Efficacy of gonioscopy-assisted transluminal trabeculotomy in advanced

Background: The prevalence and severity of many etiologies of glaucoma increase with age, often requiring surgery later in life. Surgery in the most aged demographic, however, poses multiple unique physiologic and psychosocial challenges with variable outcomes. In this study, we evaluate the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) in an advanced-age population (>85 years of age). Methods: This is a single-centre retrospective cohort study of consecutive patients who underwent GATT at or above 85 years of age. This included patients with GATT of any circumferential extent (90 degrees-360 degrees) with or without concurrent phacoemulsification cataract surgery. The primary outcome measure was proportion of successful surgeries at 1 year by the "complete success" criteria (intraocular pressure [IOP] <17 mm Hg on no medications 3 months after surgery with no additional interventions). Secondary outcomes included proportion of successful surgeries by alternative criteria, cross-sectional analyses of IOPs and medication use, and analyses of postoperative complications and interventions. Results: Forty eyes of 31 patients were included in the study. Mean baseline IOP was 16.75 +/- 7.33 mm Hg on 1.60 +/- 1.43 classes of medication. At 1 year, the cumulative survival by Kaplan-Meier analysis was 46.6%. There was a statistically significant reduction in IOP at all postoperative time points to a mean of 11.78 +/- 3.07 mm Hg at the last follow-up. There were postoperative complications in 18 eyes, with hyphema and corneal edema accounting for the majority. Conclusions: This study provides evidence that GATT is a safe and effective intervention in advanced-age glaucoma populations.