Gonioscopy-assisted transluminal trabeculotomy, Ab interno trabeculotomy: Technique report and preliminary results

Davinder S. Grover, David G. Godfrey, Oluwatosin Smith, William J Feuer, Ildamaris Montes De Oca, Ronald L. Fellman

Research output: Contribution to journalArticle

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Abstract

Purpose To introduce a minimally invasive, ab interno approach to a circumferential 360-degree trabeculotomy and to report the preliminary results. Design Retrospective, noncomparative cases series. Participants Eighty-five eyes of 85 consecutive patients who sought treatment at Glaucoma Associates of Texas with uncontrolled open-angle glaucoma and underwent gonioscopy-assisted transluminal trabeculotomy (GATT) for whom there was at least 6 months of follow-up data. Methods Retrospective chart review of patients who underwent GATT by 4 of the authors (D.S.G., D.G.G., O.S., R.L.F.) between October 2011 and October 2012. The surgery was performed in adults with various open-angle glaucomas. Main Outcome Measures Intraocular pressure (IOP), glaucoma medications, visual acuity, and intraoperative as well as postoperative complications. Results Eighty-five patients with an age range of 24 to 88 years underwent GATT with at least 6 months of follow-up. In 57 patients with primary open-angle glaucoma, the IOP decreased by 7.7 mmHg (standard deviation [SD], 6.2 mm Hg; 30.0% [SD, 22.7%]) with an average decrease in glaucoma medications of 0.9 (SD, 1.3) at 6 months. In this group, the IOP decreased by 11.1 mmHg (SD, 6.1 mmHg; 39.8% [SD, 16.0%]) with 1.1 fewer glaucoma medications at 12 months. In the secondary glaucoma group of 28 patients, IOP decreased by 17.2 mmHg (SD, 10.8 mmHg; 52.7% [SD, 15.8%]) with an average of 2.2 fewer glaucoma medications at 6 months. In this group, the IOP decreased by 19.9 mmHg (SD, 10.2 mmHg; 56.8% [SD, 17.4%]) with an average of 1.9 fewer medications (SD, 2.1) at 12 months. Treatment was considered to have failed in 9% (8/85) of patients because of the need for further glaucoma surgery. The cumulative proportion of failure at 1 year ranged from 0.1 to 0.32, depending on the group. Lens status or concurrent cataract surgery did not have a statistically significant effect on IOP in eyes that underwent GATT at either 6 or 12 months (P > 0.35). The most common complication was transient hyphema, seen in 30% of patients at the 1-week visit. Conclusions The preliminary results and safety profile for GATT, a minimally invasive circumferential trabeculotomy, are promising and at least equivalent to previously published results for ab externo trabeculotomy.

Original languageEnglish (US)
Pages (from-to)855-861
Number of pages7
JournalOphthalmology
Volume121
Issue number4
DOIs
StatePublished - 2014

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Gonioscopy
Trabeculectomy
Glaucoma
Intraocular Pressure
Open Angle Glaucoma
Hyphema
Intraoperative Complications
Cataract
Lenses
Visual Acuity
Outcome Assessment (Health Care)
Safety

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Grover, D. S., Godfrey, D. G., Smith, O., Feuer, W. J., Montes De Oca, I., & Fellman, R. L. (2014). Gonioscopy-assisted transluminal trabeculotomy, Ab interno trabeculotomy: Technique report and preliminary results. Ophthalmology, 121(4), 855-861. https://doi.org/10.1016/j.ophtha.2013.11.001

Gonioscopy-assisted transluminal trabeculotomy, Ab interno trabeculotomy : Technique report and preliminary results. / Grover, Davinder S.; Godfrey, David G.; Smith, Oluwatosin; Feuer, William J; Montes De Oca, Ildamaris; Fellman, Ronald L.

In: Ophthalmology, Vol. 121, No. 4, 2014, p. 855-861.

Research output: Contribution to journalArticle

Grover, DS, Godfrey, DG, Smith, O, Feuer, WJ, Montes De Oca, I & Fellman, RL 2014, 'Gonioscopy-assisted transluminal trabeculotomy, Ab interno trabeculotomy: Technique report and preliminary results', Ophthalmology, vol. 121, no. 4, pp. 855-861. https://doi.org/10.1016/j.ophtha.2013.11.001
Grover, Davinder S. ; Godfrey, David G. ; Smith, Oluwatosin ; Feuer, William J ; Montes De Oca, Ildamaris ; Fellman, Ronald L. / Gonioscopy-assisted transluminal trabeculotomy, Ab interno trabeculotomy : Technique report and preliminary results. In: Ophthalmology. 2014 ; Vol. 121, No. 4. pp. 855-861.
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abstract = "Purpose To introduce a minimally invasive, ab interno approach to a circumferential 360-degree trabeculotomy and to report the preliminary results. Design Retrospective, noncomparative cases series. Participants Eighty-five eyes of 85 consecutive patients who sought treatment at Glaucoma Associates of Texas with uncontrolled open-angle glaucoma and underwent gonioscopy-assisted transluminal trabeculotomy (GATT) for whom there was at least 6 months of follow-up data. Methods Retrospective chart review of patients who underwent GATT by 4 of the authors (D.S.G., D.G.G., O.S., R.L.F.) between October 2011 and October 2012. The surgery was performed in adults with various open-angle glaucomas. Main Outcome Measures Intraocular pressure (IOP), glaucoma medications, visual acuity, and intraoperative as well as postoperative complications. Results Eighty-five patients with an age range of 24 to 88 years underwent GATT with at least 6 months of follow-up. In 57 patients with primary open-angle glaucoma, the IOP decreased by 7.7 mmHg (standard deviation [SD], 6.2 mm Hg; 30.0{\%} [SD, 22.7{\%}]) with an average decrease in glaucoma medications of 0.9 (SD, 1.3) at 6 months. In this group, the IOP decreased by 11.1 mmHg (SD, 6.1 mmHg; 39.8{\%} [SD, 16.0{\%}]) with 1.1 fewer glaucoma medications at 12 months. In the secondary glaucoma group of 28 patients, IOP decreased by 17.2 mmHg (SD, 10.8 mmHg; 52.7{\%} [SD, 15.8{\%}]) with an average of 2.2 fewer glaucoma medications at 6 months. In this group, the IOP decreased by 19.9 mmHg (SD, 10.2 mmHg; 56.8{\%} [SD, 17.4{\%}]) with an average of 1.9 fewer medications (SD, 2.1) at 12 months. Treatment was considered to have failed in 9{\%} (8/85) of patients because of the need for further glaucoma surgery. The cumulative proportion of failure at 1 year ranged from 0.1 to 0.32, depending on the group. Lens status or concurrent cataract surgery did not have a statistically significant effect on IOP in eyes that underwent GATT at either 6 or 12 months (P > 0.35). The most common complication was transient hyphema, seen in 30{\%} of patients at the 1-week visit. Conclusions The preliminary results and safety profile for GATT, a minimally invasive circumferential trabeculotomy, are promising and at least equivalent to previously published results for ab externo trabeculotomy.",
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T1 - Gonioscopy-assisted transluminal trabeculotomy, Ab interno trabeculotomy

T2 - Technique report and preliminary results

AU - Grover, Davinder S.

AU - Godfrey, David G.

AU - Smith, Oluwatosin

AU - Feuer, William J

AU - Montes De Oca, Ildamaris

AU - Fellman, Ronald L.

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N2 - Purpose To introduce a minimally invasive, ab interno approach to a circumferential 360-degree trabeculotomy and to report the preliminary results. Design Retrospective, noncomparative cases series. Participants Eighty-five eyes of 85 consecutive patients who sought treatment at Glaucoma Associates of Texas with uncontrolled open-angle glaucoma and underwent gonioscopy-assisted transluminal trabeculotomy (GATT) for whom there was at least 6 months of follow-up data. Methods Retrospective chart review of patients who underwent GATT by 4 of the authors (D.S.G., D.G.G., O.S., R.L.F.) between October 2011 and October 2012. The surgery was performed in adults with various open-angle glaucomas. Main Outcome Measures Intraocular pressure (IOP), glaucoma medications, visual acuity, and intraoperative as well as postoperative complications. Results Eighty-five patients with an age range of 24 to 88 years underwent GATT with at least 6 months of follow-up. In 57 patients with primary open-angle glaucoma, the IOP decreased by 7.7 mmHg (standard deviation [SD], 6.2 mm Hg; 30.0% [SD, 22.7%]) with an average decrease in glaucoma medications of 0.9 (SD, 1.3) at 6 months. In this group, the IOP decreased by 11.1 mmHg (SD, 6.1 mmHg; 39.8% [SD, 16.0%]) with 1.1 fewer glaucoma medications at 12 months. In the secondary glaucoma group of 28 patients, IOP decreased by 17.2 mmHg (SD, 10.8 mmHg; 52.7% [SD, 15.8%]) with an average of 2.2 fewer glaucoma medications at 6 months. In this group, the IOP decreased by 19.9 mmHg (SD, 10.2 mmHg; 56.8% [SD, 17.4%]) with an average of 1.9 fewer medications (SD, 2.1) at 12 months. Treatment was considered to have failed in 9% (8/85) of patients because of the need for further glaucoma surgery. The cumulative proportion of failure at 1 year ranged from 0.1 to 0.32, depending on the group. Lens status or concurrent cataract surgery did not have a statistically significant effect on IOP in eyes that underwent GATT at either 6 or 12 months (P > 0.35). The most common complication was transient hyphema, seen in 30% of patients at the 1-week visit. Conclusions The preliminary results and safety profile for GATT, a minimally invasive circumferential trabeculotomy, are promising and at least equivalent to previously published results for ab externo trabeculotomy.

AB - Purpose To introduce a minimally invasive, ab interno approach to a circumferential 360-degree trabeculotomy and to report the preliminary results. Design Retrospective, noncomparative cases series. Participants Eighty-five eyes of 85 consecutive patients who sought treatment at Glaucoma Associates of Texas with uncontrolled open-angle glaucoma and underwent gonioscopy-assisted transluminal trabeculotomy (GATT) for whom there was at least 6 months of follow-up data. Methods Retrospective chart review of patients who underwent GATT by 4 of the authors (D.S.G., D.G.G., O.S., R.L.F.) between October 2011 and October 2012. The surgery was performed in adults with various open-angle glaucomas. Main Outcome Measures Intraocular pressure (IOP), glaucoma medications, visual acuity, and intraoperative as well as postoperative complications. Results Eighty-five patients with an age range of 24 to 88 years underwent GATT with at least 6 months of follow-up. In 57 patients with primary open-angle glaucoma, the IOP decreased by 7.7 mmHg (standard deviation [SD], 6.2 mm Hg; 30.0% [SD, 22.7%]) with an average decrease in glaucoma medications of 0.9 (SD, 1.3) at 6 months. In this group, the IOP decreased by 11.1 mmHg (SD, 6.1 mmHg; 39.8% [SD, 16.0%]) with 1.1 fewer glaucoma medications at 12 months. In the secondary glaucoma group of 28 patients, IOP decreased by 17.2 mmHg (SD, 10.8 mmHg; 52.7% [SD, 15.8%]) with an average of 2.2 fewer glaucoma medications at 6 months. In this group, the IOP decreased by 19.9 mmHg (SD, 10.2 mmHg; 56.8% [SD, 17.4%]) with an average of 1.9 fewer medications (SD, 2.1) at 12 months. Treatment was considered to have failed in 9% (8/85) of patients because of the need for further glaucoma surgery. The cumulative proportion of failure at 1 year ranged from 0.1 to 0.32, depending on the group. Lens status or concurrent cataract surgery did not have a statistically significant effect on IOP in eyes that underwent GATT at either 6 or 12 months (P > 0.35). The most common complication was transient hyphema, seen in 30% of patients at the 1-week visit. Conclusions The preliminary results and safety profile for GATT, a minimally invasive circumferential trabeculotomy, are promising and at least equivalent to previously published results for ab externo trabeculotomy.

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