Gonioscopy-Assisted Transluminal Trabeculotomy With Or Without Cataract Extraction, In Steroid-Induced And Uveitic Glaucoma: 5-Year Outcomes
Published 2025 - 43rd Congress of the ESCRS
Reference: PP24.18 | Type: Poster | DOI: 10.82333/mwka-fd66
Authors: Param Bhatter 1 , Daniel Petkovsek* 1 , Dan Arreaza 1 , Jonathan Eisengart 1 , Mary Qiu 1
1Ophthalmology,Cleveland Clinic,Cleveland,United States
Purpose
Steroid-induced and uveitic glaucomas are challenging to manage due to elevated intraocular pressure
(IOP) and resistance to standard treatments. Gonioscopy-assisted transluminal trabeculotomy (GATT) is a promising
surgical option, particularly when combined with phacoemulsification cataract surgery. This study evaluates the long-term
efficacy, safety, and complications of these procedures in patients with steroid-induced or uveitic glaucoma.
Setting
Cleveland Clinic, Cleveland, Ohio, United States.
Methods
A retrospective chart review was performed of eyes with steroid-induced or uveitic glaucoma that underwent
GATT or excisional goniotomy, either standalone or combined with phacoemulsification cataract surgery, by a single
surgeon at the Cole Eye Institute between Jan 1st 2016-Jan 31st 2020. IOP, number of glaucoma medications, and steroid
exposure were recorded preoperatively and at multiple postoperative timepoints up to 5 years. Surgical success was
defined as at least 20% IOP reduction or IOP <12. Surgical failure was defined as need for additional glaucoma surgery
or loss of light perception vision. Intraoperative and postoperative complications were reported.
Results
Forty eyes of 33 patients underwent GATT, and 24 eyes of 22 patients underwent goniotomy, with 75% and 63% having 5-year follow-up, respectively. Of all eyes, 14% had uveitic glaucoma, 28% had steroid-induced glaucoma, and 58% had combined steroid-uveitic glaucoma. GATT eyes had baseline IOP of 28.0±9.5 mm Hg on 3.3±1.1 medications, reduced to 13.0±3.4 mm Hg on 0.8±1.0 at 5 years. Goniotomy eyes had baseline IOP of 23.4±10.0 mm Hg on 3.1±1.1 medications, reduced to 15.4±4.4 mm Hg on 1.6±1.4 at 5 years. Surgical failure occurred in 18% of GATT and 17% of goniotomy eyes, with most failures (86% for GATT, 75% for goniotomy) within 2 years. 86% of GATT and 100% of goniotomy failures had ongoing steroid exposure.
Conclusions
Both GATT and goniotomy with and without phacoemulsification demonstrate favorable efficacy and safety
in steroid-induced and uveitic glaucoma eyes. Both procedures achieved sustained reductions in IOP and glaucoma
medication burden at 5-years with active steroid exposure.