Surgical Outcomes and Predictors of Success Following Gonioscopy-Assisted Transluminal Trabeculotomy for Primary Congenital and Juvenile Open-Angle Glaucoma

PRECIS: GATT is effective and safe in PCG and JOAG, with a higher success rate in PCG. Prior glaucoma surgery predicts surgical failure. IOP spike in one eye predicts fellow-eye spike in PCG. PURPOSE: To compare the efficacy and safety profiles of gonioscopy-assisted transluminal trabeculotomy (GATT) in primary congenital glaucoma (PCG) and juvenile open-angle glaucoma (JOAG), and to identify predictors for prognosis and intraocular pressure (IOP) spikes. PATIENTS AND METHODS: This is a retrospective cohort study of 27 PCG and 108 JOAG eyes undergoing suture GATT. Surgical outcomes including IOP reduction, number of anti-glaucoma medications, success rates, and adverse events were compared longitudinally and between groups. RESULTS: GATT decreased IOP significantly at all postoperative follow-ups in both groups (P<0.001) with no intergroup differences (P > 0.05). GATT also reduced the requirement of anti-glaucoma agents in both groups. The PCG group required fewer medications than the JOAG group except for the 24-month time point (P<0.05). PCG had higher cumulative partial and complete success probabilities than JOAG eyes (P=0.011 and 0.002, respectively). Prior glaucoma surgery predicted surgical failure. No vision-threatening events were recorded with transient hyphema and IOP spike being the most common complications. IOP spike in one eye had predictive value for the fellow eye in PCG, but not in JOAG. CONCLUSIONS: GATT is effective and safe in our PCG and JOAG cohorts, with superior outcomes in younger, surgery-naïve eyes. In PCG, an IOP spike in the first-operated eye predicts that in the fellow eye.