Hemi-GATT combined with phacoemulsification in patients with moderate-severe primary open-angle glaucoma: 2-year outcomes.

ABSTRACT

PURPOSE: To describe the outcomes of inferior hemisphere 180° gonioscopy-assisted transluminal trabeculotomy (hemi-GATT) in patients with moderate-severe stage primary open-angle glaucoma (POAG). METHODS: This single center, retrospective study identified patients with POAG who had undergone combined inferior hemi-GATT with phacoemulsification. Patients with moderate-severe staged POAG were included in the study. Outcome measures included surgical success, intraocular pressure (IOP), number of topical IOP-lowering drops, best-corrected visual acuity (BCVA), visual field mean deviation (MD) and complications. Success was defined using two criteria Criterion A (IOP <17 mmHg and >20% reduction) and Criterion B (IOP <12 mmHg and >20% reduction). RESULTS: One hundred-twelve eyes of 112 patients were included in this study. Of these, 91 patients were followed for 24 months or greater to assess endpoint surgical success. Kaplan-Meier survival analysis for Criterion A demonstrated a 64.8% probability of success without topical IOP-lowering therapy (complete success) and a 93.4% probability of success with or without topical IOP-lowering therapy (qualified success). Probabilities of complete and qualified success using Criterion B were 26.4% and 30.8%, respectively. IOP reduction from baseline (21.9 ± 5.8 mmHg) to 24-month follow-up (13.6 ± 3.9 mmHg) was 37.9% for the overall cohort. The most common complication was transient hyphema, which occurred in 25.9% (29 of 112) of patients. All cases of hyphema resolved spontaneously. CONCLUSIONS: Combined hemi-GATT with phacoemulsification was associated with favorable outcomes and a low complication rate in this study of patients with moderate-severe POAG. Further studies are required comparing hemi-GATT to the 360° approach.