Outcome of Gonioscopy-Assisted Transluminal Trabeculotomy in Uveitic Glaucoma

GATT was effective in decreasing the IOP and the number of glaucoma medications significantly in patients with UG. Active uveitis at the time of surgery was associated with a higher likelihood of requiring glaucoma medications.

To study the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) in uveitic glaucoma (UG).

This was a prospective interventional case series that included 42 eyes of 35 patients with open angle UG who required glaucoma surgery. Cases requiring combined GATT and cataract surgery were excluded. Surgical success was defined as achieving an IOP ≤21 mm Hg and a ≥30% IOP reduction on the same or fewer medications, without additional glaucoma interventions. The primary outcomes were changes in IOP and the number of glaucoma medications. Secondary outcomes included the success rate and complications.

After a 12-month follow-up period, the IOP was reduced from 31±10.6 to 12.5±2.5 mm Hg ( P <0.001), representing a 62.11%±25.09% reduction. The number of glaucoma medications decreased from 3.67±1.18 to 0.97±1.12 ( P <0.001). Mean BCVA (log MAR) improved from 0.62±0.79 preoperatively to 0.51±0.72 at 12 months ( P =0.054). At the final follow-up, complete success was achieved in 21 eyes (50%), qualified success in 16 eyes (38.1%), and failure in 5 eyes (11.9%). No serious complications were encountered. The only significant adverse prognostic factor was uveitis activity at the time of surgery, which was associated with a higher likelihood of requiring glaucoma medications ( P =0.04, OR=4.85).

GATT is a safe and effective procedure for UG. The outcome is influenced by the uveitis activity at the time of surgery, which can result in the need for more antiglaucoma medications postoperatively.