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Devayu A Parikh, Phoebe L Mellen, Tony Kang, Wesam Shamseldin Shalaby, Marlene R. Moster, James P Dunn; Gonioscopy-assisted transluminal trabeculotomy for the treatment of glaucoma in uveitic eyes. Invest. Ophthalmol. Vis. Sci. 2021;62(8):3420.
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To evaluate the outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) for the management of open-angle glaucoma in the setting of uveitis.
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.
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.
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.
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