Comparison of trabeculectomy and gonioscopy-assisted transluminal trabeculotomy results in long eyes wıth open-angle...

This study aims to compare one-year results and success rates of trabeculectomy and gonioscopy-assisted transluminal trabeculotomy (GATT) in eyes with long axial length (AL) and glaucoma.

This retrospective study included patients with an AL greater than 24 mm who underwent trabeculectomy (29 eyes) or GATT surgery (33 eyes) in our hospital and had at least a one-year follow-up. Complete success was defined as achieving an IOP > 5 and ≤ 21 mmHg (criterion A), > 5 and ≤ 18 mmHg (criterion B), or > 5 and ≤ 15 mmHg (criterion C), without the use of antiglaucoma medications or additional surgical interventions, except for bleb needling. The same IOP levels with or without medication were considered as overall success.

The GATT group required significantly more antiglaucoma medications at the 1-week, 1-month, and 3-month follow-ups (p < 0.05 for all). Complete success rates were higher in the trabeculectomy group based on criteria A, B, and C (p < 0.05 for each), and the overall success rates based on criteria A, B, and C were similar in both groups in one-year follow-up (p > 0.05 for each). The failure rates based on all three criteria were similar in both groups (p > 0.05 for each). The cumulative probability of overall success based on criterion B was 93.1, 86.2 and 79.3% at 3, 6 and 12 months in the trabeculectomy group and 90.9, 84.5 and 81.8% at 3, 6 and 12 months in the GATT group. The incidence of postoperative complications was higher in the GATT group, and the majority of complications were haemorrhage-related.

In eyes with long AL, the requirement for antiglaucoma medications is reduced in the first three months following trabeculectomy compared to GATT. Although the overall success rate was similar in both groups, the complete success rates of criteria A, B and C were higher in the trabeculectomy group. GATT may be considered an alternative in eyes with long AL.