Comprehensive Analysis Of Postoperative Intraocular Pressure Spikes After Gonioscopy‐Assisted Transluminal Trabeculotomy: Risk Factors And Clinical Implications
Published 2025 - 43rd Congress of the ESCRS
Reference: FP22.07 | Type: Free paper | DOI: 10.82333/qsh6-nt63
Authors: Alicia Hoi Ying Liu* 1 , Tsz Chun Jason Wong 2 , Arijit Mitra 3 , Ankur Barua 3
1Ophthalmology and Visual Sciences,The Chinese University of Hong Kong,Hong Kong,Hong Kong;Birmingham & Midland Eye Centre,Birmingham,United Kingdom, 2Ophthalmology and Visual Sciences,The Chinese University of Hong Kong,Hong Kong,Hong Kong, 3Ophthalmology and Visual Sciences,Birmingham & Midland Eye Centre,Birmingham,United Kingdom
Purpose
To evaluate the frequency, timing, and characteristics of intraocular pressure (IOP) spikes after standalone Gonioscopy-Assisted Transluminal Trabeculotomy (GATT) and to assess the related predispositions and complications along with their clinical course and management.
Setting
A single center retrospective study conducted at University of Health Sciences Beyoglu Eye Training and Research Hospital of patients who underwent GATT between September 2021 and January 2024.
Methods
A retrospective study was conducted with 210 eyes that underwent 3600 GATT with at least 12 months of follow-up. Demographic data, complications, IOP values, number of antiglaucoma medications were recorded for each visit. IOP spike was defined as IOP>30 mmHg or>10 mmHg above baseline IOP within 2 months of surgery. Surgical success was defined as an IOP between 5-21 mmHg and a reduction >20% from baseline. Eyes with IOP spikes were further categorized into three groups based on emergence: hyperacute (0–3 days), acute (4–9 days), and subacute (10–60 days). The main outcome measures were success rate, IOP spike characteristics and risk factors for IOP spikes. Secondary outcomes were risk factors for failure, complications and interventions.
Results
Out of 210 eyes, 70 (33.3%) encountered a postoperative IOP spike. Mean IOP during spikes was 33.9±6.5 mmHg. Spikes persisted for 1.9±2.9 days. The hyperacute group exhibited higher incidence of fibrinous reaction (p=0.026). The acute spike group had a higher pre-op maximal IOP, longer durations of hyphema and a higher failure rate (p=0.023, p=0.044, p=0.049 respectively). Eyes in the subacute spike group had longer steroid use and higher AL (p=0.040,p=0.004 respectively). Total success rate was 91.9%, the non-spike group being more successful than the spike group (77.1% vs 99.3%, p<0.001). Multivariate regression model identified presence of fibrinous reaction, prolonged steroid use, and prior vitrectomy as risk factors for IOP spikes.
Conclusions
Postoperative IOP spike is a risk factor for surgical failure after GATT. Timing of spikes might be signaling differences in the underlying pathology, accompanying complications and clinical course. In the postoperative period, eyes with fibrin reaction, prolonged steroid use and previous vitrectomy should be carefully evaluated. Effective and timely management of complications associated with IOP spikes is crucial to mitigate the risk of surgical failure.