The efficacy of gonioscopy-assisted transluminal trabeculectomy combined with phacoemulsification
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ORIGINAL PAPER
The efficacy of gonioscopy-assisted transluminal trabeculectomy combined with phacoemulsification Ercu¨ment Bozkurt . Fatih Yenihayat I˙brahim S¸ ahbaz
. Ali Olgun . Ahmet Taylan Yazıcı .
Received: 6 May 2020 / Accepted: 16 August 2020 Ó Springer Nature B.V. 2020
Abstract Purpose To investigate the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) with or without cataract extraction (CE) in primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PEX) patients. Methods A retrospective, non-randomized study included 108 eyes of 108 patients, with a mean age of 65.96 ± 14.84 years, who underwent GATT to treat open-angle glaucoma. We have compared two groups, GATT alone or GATT combined with CE and followed-up minimum for 12 months. Preoperative intraocular pressure (IOP), best-corrected visual acuity (BCVA) compared with final IOP, medication numbers, and BCVA levels. Surgical success was determined as IOP reduction [ 20% from baseline, IOP between 5–21 mmHg, if surgery was done for intolerance to medications, preoperative \ 21 mmHg with medications, postoperatively \ 21 mmHg without medications, and no need for further glaucoma surgery. Also, we defined success with medications
E. Bozkurt A. Olgun ˙I. S¸ ahbaz World Eye Hospital, Altunizade, ˙Istanbul, Turkey F. Yenihayat (&) World Eye Hospital, 41100 ˙Izmit, Kocaeli, Turkey e-mail: [email protected] A. T. Yazıcı Smart Lens Inc, Santa Clara, CA, USA
and success without medications. High success is defined as IOP \ 16 mmHg without medications. Results Success percentiles were found 87.5% for GATT and 83.8% for GATT with CE group (P = 0.811). IOP percentile changes were - 44.25 ± 21.32 in GATT group, - 32.29 ± 23.41 in GATT with CE group, statistically higher change observed in GATT group (P = 0.009). Final IOP levels were found statistically indifferent for comparing GATT and GATT with CE groups and between PEX and POAG groups (respectively, P = 0.412, P = 0.335). Conclusion We observed GATT alone has a superior lowering effect on IOP than combined surgery. Final IOP values and success percentiles show us combined surgery is also effective. Keywords GATT Gonioscopy-assisted transluminal trabeculectomy Phacoemulsification Moderate glaucoma
Introduction Schlemm canal (SC) surgeries (e.g., trabeculotomy, viscocanalostomy, and canaloplasty) are effective and useful alternatives to glaucoma filtration surgery [1, 2]. Circumferential suture techniques [3, 4] and flexible illuminated microcatheters (iScience Interventional Corp, Menlo Park, CA and Glaucolight,
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Dorc, NL) [5, 6] are two crucial advancements in trabeculotomy surgery. After schlemm canal and the juxtacanalicular trabeculum are incised circumferentially up to 360 degrees, the resistance of the trabecular meshwork disappears, and aqueous can flow easily from anterior chamber to Schlemm canal. The 360-degree suture trabeculotomy may lower the IOP to a level nearly to the epi
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