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International Ophthalmology

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16-04-2023 | Glaucoma | Original Paper

Evaluation of peripheral anterior synechia formation following gonioscopy-assisted transluminal trabeculotomy surgery

Authors: Murat Gunay, Adem Turk, Hilal Ozturk, Fatma Tugba Bulanik, Dilek Uzlu

Published in: International Ophthalmology | Issue 9/2023

Abstract

Purpose

To quantitatively assess the development of peripheral anterior synechia (PAS) formation rate and PAS locations on gonioscopic examination following gonioscopy-assisted transluminal trabeculotomy (GATT) surgery and investigate the surgical outcomes.

Methods

A total of 35 eyes from 31 patients with open angle glaucoma who underwent GATT or combined GATT and phacoemulsification surgery were analyzed. Presence of PAS was assessed on gonioscopy in nasal, temporal, superior and inferior quadrants at months 1, 3 and 6 following surgery. Surgical outcomes were also noted.

Results

Frequencies of PAS formation were 38.3%, 25.3%, 17.0% and 19.1% at postoperative 1 month, 34.0%, 26.4%, 17% and 22.6% at postoperative 3 months and 32.3%, 25.8%, 16.1% and 25.8% at postoperative 6 months, in nasal, temporal, superior and inferior quadrants, respectively. The highest amount of PAS involvement was 3 clock hours in the study which was identified only in nasal and inferior quadrants. Frequency of PAS formation did not significantly differ between nasal, temporal, superior and inferior quadrants at all time points (p > 0.05). No significant differences of mean IOP levels were observed between patients who developed PAS and who did not develop PAS at postoperative 1 month (p = 0.72), 3 months (p = 0.21) and 6 months (p = 0.59). The mean IOP and mean number of antiglaucoma medications decreased from 31.5 ± 7.2 mmHg and 3.6 ± 0.6 at baseline to 13.8 ± 3.1 mmHg and 1.6 ± 1.3 at postoperative 6 months, respectively (p < 0.001, for both). Cumulative success rate (95% confidence interval) was 74.3% (69.9–78.6%) at the end of the study. Mild to moderate degrees of hyphema occurred in all cases postoperatively.

Conclusion

Although PAS formation was observed to be relatively higher in nasal quadrant, PAS frequency was not statistically different between the angle quadrants.

Weinreb RN, Aung T, Medeiros FA (2014) The pathophysiology and treatment of glaucoma: a review. JAMA 311(18):1901–1911. https://doi.org/10.1001/jama.2014.3192CrossRefPubMedPubMedCentral

Heijl A, Leske MC, Hyman L, Yang Z, Bengtsson B, EMGT Group (2011) Intraocular pressure reduction with a fixed treatment protocol in the Early Manifest Glaucoma Trial. Acta Ophthalmol 89(8):749–754. https://doi.org/10.1111/j.1755-3768.2009.01852.xCrossRefPubMed

The Advanced Glaucoma Intervention Study (AGIS): 7 (2000) The relationship between control of intraocular pressure and visual field deterioration. The AGIS investigators. Am J Ophthalmol 130(4):429–440. https://doi.org/10.1016/s0002-9394(00)00538-9CrossRef

Grover DS, Kornmann HL, Fellman RL (2020) Historical considerations and innovations in the perioperative use of mitomycin C for glaucoma filtration surgery and bleb revisions. J Glaucoma 29(3):226–235. https://doi.org/10.1097/IJG.0000000000001438CrossRefPubMed

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 121(4):855–861. https://doi.org/10.1016/j.ophtha.2013.11.001CrossRefPubMed

Grover DS, Smith O, Fellman RL, Godfrey DG, Gupta A, Montes de Oca I, Feuer WJ (2018) Gonioscopy-assisted transluminal trabeculotomy: An Ab Interno circumferential trabeculotomy: 24 months follow-up. J Glaucoma 27(5):393–401. https://doi.org/10.1097/IJG.0000000000000956CrossRefPubMed

Guo CY, Qi XH, Qi JM (2020) Systematic review and Meta-analysis of treating open angle glaucoma with gonioscopy-assisted transluminal trabeculotomy. Int J Ophthalmol 13(2):317–324. https://doi.org/10.18240/ijo.2020.02.17CrossRefPubMedPubMedCentral

Cubuk MO, Unsal E (2021) One-year results of gonioscopy-assisted transluminal trabeculotomy: evaluation of prognostic factors. Eur J Ophthalmol 31(2):460–468. https://doi.org/10.1177/1120672120908716CrossRefPubMed

Faria BM, Daga FB, Rebouças-Santos V, Araújo RB, Matos Neto C, Jacobina JS, Faria MAR (2021) Gonioscopy-assisted transluminal trabeculotomy (GATT) outcomes in eyes with open-angle glaucoma resistant to maximum treatment. Arq Bras Oftalmol 84(6):587–593. https://doi.org/10.5935/0004-2749.20210083CrossRefPubMed

10.

Sharkawi E, Lindegger DJ, Artes PH, Lehmann-Clarke L, El Wardani M, Misteli M, Pasquier J, Guarnieri A (2021) Outcomes of gonioscopy-assisted transluminal trabeculotomy in pseudoexfoliative glaucoma: 24-month follow-up. Br J Ophthalmol 105(7):977–982. https://doi.org/10.1136/bjophthalmol-2020-315954CrossRefPubMed

11.

Aktas Z, Ucgul AY, Bektas C, SahinKaramert S (2019) Surgical outcomes of prolene gonioscopy-assisted transluminal trabeculotomy in patients with moderate to advanced open-angle glaucoma. J Glaucoma 28(10):884–888. https://doi.org/10.1097/IJG.0000000000001331CrossRefPubMed

12.

Hepşen İF, Güler E, Kumova D, Tenlik A, Kulak AE, HülyaYazici E, Dişli G (2016) Efficacy of modified 360-degree suture trabeculotomy for pseudoexfoliation glaucoma. J Glaucoma 25(1):e29-34. https://doi.org/10.1097/IJG.0000000000000214CrossRefPubMed

13.

Tanito M, Sano I, Ikeda Y, Fujihara E (2017) Short-term results of microhook ab interno trabeculotomy, a novel minimally invasive glaucoma surgery in Japanese eyes: initial case series. Acta Ophthalmol 95(5):e354–e360. https://doi.org/10.1111/aos.13288CrossRefPubMed

14.

Sato T, Hirata A, Mizoguchi T (2015) Prospective, noncomparative, nonrandomized case study of short-term outcomes of 360° suture trabeculotomy ab interno in patients with open-angle glaucoma. Clin Ophthalmol 9:63–68. https://doi.org/10.2147/OPTH.S75739CrossRefPubMedPubMedCentral

15.

Matsuo M, Inomata Y, Kozuki N, Tanito M (2021) Characterization of peripheral anterior synechiae formation after microhook ab-interno trabeculotomy using a 360-degree gonio-camera. Clin Ophthalmol 15:1629–1638. https://doi.org/10.2147/OPTH.S306834CrossRefPubMedPubMedCentral

16.

Elhusseiny MA, Jamerson EC, Menshawey R, Tam EK, El Sayed YM (2020) Collector channels: role and evaluation in Schlemm’s canal surgery. Curr Eye Res 45(10):1181–1187. https://doi.org/10.1080/02713683.2020.1773866CrossRef

17.

Wan Y, Cao K, Wang J, Sun Y, Du R, Wang Z, Zhang J, Wang H, Wang N (2022) Gonioscopy-assisted transluminal trabeculotomy (GATT) combined phacoemulsification surgery: outcomes at a 2-year follow-up. Eye (Lond). https://doi.org/10.1038/s41433-022-02087-2CrossRefPubMed

18.

Quan AV, Chen J, Wang YE, Vanner EA, Grajewski AL, Hodapp EA, Chang TC (2022) Factors associated with gonioscopy-assisted transluminal trabeculotomy (GATT) complications and failure in children. Am J Ophthalmol 241:168–178. https://doi.org/10.1016/j.ajo.2022.04.023CrossRefPubMed

19.

Smith OU, Butler MR, Grover DS, Kornmann HL, Emanuel ME, Godfrey DG, Fellman RL, Feuer W (2022) Twenty-four-month outcome of gonioscopy-assisted transluminal trabeculotomy (GATT) in eyes with prior corneal transplant surgery. J Glaucoma 31(1):54–59. https://doi.org/10.1097/IJG.0000000000001949CrossRefPubMed

20.

Hirabayashi MT, Lee D, King JT, Thomsen S, An JA (2019) Comparison Of surgical outcomes of 360° circumferential trabeculotomy versus sectoral excisional goniotomy with the Kahook dual blade at 6 months. Clin Ophthalmol 13:2017–2024. https://doi.org/10.2147/OPTH.S208468CrossRefPubMedPubMedCentral

21.

Asafali F, Rajamani M, Ramamurthy C, Chaya CJ (2022) Relationship of degrees of gonioscopy assisted transluminal trabeculotomy and trabecular shelf to success using a marker suture technique. Eye (Lond). https://doi.org/10.1038/s41433-021-01838-xCrossRefPubMed

22.

Chen J, Wang YE, Quan A, Grajewski A, Hodapp E, Vanner EA, Chang TC (2020) Risk factors for complications and failure after gonioscopy-assisted transluminal trabeculotomy in a young cohort. Ophthalmol Glaucoma 3(3):190–195. https://doi.org/10.1016/j.ogla.2020.02.002CrossRefPubMed

23.

Borrás T (2018) Growth factors, oxidative damage, and ınflammation in exfoliation syndrome. J Glaucoma 27(Suppl 1):S54–S60. https://doi.org/10.1097/IJG.0000000000000904CrossRefPubMedPubMedCentral

24.

Cakir I, Altan C, Yalcinkaya G, Ozveren M, Kabakci AK, Taskapili M (2022) Evaluation of post phacoemulsification inflammation in eyes with and without pseudoexfoliation syndrome according to phaco parameters via laser flare photometry. Photodiagnosis Photodyn Ther 38:102805. https://doi.org/10.1016/j.pdpdt.2022.102805CrossRefPubMed

25.

Yasuda K, Motohashi R, Kotake O, Nakagawa H, Noma H, Shimura M (2016) Comparative effects of topical diclofenac and betamethasone on inflammation after vitrectomy and cataract surgery in various vitreoretinal diseases. J Ocul Pharmacol Ther 32(10):677–684. https://doi.org/10.1089/jop.2016.0099CrossRefPubMed

26.

Kobayashi H, Kobayashi K, Okinami S (2003) A comparison of the intraocular pressure-lowering effect and safety of viscocanalostomy and trabeculectomy with mitomycin C in bilateral open-angle glaucoma. Graefes Arch Clin Exp Ophthalmol 241(5):359–366. https://doi.org/10.1007/s00417-003-0652-6CrossRefPubMed

Title: Evaluation of peripheral anterior synechia formation following gonioscopy-assisted transluminal trabeculotomy surgery
Authors: Murat Gunay
Adem Turk
Hilal Ozturk
Fatma Tugba Bulanik
Dilek Uzlu
Publication date: 16-04-2023
Publisher: Springer Netherlands
Keywords: Glaucoma
Trabeculotomy
Published in: International Ophthalmology / Issue 9/2023
Print ISSN: 0165-5701
Electronic ISSN: 1573-2630
DOI: https://doi.org/10.1007/s10792-023-02704-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Evaluation of peripheral anterior synechia formation following gonioscopy-assisted transluminal trabeculotomy surgery

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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