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Marlene Moster, Kamran Rahmatnejad, Sarah Amanullah, Michael Waisbourd, ARTHUR RESENDE; The Outcomes of Gonioscopy-Assisted Transluminal Trabeculotomy (GATT) in Open-Angle Glaucoma.. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4988.
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To evaluate the outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) in open-angle glaucoma
Patients with primary or secondary open-angle glaucoma (OAG) whose IOP was inadequately controlled with medication or were intolerant to medications were included retrospectively. The number of medications, intraocular pressure, best corrected visual acuity, and surgical complications was recorded from pre-surgery and several follow-up visits. Surgical failure was defined as an IOP > 21 mmHg or < 5mmHg, an IOP reduction from baseline of less than 20%, reoperation needed, or loss of light perception on 2 consecutive visits 3 months after the procedure.
Seventy-six patients with an age range of 16-85 years (mean±standard deviation [SD], 57.3±17.8) underwent GATT. Of these patients, 55.2% were male, 64.5% Caucasian, and 28.9% were African American. Follow-up data for 8.1±6.6 months postoperatively was gathered. At 3 months follow-up, Intraocular pressure (IOP) decreased by 26.4% (SD, 41%), with an average decrease in glaucoma medication of 1.1 (SD, 1.2). At 6 months, IOP decreased by 36.2% (SD, 24.8%) with an average of 1.4 fewer medications (SD, 1.3). Decrease in IOP was significantly greater in Caucasians than in African Americans (p=0.02). Mean preoperative best-corrected visual acuity was 0.20 log MAR which changed to 0.23 log MAR at last follow-up (p=0.15). The most common complication was transient hyphema, seen in 20% of patients at their 1-week postoperative visit. Two other complications, inflammation needing treatment, and hypotony, each occurred at a rate of 5.3% and were not associated with procedure failure. Failure rate at 6 months follow-up was 19.0%. Postoperative IOP spikes>30 mm Hg was present in 23.6% and was significantly related to surgical failure (p<0.001). African Americans and patients with pseudoexfoliation glaucoma had a higher rate of surgical failure but it was not statistically significant. Age, gender, preoperative pressure, and number of glaucoma medications were not significantly related to surgical success.
Preliminary results for GATT, a minimally invasive, conjunctival-preserving glaucoma surgery, are promising, showing it to be a safe option for patients who are unresponsive or intolerant to glaucoma medications. Possibly GATT could bridge the gap between medication/laser treatment and trabeculectomy.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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