Clinical effect of trabecular meshwork peeling in gonioscopy-assisted transluminal trabeculotomy (GATT)

To determine the effect of trabecular meshwork (TM) peeling on gonioscopy-assisted transluminal trabeculotomy (GATT) surgical outcomes in patients with open-angle glaucoma.

In this retrospective cross-sectional study, patients who underwent GATT surgery with 5/0 prolene for moderate-to-advanced glaucoma were included. In group 1, the TM was only torn using a prolene suture, and in group 2, the TM was peeled after tearing. A decrease in intraocular pressure (IOP) below 18mmHg after surgery without the need for glaucoma medications or a 30% decrease in IOP from preoperative values were accepted as complete success. Achieving the same outcome with a maximum of two topical medications was defined as a qualified success. The requirement for additional surgery was defined as a failure. Patient demographics, pre- and postoperative IOP, number of glaucoma medications, complete and qualified surgical success, mean retinal nerve fiber layer thickness, and surgical complications were evaluated.

Each group contained twenty eyes. Complete trabeculotomy (360°) was performed in 60% of group 1 and 80% of group 2 patients; partial trabeculotomy (200°-270°) was performed in 40% of group 1 and 20% of group 2 patients. Both groups had similar mean IOP levels and number of medications (P>0.05). Surgical success rates were similar between patient groups (P>0.05). Hyphema, which resolved spontaneously, occurred in 75% of group 1 and 70% of group 2.

In conclusion, adding TM peeling to GATT surgery did not improve early postoperative outcomes. Longitudinal investigations with a larger patient group are needed.