Outcomes Of Gonioscopy-Assisted Transluminal Trabeculotomy (Gatt) Combined Phacoemulsification Surgery In Patients With Glaucoma
Published 2023 - 41st Congress of the ESCRS
Reference: PP23.07 | Type: Free paper | DOI: 10.82333/pnpc-z388
Authors: Susan Bernales-Urbina 1 , Jose Galvez-Olortegui* 2 , Rosmery Mollo-Bautista 3 , Tomas Galvez-Olortegui 4
1Evidence Based Ophthalmology Unit (Oftalmoevidencia),Scientia Clinical and Epidemiological Research Institute,Trujillo,Peru;Glaucoma - Centro de Excelencia,Lima,Peru, 2Evidence Based Ophthalmology Unit (Oftalmoevidencia),Scientia Clinical and Epidemiological Research Institute,Trujillo,Peru;Service of ophthalmology,Hospital Universitario Central de Asturias,Oviedo,Spain, 3Evidence Based Ophthalmology Unit (Oftalmoevidencia),Scientia Clinical and Epidemiological Research Institute,Trujillo,Peru;Service of ophthalmology,Hospital Nacional Dos De Mayo,Lima,Peru, 4Evidence Based Ophthalmology Unit (Oftalmoevidencia),Scientia Clinical and Epidemiological Research Institute,Trujillo,Peru;Department of Ophthalmology,Hospital Nacional Guillermo Almenara Irigoyen,Lima,Peru
Purpose
To report outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) surgery alone and combined with phacoemulsification, in patients with glaucoma.
Setting
GATT, introduced in 2014 by Grover and Fellman, is a minimally invasive glaucoma surgery that allows the cannulation of the Schlemm’s canal. It requires a single corneal incision, and avoid the postoperative complications of filtering surgery. GATT can be used in most types of glaucoma
Methods
We included 80 eyes of patients with glaucoma, who underwent GATT surgery alone or combined with phacoemulsification (FG) and IOL implantation, in a third level hospital, between 2019 and 2022. Main outcome measures included surgical success rate (Intra Ocular Pressure(IOP) decrease >20% or Number of Antiglaucoma Medications(NAM) decrease ≥2), changes in IOP, NAM, best corrected visual acuity (BCVA), postoperative complications and follow-up. Surgery was divided in four groups: GATT alone(G), GATT combined with phacoemulsification(FG), HemiGATT alone(HG), and HemiGATT combined with phacoemulsification(HFG).
Results
In 80 eyes(58 patients), success rate was 76.9% in G, 92.3% in FG, 66.7% in HG and 81.3% in HFG. IOP decreased from 23.46 mmHg on 2.62 medications preoperatively to 12.38 on 0.77 medications postoperatively in G, from 21.00 on 2.59 medications preoperatively to 13.59 mmHg on 0.49 medications postoperatively in FG, from 27.25 mmHg on 2.92 medications preoperatively to 17.33 mmHg on 1.92 medications postoperatively in HG, and from 23.56 mmHg on 2.69 medications preoperatively to 15.87 mmHg on 0.94 medications postoperatively in HFG. Mean NAM decrease was 1.85(G), 2.10(FG), 1(HG) and 2(FHG).
Additionally, mean BCVA improved from 0.41 preoperatively to 0.69 in G, from 0.34 to 0.73 in FG, from 0.25 to 0.29 in HG, and from 0.33 to 0.51 in FHG.
Conclusions
GATT combined with cataract surgery is a safe and effective treatment for decreasing IOP and NAM in patients with glaucoma and cataract. FG has better success rate and is more effective decreasing NAM, than G.