The following is the summary of “Segmental Suture Gonioscopy-Assisted Transluminal Trabeculotomy: Comparison of Superior Versus Inferior Hemisphere Outcomes,” published in the May 2023 issue of Glaucoma by Waldner, et al.
There was no statistically significant difference in efficacy, safety, or risk factors for failure comparing superior and inferior 180-degree segmental gonioscopy-assisted transluminal trabeculotomy. Evaluate the success rate, complication rate, and risk factors for failure of 180-degree segmental suture gonioscopy-assisted transluminal trabeculotomy (GATT) performed on the superior versus inferior trabecular opening. Combined superior and inferior 180-degree suture hemi-GATT and phacoemulsification in 297 eyes of 243 glaucomatous patients at one of 3 Canadian ophthalmological surgical centers in Calgary, Alberta, or Toronto, Ontario; a multicenter, retrospective, interventional cohort study.
The primary outcome measure was the hazard ratio (HR) for the “primary success” criteria. “Primary success” was defined as intraocular pressure (IOP) of <18 mmHg while taking the same number of IOP-lowering drugs as before or an IOP of <18 mm Hg while taking fewer medications. They also conducted a cross-sectional analysis and a Cox proportional hazard analysis to identify risk variables for more significant failure throughout the entire cohort, as well as HRs of a disappointment for alternative criteria (“complete success,” “qualified success,” and “20% IOP reduction”). Both groups shared similar baseline characteristics. There was no statistically significant difference in the HR of failure for the “primary success” criteria between the superior and inferior procedures (HR = 1.27, 95% CI = 0.86-1.88; adjusted HR = 1.50% CI = 0.91-2.46). A crude analysis of the “20% reduction” criterion (1.40/1.27 (95% CI = 1.01-1.92)) showed statistical significance in favor of inferior operations but not for any of the other secondary criteria.
Principal open-angle glaucoma, severe illness, and patients younger than 70 years old were associated with an increased likelihood of failure according to the “primary success” criterion for both interventions. Only 44.4% of eyes in the superior group and 49.6% in the inferior group (P = 0.41; most early postoperative hyphema, iritis, and corneal edema) had problems following surgery. This retrospective study found no statistically significant difference between inferior and superior 180-degree hemi-GATT/phacoemulsification cataract operations. Glaucoma subtype, disease severity, and younger age were independent predictors of treatment failure in this group. This calls for more research.
