Long-Term outcomes of gonioscopy-assisted transluminal trabeculotomy in open-angle glaucoma: A minimum 3-year follow-up

Purpose To report five-years follow-up on the efficacy of gonioscopy-assisted transluminal trabeculotomy (GATT) combined with or without cataract surgery (CS). Methods Chart review of patients with primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG), who underwent GATT at a single centre. Intraocular pressure (IOP), number of medications and failure rates (reoperation or criterion A; IOP ≤18 mmHg and IOP reduction ≤20%, criterion B; IOP≤15 mmHg and reduction≤30%), were compared between combined (GATT + CS group) and standalone procedure (GATT-alone group). Risk factors for failure were investigated by logistic regression analysis. Results In the 157 eyes of 157 patients, at a mean follow-up of 55.62 ± 9.57 (range:36–72) months, IOP reduced from 24.49 ± 4.13 to 14.49 ± 6.20 mmHg, and the number of medications reduced from 2.94 ± 0.65 to 1.22 ± 1.48. By the final follow-up, the number of medications were significantly higher in the GATT-alone group than in the GATT + CS group (1.66 ± 1.68, 0.84 ± 1.17; respectively) ( p = 0.003). The GATT-alone group had significantly higher failure rates at final follow-up in the GATT group compared to GATT + CS group based on criterion A (16.7% vs 1.2%) and B (26.4% vs 11.8%) ( p < 0.001, p = 0.01; respectively). Risk factors for failure were, GATT alone procedure (OR:0.24, p = 0.01) and eyes with POAG (OR:4.74, p = 0.004) in 157 eyes, and a postoperative IOP spike (OR:7.0, p = 0.01) in the GATT-alone group. Conclusion Long-term success was achievable after GATT. The more favorable results were obtained in the GATT + CS group compared to the GATT-alone group and in the PXG eyes compared to the POAG eyes.