Gonioscopy-Assisted Transluminal Trabeculotomy In Pigmentary Glaucoma: 3-Year Outcomes

To describe a case series of pigmentary glaucoma (PG) patients treated with gonioscopy-assisted transluminal trabeculotomy (GATT).

Retrospective case series of 3-year outcomes of all PG patients who underwent GATT from multiple surgeons with the glaucoma service at the Cleveland Clinic Cole Eye Institute.

Retrospective chart review was performed of all PG patients who underwent GATT with at least 3 years of follow-up. All treatments were 360 degrees with the iTrack 250A microcatheter (Nova Eye Medical). Mean IOP and number of glaucoma medications were recorded preoperatively and at multiple timepoints postoperatively through 3 years. Success rate (IOP ≤ 21 mmHg + 20% reduction from baseline without increase in medications, additional laser/surgery, loss of light perception vision, or hypotony) was calculated at the same timepoints. Postoperative complications and need for additional glaucoma surgery prior to the 3-year endpoint were noted, along with rate of IOP spike (IOP > 30 mmHg or > 10 mmHg from baseline in the first 3 months).

11 eyes of 9 patients (55% male, 45% female) were included. Mean age was 67.8 years (range 56-76 years). Combined phaco-GATT was performed in 9 eyes and standalone GATT in 2 phakic eyes. Mean preoperative IOP was 20.8 ± 5.0 mmHg on 2.5 ± 1.4 medications. 2 eyes required additional glaucoma surgery (1 at POM1, 1 at POY1). Among those succeeding, the mean postoperative IOPs were: POY1 16.6 ± 5.5 mmHg (21% reduction) on 2.1 ± 0.7 medications, POY2 18.3 ± 7.7 mmHg (12% reduction) on 2.0 ± 1.0 medications, and POY3 14.7 ± 3.1 mmHg (30% reduction) on 1.7 ± 1.1 medications. Success rate was 46% at POY1, 36% at POY2, and 46% at POY3. The most common complication was hyphema (64%) – only 2 eyes requiring washout – and the rate of IOP spike was 36%.

GATT is effective in patients with PG. Hyphema is the most common postoperative complication, though often self-resolving. Further studies are needed to directly compare the safety and efficacy of GATT versus traditional glaucoma surgery in these patients.