One-year results of gonioscopy-assisted transluminal trabeculotomy: Evaluation of prognostic factors

Purpose: To present the results and complications of gonioscopy-assisted transluminal trabeculotomy in adults with open-angle glaucoma using our different approaches during and after surgery. Method: A retrospective comparative study was designed. Patients with regular 12-month follow-up history were included. Two groups were defined: group 1 comprised patients with open-angle glaucoma who underwent gonioscopy-assisted transluminal trabeculotomy surgery alone; group 2 included patients with open-angle glaucoma who underwent combined gonioscopy-assisted transluminal trabeculotomy and cataract extraction. A 30% reduction in preoperative intraocular pressure or postoperative intraocular pressure below 18 mm Hg was considered as surgical success. The success rate, alteration in intraocular pressure, alteration in best-corrected visual acuity, alteration in the need for antiglaucomatous medications, surgical complications, and the need for additional glaucoma surgery were evaluated and compared between the groups. Multivariate logistic regression analysis was used to show the association between the surgical success and possible prognostic factors. Results: A total of 37 eyes fulfilled the inclusion criteria and were analyzed in this study. An overall mean decrease in intraocular pressure of 11.3 +/- 9.3 mm Hg was shown at 12 months (p < 0.001). The medication-free surgical success rate was 37.8% (14/37), and the surgical success rate with medication was 91.8% (33/37) at 12 months. Surgical outcomes were similar between patients who underwent gonioscopy-assisted transluminal trabeculotomy alone and those who had combined gonioscopy-assisted transluminal trabeculotomy and cataract extraction (p > 0.05). The most common postoperative complication was hyphemia (89.1%). There were no complications that threatened best-corrected visual acuity. Multivariate logistic regression analysis revealed one significant association between the presence of blood in Schlemm's canal and surgical success (odds ratio = 1.47; 95% confidence interval = 1.25-1.68; p = 0.047). Conclusion: This study showed that the gonioscopy-assisted transluminal trabeculotomy procedure is an effective and minimally invasive form of glaucoma surgery. Its effect was related to intraoperative blood in Schlemm's canal.