What question did this study set out to answer?

Evaluate the efficacy and safety of GATT for treating normal-tension glaucoma over a two-year period.

April 21, 2026Open Access

Two-year clinical outcomes of standalone gonioscopy-assisted transluminal trabeculotomy in normal-tension glaucoma

Key Points

Evaluate the efficacy and safety of GATT for treating normal-tension glaucoma over a two-year period.
Conducted a retrospective case series at a single center involving 9 NTG patients with 12 eyes
Measured intraocular pressure and medication burden at multiple follow-up points over 24 months
Used statistical tests to assess outcomes and success rates.
Mean intraocular pressure decreased significantly from 17.33 mmHg to 13.33 mmHg at 24 months
Medication burden reduced from 1 active ingredient to 0, indicating less need for medicines
Qualified and complete success rates were both 50% at 24 months with no serious complications reported.

Abstract

Purpose To evaluate the 2-year efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) for normal-tension glaucoma (NTG). Methods This single-center retrospective case series included 9 NTG patients (12 eyes) undergoing GATT, with follow-up at postoperative day 1, week 1, and months 1, 3, 6, 12, 18, and 24. Primary outcomes were changes in intraocular pressure (IOP) and IOP-lowering medication burden at 24 months (counted by active ingredients). Complete and qualified success were assessed using strict criteria (from postoperative month 1 onward: IOP 6–15 mmHg and ≥20% reduction from baseline). Postoperative events and additional interventions/reoperations were recorded. Paired t tests or Wilcoxon signed-rank tests were used as appropriate; a one-eye-per-patient sensitivity analysis was performed. Results The median age at surgery was 65 (53–70) years, and most eyes had moderate-to-advanced glaucoma. Mean IOP decreased from 17.33 ± 3.53 mmHg to 13.33 ± 2.35 mmHg at 24 months (mean reduction 4.00 ± 2.86 mmHg; 95% CI 2.18–5.82; t = 4.844; p 0.001), corresponding to a 23.1% reduction. Medication burden decreased from 1 (0, 2) to 0 (0, 0) ( Z = −2.251; p = 0.024). At 24 months, qualified and complete success rates were both 50.0% (6/12); sensitivity analysis ( n = 9) was consistent. No hypotony, IOP spikes, or serious complications occurred. Events were mild and self-limited (mainly hyphema and aqueous flare). No SLT, needling, or additional glaucoma surgery was required. Conclusion GATT significantly reduced IOP and medication burden in NTG with a safety profile through 24 months. Larger prospective studies are warranted.

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