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Factors Associated With Gonioscopy-Assisted Transluminal Trabeculotomy (GATT) Complications and Failure in Children
Ann V Quan1, Jenny Chen2, Ye Elaine Wang3
1From Scripps Health (A.V.Q.), Department of Ophthalmology, San Diego, California, USA.
Insights
Gonioscopy-assisted transluminal trabeculotomy (GATT) shows effectiveness in childhood glaucoma. Postoperative NSAID use may reduce GATT failure risk, while IOP spikes without hyphema indicate higher failure risk.
Area of Science:
- Ophthalmology
- Pediatric Glaucoma Surgery
Background:
- Childhood glaucoma requires effective surgical interventions.
- Gonioscopy-assisted transluminal trabeculotomy (GATT) is a surgical option for pediatric glaucoma.
- Identifying factors influencing GATT success is crucial for optimizing outcomes.
Purpose of the Study:
- To determine factors associated with complications and failure after GATT in children.
- To analyze the impact of intraocular pressure (IOP) spikes and medications on GATT outcomes.
Main Methods:
- Retrospective case series of pediatric patients (<18 years) who underwent GATT.
- Analysis of pre- and postoperative IOP, angle treatment extent, medications, complications, and failure.
- Failure defined by specific IOP criteria, need for further surgery, or vision loss.
Main Results:
- 48.6% of eyes experienced GATT failure over a median follow-up of 28.5 months.
- IOP spikes were a significant risk factor for failure (HR=2.17, P=.0207).
- Topical NSAID use was associated with lower IOP spike risk (HR=0.27, P=.0016), while corticosteroids increased failure risk (HR=5.72, P=.0005).
Conclusions:
- GATT is a reasonably effective procedure for childhood glaucoma.
- Postoperative topical NSAIDs (without corticosteroids) may reduce GATT failure.
- Eyes with IOP spikes and no hyphema face the highest risk of failure.
Purpose:
To identify the factors associated with the complications and failure of gonioscopy-assisted transluminal trabeculotomy (GATT) in children.
Design:
Retrospective case series.
Methods:
This study was conducted in an institutional setting in a pediatric population (aged <18 years) who had undergone GATT. Records were reviewed, and pre- and postoperative intraocular pressures (IOP), extent of angle treated, medications, complications, and failure were recorded. Failure was defined as IOP >21 mm Hg or <5 mm Hg, absence of at least 20% IOP reduction, performance of additional IOP-lowering surgery, or loss of light perception vision.
Results:
A total of 74 eyes of 57 patients were included (mean age, 7.1 years). Over a median follow-up period of 28.5 months, 36 eyes (48.6%) failed. IOP spikes occurred in 25 eyes (33.8%) and were a significant risk factor for failure (hazard ratio [HR] = 2.17; P = .0207). Postoperative hyphema was a significant risk factor for IOP spike (HR = 4.13, P = .003) but not for failure (HR = 0.7, P = .2977). The risk of IOP spike was lowest in eyes treated with nonsteroidal anti-inflammatory drugs (NSAIDs; HR = 0.27, P = .0016). The risk of failure increased significantly in eyes that received topical corticosteroids (compared to NSAIDs; HR = 5.72, P = .0005), in eyes with <360○ incisions (HR = 4.69, P < .0001), and in younger children.
Conclusions:
GATT is a reasonably effective procedure in childhood glaucoma. Postoperatively, the use of topical NSAIDs (without corticosteroid) may decrease the risk of failure. Eyes with IOP spikes without hyphema are at the highest risk for failure.
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