Gonioscopy-assisted transluminal trabeculotomy (GATT) for the treatment of uveitic glaucoma: a multi-centered, retrospective case series
Yuri V. Chaban1,
Avner Belkin2, Derek Waldner3, Saba Samet4,
Jeb A. Ong4, Patrick Gooi5, Iqbal K. Ahmed4,
Matthew B. Schlenker4.
1Temerty Faculty of Medicine, University of Toronto, 2Department of Ophthalmology, Meir Medical Center, 3Cumming School of Medicine, University of Calgary, 4Department of Ophthalmology and Vision Sciences, University of Toronto, 5Department of Ophthalmology, University of Calgary.
Author Disclosure Block:Y.V. Chaban: None. A. Belkin: None. D. Waldner: None. S. Samet: None. J.A. Ong: None. P. Gooi: None. I.K. Ahmed: Any direct financial payments including receipt of honoraria; Name of for-profit or not-for-profit organization(s); Alcon, Allergan, Carl Zeiss Meditec, Johnson & Johnson Vision, MST Surgical, Aequus, Akorn, ArcScan, Bausch Health, Beaver Visitec, Beyeonics, CorNeat Vision, Camras Vision, Ellex, ELT Sight, ElutiMed, Equinox, Genentech, Glaukos, Gore, InjectSense, Iridex, iStar, Ivantis, KeLoTec, LayerBio, Leica Microsystems, MicroOptx, New World Medical, Ocular Instruments, Ocular Therapeutix, Omega Ophthalmics, PolyActiva, Sanoculis, Santen, Science Based Health, Sight Sciences, Stroma, ViaLase, Vizzario. Funded grants or clinical trials; Name of for-profit or not-for-profit organization(s); Aerie Pharmaceuticals, Alcon, Allergan, Camras Vision, Glaukos, Ivantis, Johnson & Johnson Vision, New World Medical, Santen. M.B. Schlenker: None.
Purpose: Nearly 20% of uveitis patients will
develop uveitic glaucoma (UG), the current first-line surgical options for
which are associated with vision threatening complications and variable success
rates. Gonioscopy-assisted transluminal trabeculotomy (GATT) is a minimally
invasive ab interno procedure that improves drainage by incising the trabecular
meshwork and connecting the anterior chamber directly with Schlemm’s canal.
GATT has been shown to effectively lower IOP in various open angle glaucomas;
however, data on its effect in UG is limited.
Study Design: Consecutive patient retrospective case series.
Methods: A consecutive patient retrospective case series was performed at the Kensington Eye Institute (Toronto, ON) and Cloudbreak Eye Care (Calgary, AB). Outcome measures included intraocular pressure (IOP), medications, complications, and additional glaucoma surgery required.
Results: 34 eyes of 32 patients were included with a mean age of 49.91 ± 16.5 years (range: 18-79) and mean follow-up time of 16.8 ± 12.3 months (range: 1.5-46.1). Pre-operatively, the mean IOP was 25.1 ± 10.9 mmHg (range: 8.0-47.0), mean deviation was -10.4 ± 7.0 (range: -28.9-(-1.64)), and median CDVA was 20/55 (IQR: 20/40 - 20/287). The median number of medication classes at baseline was 4 (interquartile range, IQR: 3-5), and 44.1% of patients were also on an oral carbonic anhydrase inhibitor (CAI). Mean GATT degrees performed was 231.8 ± 80.3 (range: 90-360) and 47.1% were combined with phacoemulsification. Uveitis was anterior in 32.4% of cases and 32.4% of patients also had a diagnosed non-ocular rheumatologic disease at the time of surgery. At the final follow-up appointment, mean IOP was 12.4 ± 3.0 mmHg (range: 5.0-19.0) and median CDVA was 20/40 (IQR: 20/25 - 20/80). The median number of medication groups used was 2 (IQR: 0-2) and 5.9% of patients were taking an oral CAI. An additional surgical or cycloablative IOP-lowering intervention was required in 8.8% of patients. No vision-threatening complications occurred in either groups.
Conclusions: The significant and safe reduction in IOP and medications suggests GATT as a potential first-line treatment for medically uncontrolled UG.