Abstract
Purpose :
To evaluate the outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) for the management of open-angle glaucoma in the setting of uveitis.
Methods :
A retrospective chart review was performed of patients diagnosed with uveitis who underwent GATT between January 1st, 2014 and December 31st, 2019 due to medication-refractory open-angle glaucoma in the setting of uveitis. The primary outcomes analyzed included success rate, defined as IOP reduction >20% from baseline or IOP between 5-21mmHg at the 3-month visits; on a stable number or fewer IOP lowering agents, and no need for additional glaucoma surgery. Additional endpoints include IOP, number of glaucoma medications, and steroid regimen.
Results :
16 eyes from 13 patients were included in the study. The average age was 45.3±12.7 years (56% female). Average follow-up period was 29.5±14.7 months (range of 7.2-48.9 months). The predominant cause of glaucoma was inflammatory in 56%, steroid-induced in 19% and a mixture of both in 25%. At 12 months, the cumulative success rate was 81%. The 19% of eyes that failed required reoperation due to IOP spikes >25 mmHg. Mean IOP was 37.8±13.0 mmHg at baseline and 12.2±3.0 mmHg at 12 months (68% reduction; p<0.0001). The average number of glaucoma medications was 4.6±1.3 at baseline and 2.2±0.7 at 12 months (52% reduction; p<0.0001). At the 12-month visit when compared to the baseline, not only were a greater number of patients on both oral and topical steroid regimens, the mean dose was higher. Transient hyphema was the most common post-operative complication seen in 44% of eyes at 1 week, but all cases self-resolved by 1 month.
Conclusions :
This small retrospective study shows that GATT is successful, effective and safe for the management of glaucoma in uveitic adult eyes. As a conjunctival-sparing, minimally-invasive procedure, GATT is promising as an initial treatment for refractory glaucoma in uveitis.
This is a 2021 ARVO Annual Meeting abstract.