Trabectome-Initiated Gonioscopy-Assisted Transluminal Trabeculotomy

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Minimally Invasive Glaucoma Surgery

Background:

• Primary open-angle glaucoma (POAG) is a leading cause of irreversible blindness worldwide.
• Current surgical treatments for POAG aim to reduce intraocular pressure (IOP) but can have significant side effects or limitations.
• Trabecular bypass surgeries offer a less invasive approach to IOP reduction.

Purpose of the Study:

• To introduce a novel surgical technique: trabectome-initiated gonioscopy-assisted transluminal trabeculotomy (TIGATT).
• To evaluate the preliminary efficacy and safety of the TIGATT procedure in patients with POAG.
• To compare TIGATT outcomes with existing glaucoma surgical procedures.

Main Methods:

• A preliminary case series of eight adult patients with POAG.
• The TIGATT procedure combines ab interno trabeculectomy ablation using the trabectome with gonioscopy-assisted transluminal trabeculotomy (GATT).
• Intraocular pressure (IOP), number of medications, and complications were recorded as outcome measures with follow-up up to 2 years.

Main Results:

• Mean preoperative IOP of 25 mmHg decreased to 14 mmHg at 3 months and 1 year post-surgery.
• The average number of glaucoma medications decreased from four to two at 3 months and one at 1 year.
• Two patients (25%) experienced treatment failure requiring further surgery; one patient was lost to follow-up.

Conclusions:

• The TIGATT procedure demonstrates promising preliminary results and a favorable safety profile for POAG management.
• Initiating transluminal trabeculotomy with the trabectome facilitates Schlemm's canal access and microcatheter insertion.
• TIGATT offers a potential alternative glaucoma surgery, with trabectome ablation serving as a fallback if full 360-degree trabeculotomy is not achievable.