Two-year Outcomes of Combined Gonioscopy-Assisted Transluminal Trabeculotomy and Cataract Extraction in Ocular Hypertension and Primary Open-Angle Glaucoma

Two-year Outcomes of Combined Gonioscopy-Assisted Transluminal Trabeculotomy and Cataract Extraction in Ocular Hypertension and Primary Open-Angle Glaucoma

Aim: To evaluate the 24-month data on efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT), combined with cataract extraction (CE) in patients with ocular hypertension (OHT) and primary open-angle glaucoma (POAG).

Materials and Methods: A retrospective chart review was conducted of patients undergoing GATT combined with CE from November 2018 to November 2021. The primary outcome was surgical success, defined as a composite endpoint: ≥ 20% intraocular pressure (IOP) reduction AND/OR ≥ 1 medication reduction, without further IOP-lowering procedures, and IOP maintained between 5 and 21 mmHg. Secondary outcomes included: IOP, number of glaucoma medications (NGM), best corrected visual acuity (BCVA), complications, and failure-associated factors.

Results: A statistically significant reduction in mean IOP (from 18.6 ±3.8 mmHg preoperatively to 15.6 ±3.3 mmHg at 24 months) and NGM (from 2.1 ±1.3 medications to 0.8 ±1.2 medications) was observed (P < 0.001). At 24 months, the overall success rate was 84.2%. Age ≤ 65 years (HR 7.06) and male sex (HR 11.12) were associated with an increased risk of GATT failure. No statistically significant differences were observed in the mean IOP or NGM at the final visit between the OHT and POAG groups. No serious ocular adverse events were reported. Mean BCVA improved from 0.51 ±0.2 logMAR preoperatively to 0.10 ±0.1 logMAR at 24 months postoperatively (P < 0.001).

Conclusion: Combined GATT and cataract surgery is an effective and safe procedure for reducing IOP and NGM in patients with OHT and POAG.

Keywords:

glaucoma; open-angle; ocular hypertension; minimally invasive surgical procedures; trabeculectomy; cataract extraction