Gonioscopy-Assisted Transluminal Trabeculotomy (Gatt) For Secondary Glaucoma Following Pediatric Cataract Surgery: A 12-Month Prospective Cohort Study

To evaluate the clinical efficacy and safety of Gonioscopy-Assisted Transluminal Trabeculotomy (GATT) in managing secondary glaucoma in children following cataract surgery. The study seeks to establish an optimal minimally invasive surgical strategy for this high-risk pediatric population by assessing intraocular pressure (IOP) reduction and medication burden.

This prospective, single-center cohort study was conducted at the Department of Ophthalmology, University City Hospital Affiliated to Chongqing Medical University, Chongqing, China. The setting provided specialized tertiary care for pediatric glaucoma and complex postoperative complications.

The study included 45 children (46 eyes) aged 2–14 years diagnosed with glaucoma following cataract surgery, with a baseline IOP $\ge$ 22 mmHg despite medical therapy. All subjects underwent 360° GATT performed by a single surgeon using standard transluminal techniques. Primary outcomes were the reduction in mean IOP and the surgical success rate (defined as IOP $\le$ 21 mmHg with $\ge$ 20% reduction). Secondary outcomes included changes in the number of anti-glaucoma medications, Best Corrected Visual Acuity (BCVA), corneal endothelial cell count (ECC), and postoperative complications over a 12-month follow-up period. Data were analyzed using repeated measures ANOVA.

The baseline mean IOP was 26.3 $\pm$ 4.2 mmHg with an average of 2.5 $\pm$ 1.1 medications. At 12 months post-GATT, the mean IOP significantly decreased to 15.1 $\pm$ 3.2 mmHg ($P < 0.001$), achieving a total success rate of 93.5% (43/46 eyes). Complete success (no medications) was achieved in 30.4% of eyes, while 58.7% required $\ge$ 50% fewer medications. BCVA remained stable or improved in 86.9% of eyes, and no significant loss of endothelial cells was observed (3200 $\pm$ 400 vs. 3050 $\pm$ 350 cells/mm², $P=0.18$). Complications were primarily self-limiting, including transient hyphema (13.0%) and subconjunctival hemorrhage (17.4%).