Comparison of 1-year surgical outcomes of combined cataract surgery and gonioscopy-assisted transluminal trabeculotomy (GATT) versus cataract surgery and iStent Inject

Comparison of One-Year Postoperative Outcomes Between Phacoemulsification With iStent Inject W and Phacoemulsification With Microhook Trabeculotomy: Real-World Data and Propensity Score-Matched Analysis

Purpose This study aimed to compare the one-year postoperative outcomes of cataract surgery combined with the iStent inject W trabecular micro-bypass stent (iStent IW) implantation and cataract surgery combined with microhook trabeculotomy (μLOT) in a real-world clinical setting, before and after propensity score matching (PSM). Methods This retrospective comparative chart review included 41 eyes in the iStent IW group and 72 in the μLOT group. The primary outcomes assessed were postoperative intraocular pressure (IOP) and the number of glaucoma medications. Initially, we compared baseline characteristics and surgical outcomes between both groups before PSM. Then, PSM was performed to minimize baseline differences in glaucoma type, preoperative IOP, and the number of glaucoma medications, enabling a more accurate comparison of the IOP-lowering effects of both procedures. Results In the unadjusted analysis, the iStent IW group had a lower baseline IOP (14.5 ± 3.3 mmHg) than the μLOT group (19.3 ± 4.9 mmHg, p < 0.0001), as well as fewer medications (3.6 ± 1.3 vs. 4.8 ± 1.5, p < 0.0001). Furthermore, the iStent IW group primarily comprised patients with primary open-angle glaucoma and normal-tension glaucoma, whereas the μLOT group included patients with a wider variety of glaucoma types. At 12 months, IOP was comparable between the iStent IW group (12.7 ± 2.8 mmHg) and the μLOT group (14.0 ± 4.1 mmHg; p = 0.2883), although the number of medications remained lower in the iStent IW group (2.2 ± 1.5 vs. 3.3 ± 1.7; p = 0.0299). After PSM, no significant differences in IOP or medications were observed. Layered hyphema occurred more frequently in the μLOT group. Conclusion Both procedures had comparable IOP reduction; however, the μLOT group had more postoperative layered hyphema and required more medications in the unadjusted analysis.

The Two-Year Outcomes of Phacoemulsification Combined with GATT Versus Standalone GATT in Open-Angle Glaucoma: A Comparative Study

Background/Objectives: The aim of this paper was to evaluate the two-year outcomes of phacoemulsification combined with gonioscopy-assisted transluminal trabeculotomy (PHACO-GATT) versus standalone GATT in terms of efficacy, safety, and surgical success. Methods: This retrospective, comparative study included 64 eyes of 64 patients with moderate-to-severe open-angle glaucoma: 35 patients (54.7%) with primary open-angle glaucoma (POAG) and 29 patients (45.3%) with pseudoexfoliative glaucoma (PEG). Group 1 (n = 38) underwent PHACO-GATT, and Group 2 (n = 26) underwent standalone GATT. Data, including intraocular pressure (IOP), the number of anti-glaucomatous medications, and complications, were analyzed preoperatively and postoperatively (1st, 3rd, 6th, 12th, and 24th months). Surgical success was defined as achieving a ≥ 20% IOP reduction or IOP ≤ 21 mmHg with or without medications. Results: The mean age was 74.4 ± 7.2 years in Group 1 and 70.8 ± 7.3 years in Group 2. Both groups achieved significant IOP reductions at the 24-month follow-up: Group 1 from 28.6 ± 6.3 mmHg to 12.7 ± 2.4 mmHg, and Group 2 from 27 ± 4.8 mmHg to 13 ± 1.7 mmHg (both p < 0.001). BCVA in Group 1 improved significantly from 0.77 ± 0.29 logMAR to 0.28 ± 0.13 logMAR at 24 months (p < 0.001), while in Group 2, it remained stable at 0.46 ± 0.19 logMAR at baseline and 0.47 ± 0.19 logMAR at 24 months (p > 0.05). The mean number of anti-glaucoma medications decreased significantly in both groups (p < 0.001) without significant intergroup differences (p > 0.05). Complication-free rates were 68.4% in Group 1 and 69.2% in Group 2 (p = 0.899). Surgical success rates were comparable between groups at 12 (100% in both groups) and 24 months (94.7% in Group 1, 96.2% in Group 2). Conclusions: Both PHACO-GATT and standalone GATT demonstrated comparable efficacy and safety over a two-year period. PHACO-GATT provided significant visual acuity improvements due to cataract extraction, making it a suitable option for patients with coexisting cataracts and glaucoma.

Ab interno canaloplasty versus gonioscopy-assisted transluminal trabeculotomy in open-angle glaucoma: a randomised controlled trial

OBJECTIVE

To compare the efficacy and safety of ab interno canaloplasty (ABiC) with gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with open-angle glaucoma (OAG).

METHOD

This randomised clinical trial recruited eyes with OAG and no previous incisional ocular surgery, among which 38 were randomised to ABiC and 39 to GATT. Follow-ups were performed at 1, 3, 6 and 12 months postoperatively. The primary outcome measures were intraocular pressure (IOP) and use of glaucoma medication at 12 months postoperatively. The secondary outcome measure was complete surgical success (not requiring glaucoma surgery, IOP ≤21 mm Hg and non-use of glaucoma medications).

RESULTS

Both groups had similar demographic and ocular characteristics. A total of 71 of the 77 subjects (92.2%) completed 12-month follow-up. At 12 months, mean IOP was 19.0±5.2 mm Hg in the ABiC group and 16.0±3.1 mm Hg in the GATT group (p=0.003). Overall, 57.2% of ABiC patients and 77.8% of GATT patients were medication free (p=0.06). The number of glaucoma medications was 0.9±1.3 in the ABiC group and 0.6±1.2 in the GATT group (p=0.27). The 12-month cumulative rate of complete surgical success was 56% in the ABiC group and 75% in the GATT group (p=0.09). Three eyes in the ABiC group and one eye in the GATT group required additional glaucoma surgery. Hyphema (87% vs 47%) and supraciliary effusion (92% vs 71%) were noted more often in the GATT group than in the ABiC group.

CONCLUSIONS

The preliminary result showed that GATT had an advantage over ABiC in IOP reduction for OAG patients, accompanied by favourable safety at 12-month postoperatively.

TRIAL REGISTRATION NUMBER

ChiCTR1800016933.

Comparison of clinical outcomes between gonioscopy-assisted transluminal trabeculotomy and trabeculectomy in advanced-stage pseudoexfoliation glaucoma

PURPOSE

To compare clinical outcomes between gonioscopy-assisted transluminal trabeculotomy (GATT) and trabeculectomy (TRAB) in patients with advanced-stage pseudoexfoliation glaucoma (PEXG).

METHODS

This comparative study comprised 62 patients who underwent GATT (N = 31) or TRAB (N = 31) for advanced-stage PEXG. Primary outcome was cumulative probability of surgical success at the end of 12-month follow-up. Success was determined as intraocular pressure (IOP) reduction ≥ 30% from baseline, IOP between 6 and 18 mmHg and IOP upper limits for IOP < 15 mmHg and < 12 mmHg, separately. Secondary outcomes were IOP reduction, antiglaucoma medication (AGM) use, and complications in the study.

RESULTS

Age, sex, cup/disc ratio, mean deviation, pattern standard deviation, and retinal nerve fiber layer thickness did not significantly differ between the groups (p > 0.05 for all). The probability of cumulative surgical success at the end of 12 months was similar between the two groups for IOP < 15 mmHg and < 18 mmHg but significantly higher after TRAB (92.0%) than GATT (82.5%) for IOP < 12 mmHg (log-rank test p = 0.035). Percentage of IOP reduction from baseline was similar between the groups (53.1 ± 18.6% in GATT group and 53.0 ± 16.6% in TRAB group, p = 0.98) at the end of 12 months. No significant difference in the mean number of AGM was present at the 12-month visit (1.3 ± 1.4 in GATT and 1.1 ± 1.4 in TRAB, p = 0.65).

CONCLUSION

At the end of 12 months, IOP reduction rate was similar between GATT and TRAB. Cumulative surgical success was higher after TRAB than GATT for IOP < 12 mmHg.

Minimally Invasive Glaucoma Surgery: Safety of Individual Devices

Primary open-angle glaucoma progression in those already on maximal medical therapy has traditionally been treated with trabeculectomy, a surgical procedure that carries a high degree of morbidity. In the last few decades, significant advances have been made in the field of minimally invasive glaucoma surgery (MIGS) devices, which aim to defer or prevent trabeculectomy via less arduous surgical techniques in certain types of glaucoma. Although reviews have been published examining the efficacy of various MIGS techniques, no article synthesises the comparative safety of all available devices. We performed a literature review examining the safety of MIGS devices. Fifteen devices were included, variously attempting to increase aqueous outflow through the trabecular meshwork or the suprachoroidal space, shunting into the subconjunctival space, or reducing aqueous production through ciliary body ablation. Notably, the earliest product attempting to increase outflow to the suprachoroidal space, Alcon's CyPass Micro-Stent, was withdrawn from the market due to concerns regarding increased corneal endothelial cell loss at five years post-implantation. All other devices were described as well-tolerated, with the most common adverse effects including hyphaema, intraocular pressure spikes, and device migration or obstruction. MIGS devices are purported to be uniformly safe, and many studies report no statistically significant increased complications beyond those associated with cataract surgery alone. It is important to note, however, the generally poor quality of current studies, with a dearth of randomised, or even prospective, data, and a large proportion of studies funded by device producers.

Gonioscopy-Assisted Transluminal Trabeculotomy; A Review

AIM

To review the recent evidence in the literature regarding the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) in the management of pediatric and adult glaucoma.

METHODS

A literature search was performed in the electronic databases of PubMed, Google Scholar, Embase the Register of Controlled Trials, and Ovid Medline for studies evaluating the safety and outcomes of GATT in glaucoma.

RESULTS

GATT is a novel minimally invasive glaucoma surgery that allows the incision of the inner wall of Schlemm's canal increasing aqueous drainage through the physiologic outflow pathway with subsequent intraocular pressure reduction in different types if of glaucoma.

CONCLUSION

GATT demonstrated favorable results in a wide range of both primary and secondary open-angle and angle-closure glaucoma.