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Outcomes of gonioscopy-assisted transluminal trabeculotomy in juvenile-onset primary open-angle glaucoma

Abstract

Purpose

To report the outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) for juvenile-onset primary open-angle glaucoma (JOAG).

Methods

A consecutive case series of JOAG patients who underwent GATT was reviewed with follow-up period of up to 18 months. Intraocular pressure (IOP), number of glaucoma medications and success rate were compared between eyes with and without prior glaucoma surgery, and between mild-to-moderate and severe cases defined based on Humphrey Visual Field mean deviation.

Results

In total, 59 eyes of 48 patients were included. Overall, IOP was reduced from 26.5 ± 9.0 mmHg on 3.7 ± 0.9 medications preoperatively to 14.7 ± 3.0 mmHg on 0.7 ± 1.2 medications at 12 months and to 14.1 ± 2.3 mmHg on 0.4 ± 0.8 medications at 18 months postoperatively (P < 0.001). The complete and qualified success rates were 70.8% and 81.2% at 12 months, and 58.6% and 81.2% at 18 months, respectively. Eyes with and without prior glaucoma surgery did not differ significantly in terms of postoperative IOP, glaucoma medication and success rate. In addition, GATT was effective for both mild-to-moderate and severe cases; the latter achieved a surgical success of 79.1%.

Conclusions

GATT is effective for JOAG. In particular, this case series suggests that GATT is promising in treating severe JOAG and those with prior glaucoma surgery.

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Fig. 1: Kaplan–Meier analysis of the cumulative probabilities of surgical success.
Fig. 2: Preoperative versus postoperative IOP and glaucoma medications in eyes without prior glaucoma surgery (Group 1) and those with prior surgery (Group 2).
Fig. 3: The percent reduction of IOP in eyes with mild-to-moderate JOAG (MD ≥ −12 dB) and in eyes with severe JOAG (MD < −12 dB).
Fig. 4: Kaplan–Meier analysis of the cumulative proportion of surgical success in mild-to-moderate (MD ≥ −12 dB) and severe (MD < −12 dB) JOAG.

References

  1. Gupta V, Dutta P, Mary OV, Kapoor KS, Sihota R, Kumar G. Effect of glaucoma on the quality of life of young patients. Investig Ophthalmol Vis Sci. 2011;52:8433–7.

    Article  Google Scholar 

  2. Wiggs JL, Del Bono EA, Schuman JS, Hutchinson BT, Walton DS. Clinical features of five pedigrees genetically linked to the juvenile glaucoma locus on chromosome 1q21-q31. Ophthalmology. 1995;102:1782–9.

    CAS  Article  Google Scholar 

  3. Johnson AT, Richards JE, Boehnke M, Stringham HM, Herman SB, Wong DJ, et al. Clinical phenotype of juvenile-onset primary open-angle glaucoma linked to chromosome 1q. Ophthalmology. 1996;103:808–14.

    CAS  Article  Google Scholar 

  4. Turalba AV, Chen TC. Clinical and genetic characteristics of primary juvenile-onset open-angle glaucoma (JOAG). Semin Ophthalmol. 2008;23:19–25.

    Article  Google Scholar 

  5. Kwun Y, Lee EJ, Han JC, Kee C. Clinical characteristics of juvenile-onset open angle glaucoma. Korean J Ophthalmol. 2016;30:127–33.

    Article  Google Scholar 

  6. Tsai JC, Chang HW, Kao CN, Lai IC, Teng MC. Trabeculectomy with mitomycin C versus trabeculectomy alone for juvenile primary open-angle glaucoma. Ophthalmologica. 2003;217:24–30.

    Article  Google Scholar 

  7. Nash DL, Crouch ER, Crouch ER Jr. Comparison of EX-PRESS shunt and trabeculectomy with mitomycin-C in congenital and juvenile glaucoma. J Glaucoma. 2017;26:e58–e63.

    Article  Google Scholar 

  8. Pathania D, Senthil S, Rao HL, Mandal AK, Garudadari CS. Outcomes of trabeculectomy in juvenile open angle glaucoma. Indian J Ophthalmol. 2014;62:224–8.

    Article  Google Scholar 

  9. Gressel MG, Heuer DK, Parrish RK 2nd. Trabeculectomy in young patients. Ophthalmology. 1984;91:1242–6.

    CAS  Article  Google Scholar 

  10. Jacobi PC, Dietlein TS, Krieglstein GK. Primary trabeculectomy in young adults: long-term clinical results and factors influencing the outcome. Ophthalmic Surg Lasers. 1999;30:637–46.

    CAS  Article  Google Scholar 

  11. Kjer B, Kessing SV. Trabeculotomy in juvenile primary open-angle glaucoma. Ophthalmic Surg. 1993;24:663–8.

    CAS  PubMed  Google Scholar 

  12. Kubota T, Takada Y, Inomata H. Surgical outcomes of trabeculotomy combined with sinusotomy for juvenile glaucoma. Jpn J Ophthalmol. 2001;45:499–502.

    CAS  Article  Google Scholar 

  13. Gupta V, Ov M, Rao A, Sharma A, Sihota R. Long-term structural and functional outcomes of therapy in juvenile-onset primary open-angle glaucoma: a five-year follow-up. Ophthalmologica. 2012;228:19–25.

    Article  Google Scholar 

  14. McPherson SD Jr., Berry DP. Goniotomy vs external trabeculotomy for developmental glaucoma. Am J Ophthalmol. 1983;95:427–31.

    Article  Google Scholar 

  15. Yeung HH, Walton DS. Goniotomy for juvenile open-angle glaucoma. J Glaucoma. 2010;19:1–4.

    Article  Google Scholar 

  16. Grover DS, Godfrey DG, Smith O, Feuer WJ, Montes de Oca I, Fellman RL. Gonioscopy-assisted transluminal trabeculotomy, ab interno trabeculotomy: technique report and preliminary results. Ophthalmology. 2014;121:855–61.

    Article  Google Scholar 

  17. Grover DS, Fellman RL. Gonioscopy-assisted transluminal trabeculotomy (GATT): thermal suture modification with a dye-stained rounded tip. J Glaucoma. 2016;25:501–4.

    Article  Google Scholar 

  18. Sarkisian SR, Mathews B, Ding K, Patel A, Nicek Z. 360 degrees ab-interno trabeculotomy in refractory primary open-angle glaucoma. Clin Ophthalmol. 2019;13:161–8.

    CAS  Article  Google Scholar 

  19. AGIS Investigators. The Advanced Glaucoma Intervention Study (AGIS): 11. risk factors for failure of trabeculectomy and argon laser trabeculoplasty. Am J Ophthalmol. 2002;134:481–98.

    Article  Google Scholar 

  20. Law SK, Shih K, Tran DH, Coleman AL, Caprioli J. Long-term outcomes of repeat vs initial trabeculectomy in open-angle glaucoma. Am J Ophthalmol. 2009;148:685–.e681.

    Article  Google Scholar 

  21. Grover DS, Godfrey DG, Smith O, Shi W, Feuer WJ, Fellman RL. Outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) in eyes with prior incisional glaucoma surgery. J Glaucoma. 2017;26:41–5.

    Article  Google Scholar 

  22. Grover DS, Smith O, Fellman RL, Godfrey DG, Gupta A, Montes de Oca I, et al. Gonioscopy assisted transluminal trabeculotomy: an ab interno circumferential trabeculotomy - 24-month follow-up. J Glaucoma. 2018;27:393–401.

    Article  Google Scholar 

  23. Aktas Z, Ucgul AY, Bektas C, Sahin, Karamert S. Surgical outcomes of prolene gonioscopy assisted transluminal trabeculotomy in patients with moderate to advanced open angle glaucoma. J Glaucoma. 2019;28:884–8.

    Article  Google Scholar 

  24. Boese EA, Shah M. Gonioscopy-assisted transluminal trabeculotomy (GATT) is an effective procedure for steroid-induced glaucoma. J Glaucoma. 2019;28:803–7.

    Article  Google Scholar 

  25. Broadway DC, Chang LP. Trabeculectomy, risk factors for failure and the preoperative state of the conjunctiva. J Glaucoma. 2001;10:237–49.

    CAS  Article  Google Scholar 

  26. Sugimoto Y, Mochizuki H, Ohkubo S, Higashide T, Sugiyama K, Kiuchi Y. Intraocular pressure outcomes and risk factors for failure in the collaborative bleb-related infection incidence and treatment study. Ophthalmology. 2015;122:2223–33.

    Article  Google Scholar 

  27. Grover DS, Smith O, Fellman RL, Godfrey DG, Butler MR, Montes de Oca I, et al. Gonioscopy assisted transluminal trabeculotomy: an ab interno circumferential trabeculotomy for the treatment of primary congenital glaucoma and juvenile open angle glaucoma. Br J Ophthalmol. 2015;99:1092–6.

    Article  Google Scholar 

  28. Sato T, Hirata A, Mizoguchi T. Prospective, noncomparative, nonrandomized case study of short-term outcomes of 360 degrees suture trabeculotomy ab interno in patients with open-angle glaucoma. Clin Ophthalmol. 2015;9:63–8.

    Article  Google Scholar 

  29. Alnahrawy O, Blumenstock G, Ziemssen F, Szurman P, Leitritz MA, Dimopoulos S, et al. Exit strategies in canaloplasty: intraoperative conversion into 180-degree trabeculotomy or 360-degree trabeculotomy in cases of unsuccessful catheterisation of Schlemm’s canal: influence of degree of canal cleavage. Graefes Arch Clin Exp Ophthalmol. 2015;253:779–84.

    Article  Google Scholar 

  30. Dao JB, Sarkisian SR Jr., Freedman SF. Illuminated microcatheter-facilitated 360-degree trabeculotomy for refractory aphakic and juvenile open-angle glaucoma. J Glaucoma. 2014;23:449–54.

    Article  Google Scholar 

  31. Lim ME, Dao JB, Freedman SF. 360-degree trabeculotomy for medically refractory glaucoma following cataract surgery and juvenile open-angle glaucoma. Am J Ophthalmol. 2017;175:1–7.

    Article  Google Scholar 

  32. Furuyoshi N, Furuyoshi M, Futa R, Gottanka J, Lutjen-Drecoll E. Ultrastructural changes in the trabecular meshwork of juvenile glaucoma. Ophthalmologica. 1997;211:140–6.

    CAS  Article  Google Scholar 

  33. Aktas Z, Ozmen MC, Atalay HT, Ucgul AY. Evaluation of episcleral venous fluid wave during gonioscopy assisted transluminal trabeculotomy in patients with advanced glaucoma. Eye. 2019;33:668–73.

    Article  Google Scholar 

  34. Rahmatnejad K, Pruzan NL, Amanullah S, Shaukat BA, Resende AF, Waisbourd M, et al. Surgical outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with open-angle glaucoma. J Glaucoma. 2017;26:1137–43.

    Article  Google Scholar 

  35. Sato T, Kawaji T, Hirata A, Mizoguchi T. 360-degree suture trabeculotomy ab interno to treat open-angle glaucoma: 2-year outcomes. Clin Ophthalmol. 2018;12:915–23.

    CAS  Article  Google Scholar 

Download references

Funding

This work was supported by National Natural Science Foundation of China (81730027). The funding organization had no role in the design or conduct of this research.

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Correspondence to Ningli Wang.

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Wang, Y., Wang, H., Han, Y. et al. Outcomes of gonioscopy-assisted transluminal trabeculotomy in juvenile-onset primary open-angle glaucoma. Eye 35, 2848–2854 (2021). https://doi.org/10.1038/s41433-020-01320-0

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