Two-Year Outcomes of Goniotomy After Failed Surgery for Glaucoma: A Multicenter Study

To evaluate the 2-year outcomes of goniotomy (GT) in patients with prior failed glaucoma surgery.

A prospective, observational multicentered study.

Patients who underwent GT after previous failed glaucoma surgery.

Patients were enrolled from May 2021 to October 2022. They underwent comprehensive ophthalmic examination, including medical history review, slit lamp examination, best-corrected visual acuity, and intraocular pressure (IOP) assessments preoperatively and postoperatively. Postoperative complications were also evaluated. Complete success was defined as IOP of 6 to 18 mmHg with ≥20% reduction from baseline, without medication. Qualified success required similar IOP control with medication.

Intraocular pressure change, medication use, treatment success rate, and postoperative complications over 24 months.

A total of 61 eyes from 51 patients were included, with 20 eyes (17 patients) diagnosed with primary open-angle glaucoma and 41 eyes (34 patients) with primary angle-closure glaucoma as their primary condition. The mean age was 60.6 ± 10.6 years, with 30 (58.8%) female patients. Prior surgeries included peripheral iridectomy (23 eyes), trabeculectomy (39 eyes), XEN Gel implant (1 eye), Ahmed valve implant (1 eye), and phacoemulsification and intraocular lens implantation (17 eyes). Among these, complete success was achieved in 26 eyes (42.6%) and qualified success in 52 eyes (85.2%). The mean IOP dropped from 26.4 ± 6.2 mmHg preoperatively to 16.3 ± 4.8 mmHg at 24 months (35.8% reduction; P < 0.001). Antiglaucoma medications decreased from 2.6 ± 1.2 to 1.4 ± 1.4 over 24 months (P < 0.001). Best-corrected visual acuity remained stable during the follow-up (P = 0.987). Complications included hyphema (n = 7), IOP spikes (n = 6), mild corneal edema (n = 3), and shallow anterior chamber (n = 2), all within the first postoperative month. Regression analysis showed that older age was positively correlated with complete success (odds ratio = 1.06; 95% confidence interval, 1.00-1.12; P = 0.044) and qualified success (odds ratio = 1.16; 95% confidence interval, 1.05-1.28; P = 0.004). Primary open-angle glaucoma was negatively associated with qualified success (odds ratio = 0.18; 95% confidence interval, 0.04-0.84; P = 0.029).

Goniotomy proves to be a safe and effective procedure for patients with previous failed glaucoma surgery over the 24-month study period.

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.