C; Genentech: C; Glaukos: C, R’;Gore: C; Iantrek: C; InjectSense: C; Iridex: C; iStar: C; Ivantis: C, R; Johnson & Johnson Vision: C, S, R; LayerBio: C; Leica Microsystems: C; Long Bridge Medical, Inc: C; MicroOptx: C; MST Surgical: C, S; Mundipharma: S; New World Medical: C, R; Ocular Instruments: C; Ocular Therapeutix: C; Oculo: C; Omega Ophthalmics: C; PolyActiva: C; Radiance Therapeutics, Inc: C; Ripple Therapeutics: C; Sanoculis: C; Santen: C, R; Shifamed: C; Sight Sciences: C; Smartlens: C; Stroma: C; Thea Pharma: C; ViaLase: C; Vizzario: C. PG—C for Alcon, Allergan, Bausch andLomb, Glaukos, Santen. MBS—Aerie Pharmaceuticals: C; Alcon: C,S,R; Allergan: C,S,R; Bausch Health: C,R; Carl Zeiss Meditec: S; Ivantis: C; Johnson & Johnson Vision: C,S,R; Labtician: C; Santen: C,S,R.
Provenance and peer review Not commissioned; externally peer reviewed.
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