EARLY CHANGES IN MACULAR AND PERIPAPILLARY VESSEL DENSITIES FOLLOWING GONIOSCOPY-ASSISTED TRANSLUMINAL TRABECULOTOMY IN OPEN-ANGLE GLAUCOMA

To evaluate early macular and peripapillary vessel density (VD) changes following gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with open-angle glaucoma (OAG) and to examine the relationship between these vascular changes and intraocular pressure (IOP).

Retrospective, interventional comparative study

In this retrospective, interventional comparative study, 57 eyes of 57 OAG patients who underwent standalone GATT due to uncontrolled IOP despite maximum tolerated medical therapy were included. Preoperative and 1-month postoperative optical coherence tomography angiography (OCT-A) measurements, IOP, and the number of antiglaucoma medications were recorded. 

The mean age was 64 ± 9 years, with 68.4% male and 31.6% female. Mean IOP decreased from 22 ± 6 mmHg preoperatively to 15 ± 5 mmHg postoperatively (p < 0.001). The mean number of antiglaucoma medications declined from 3 ± 1 to 1 ± 1 (p < 0.001). OCT-A analysis showed significant reductions in VD in the inferior and nasal regions of the superficial capillary plexus (SCP) (p = 0.047, p = 0.004) and in the nasal region of the deep capillary plexus (DCP) (p = 0.013). The deep foveal avascular zone (FAZ) enlarged significantly (p = 0.004). Changes in central macular thickness correlated with IOP reduction (r = 0.294; p = 0.027). No postoperative hypotony occurred, and IOP spikes were observed in 3 eyes (5.2%).

GATT surgery leads to a significant reduction in IOP and decreases the dependence on antiglaucoma medications. In the early postoperative period, the procedure may cause regional changes in the retinal microvasculature, particularly localized reductions in VD. These findings highlight the need for further investigation, and long-term follow-up studies are required to clarify the lasting effects of GATT on retinal vascular structures.