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Gonioscopy-assisted transluminal trabeculotomy is an effective surgical treatment for uveitic glaucoma
  1. Avner Belkin1,2,
  2. Yuri Valere Chaban3,
  3. Derek Waldner4,
  4. Saba Samet5,
  5. Iqbal Ike K Ahmed5,
  6. Patrick Gooi6,
  7. Matthew B Schlenker5
  1. 1Meir Medical Center, Kfar Saba, Israel
  2. 2Department of Ophthalmology, Tel Aviv University, Tel Aviv, Israel
  3. 3University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
  4. 4Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
  5. 5Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
  6. 6Department of Ophthalmology, University of Calgary, Calgary, Alberta, Canada
  1. Correspondence to Dr Avner Belkin, Meir Medical Center, Kfar Saba 44281, Israel; avner.belkin{at}gmail.com

Abstract

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
  • glaucoma

Data availability statement

Data are available on reasonable request. Data are available on reasonable request where legally and ethically possible.

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Data availability statement

Data are available on reasonable request. Data are available on reasonable request where legally and ethically possible.

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Footnotes

  • 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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