Comparative evaluation of surgical outcomes of gonioscopy-assisted transluminal trabeculotomy and trabeculectomy in open-angle glaucoma

PURPOSE: To investigate the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) for open-angle glaucoma in comparison with trabeculectomy, the traditional gold standard.
METHODS: A total of 22 patients who underwent surgical intervention between January 2021 and February 2022 were divided into 2 groups according to the surgery type: GATT (Group 1, n=11) and trabeculectomy (Group 2, n=11). Pre-operative and post-operative findings at 1st week, 1st, 3rd, 6th, and 9th months, including best-corrected visual acuity (BCVA), anterior and posterior segment findings, intraocular pressure (IOP), retinal nerve fiber layer (RNFL) thickness, complications, and topical and/or systemic medication requirements were recorded and compared between the groups.
RESULTS: The mean age was 56.5±19.8 (18–80) years in Group 1 and 59.4±6.9 (16–77) years in Group 2 (p>0.05). The female/male ratio was 4/7 in both groups. Post-operative IOPs were significantly lower in both groups compared to the pre-operative IOPs (p=0.01). In addition, IOP values were similar between the groups in the pre-operative period and at all post-operative time points (p>0.05). BCVA and RNFL values remained stable as well. The number of topical anti-glaucomatous agents used decreased significantly and to a similar extent in the post-operative period in both groups. While hypotony was the most common complication in the TRAB group, hyphema was the most prevalent in the GATT group.
CONCLUSION: GATT is a safe and effective method of lowering IOP and reducing the amount of antiglaucomatous medication, and offers acceptable results that are comparable to trabeculectomy. GATT can be considered a viable alternative, especially in patients prone to serious complications, such as hypotony.