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Surgical Outcomes of Prolene Gonioscopy-assisted Transluminal Trabeculotomy in Patients With Moderate to Advanced Open-Angle Glaucoma

Aktas, Zeynep MD, FEBO*; Ucgul, Ahmet Y. MD; Bektas, Caglar MD*; Sahin Karamert, Selin MD*

doi: 10.1097/IJG.0000000000001331
Original Studies

Précis: The present study demonstrates that surgical success rate of gonioscopy-assisted transluminal trabeculotomy (GATT) is 83.7% according to target intraocular pressure (IOP) ≤21 mm Hg and ≥20% reduction from baseline in patients with moderate to advanced glaucoma, with an average follow-up of 19.4 months.

Purpose: The aim of the study was to assess the outcomes of GATT in eyes with moderate to advanced open-angle glaucoma.

Patients and Methods: A retrospective study included 104 eyes of 104 patients, with a mean age of 58.9±18.5 (15 to 87) years, who underwent GATT using the 6/0 prolene suture to treat open-angle glaucoma. The GATT procedure was carried out alone or in combination with phacoemulsification. IOP at baseline, third, sixth, ninth, 12th, and 18th months of follow-up; need of antiglaucoma medication; need of further glaucoma surgery; cup/disc ratio; and best-corrected visual acuity (BCVA) were recorded. Patients with prior incisional glaucoma surgery were excluded. Surgical success was determined for both IOP <21 and <18 mm Hg and also ≥20% reduction from baseline without further glaucoma surgery.

Results: A total of 65 patients with primary open-angle glaucoma (POAG) and 39 patients with secondary open-angle glaucoma (SOAG), including pseudoexfoliative, pigmentary, uveitic, and steroid-induced glaucoma underwent GATT. Preoperative mean IOP was 25.0±7.3 mm Hg. Preoperative average number of antiglaucoma medications was 3.4±0.6. The average follow-up time was 19.4±8.1 (6 to 37) months. Preoperative average BCVA was 0.51±0.24, and cup/disc ratio was 0.85±0.14. Surgical success was achieved in 87 of 104 (83.7%). Seven patients had medically uncontrolled glaucoma after GATT surgery, and they underwent further surgery. Patients with POAG had a higher percentage of IOP reduction than patients with SOAG at 18th month of follow-up (40.1% vs. 27.6%). Need for medication at final visit was similar between POAG and SOAG.

Conclusion: GATT procedure is a safe and successful option for the treatment of moderate to advanced open-angle glaucoma. Surgical success could be maintained up to ∼18 months.

*Department of Ophthalmology, Gazi University School of Medicine, Ankara

Department of Ophthalmology, Abant Izzet Baysal University, Training and Research Hospital, Bolu, Turkey

Disclosure: The authors declare no conflict of interest.

Reprints: Zeynep Aktas, MD, FEBO, 172. Sok Bahcelievler mah, Safak Sitesi No: 4, Golbasi-Ankara 06830, Turkey (e-mail:

Received February 26, 2019

Accepted July 14, 2019

Online date: August 2, 2019

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.