Intraocular pressure spikes after trabecular meshwork strip peeling during hemi-GATT

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Intraocular Pressure Management

Background:

• Glaucoma management often requires surgical intervention to lower intraocular pressure (IOP).
• Hemi-gonioscopy-assisted transluminal trabeculotomy (hemi-GATT) is a minimally invasive glaucoma surgery.
• Postoperative IOP spikes can complicate the recovery after glaucoma surgery.

Purpose of the Study:

• To assess the impact of trabecular meshwork strip peeling (TP) during hemi-GATT on early postoperative IOP spikes.
• To evaluate the effect of TP on surgical success rates following hemi-GATT.
• To identify predictors of early postoperative IOP spikes in patients undergoing hemi-GATT.

Main Methods:

• Retrospective analysis of 42 eyes with primary open-angle or pseudoexfoliative glaucoma.
• Comparison between hemi-GATT with TP (n=14) and standard hemi-GATT without TP (n=28).
• Definition of IOP spike as IOP > 30 mm Hg or an increase of ≥ 10 mm Hg; surgical success defined by IOP ≤ 21 mm Hg with ≥ 30% reduction.

Main Results:

• Early postoperative IOP spikes occurred in 26.2% of eyes, with a lower frequency in the hemi-GATT + TP group (7.1% vs. 35.7%, p=0.048).
• TP was associated with a reduced risk of IOP spikes (OR, 0.01; p=0.014), while higher baseline IOP increased risk (OR, 1.48; p=0.013).
• Qualified and complete surgical success rates were comparable between the groups (92.9% vs. 89.3% and 42.9% vs. 35.7%, respectively).

Conclusions:

• Trabecular meshwork strip peeling during hemi-GATT significantly decreases the incidence of early postoperative IOP spikes.
• TP enhances early IOP control following hemi-GATT.
• The addition of TP to hemi-GATT maintains favorable surgical success rates.