Abstract
Purpose :
The treatment of glaucoma has undergone dramatic development over the past century. In recent decades surgical treatment has shifted toward less invasive techniques, some of which utilize intact collector channels by stenting, modification, or removal of the diseased trabecular meshwork (TM). One of these procedures, known as the trabeculotomy, has become an effective and safe option for a variety of glaucoma conditions. The gonioscopy-assisted transluminal trabeculotomy (GAAT) uses corneal and goniotomy incisions to thread a microcatheter or suture through Schlemm’s canal, after which traction causes 360° TM cleavage. Data on post-operative complications and post-treatment IOP are currently limited to 24 months. This study aims to extend the follow-up period to 3 years across multiple glaucoma sub-types.
Methods :
The University of Utah IRB approved this study. All participants received informed consent and standard pre- and post-operative care. A retrospective review was conducted with 52 patients, 85 eyes, and 543 patient visits. IOP data was collected at pre-op, 1 month, 2 months, 6 months, 12 months, 24 months, and 36 months. We also use a linear mixed-effects model to estimate the expected change in IOP from baseline at each visit. In this model, we include a patient eye nested in patient MRN random effect to account for within-eye and within-patient correlation. For each model coefficient, we provide the estimate, 95% confidence interval (CI), and p-value. We also provide expected IOP at each time point by device for the reference category along with 95% CI for the average aged patient.
Results :
The average estimated IOP pre-operatively was found to be 24.94 (95% CI [23.61, 26.27]); Following GAAT average change in IOP from baseline at month 1 was -9.61 (95% CI [-11.16, -8.06]); at month 2 it was -10.87 (95% CI [-12.45, -9.28]); at month 6 it was -10.45 (95% CI [-12.0, -8.9]); at month 12 it was -10.9 (95% CI [-12.45, -9.35]); at month 24 it was -11.84 (95% CI [-13.48, -10.21]); and at month 36 it was -11. 67 (95% CI [-13.33, -10.03]). All p values for these coefficients were <0.001.
Conclusions :
Following GAAT, a reduction in intraocular pressure was seen at 1 month and continued through a 36-month follow-up period compared to average estimated IOP at baseline. These results support previous studies showing the advantages of GAAT in treatment of various glaucoma sub-types.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.