Safety of gonioscopy-assisted transluminal trabeculotomy without antithrombotic discontinuation versus no antithrombotic therapy: a large cohort study.

PURPOSE: To evaluate the influence of antithrombotic agent use on early postoperative complications and surgical success.

METHODS

A retrospective, single-center study including all patients who underwent GATT between December 2019 and December 2023 with at least three months follow-up. Pre-operative characteristics, post-operative complications and surgical success were compared between the antithrombotic (AT) and the non-antithrombotic (NAT) groups.

RESULTS

Antithrombotic agents were used in 139 of the 444 cases (31.3%). 73% of the antithrombotic agents were anti platelet COX-1 inhibitors. Patients in the AT group were older (75 ± 7.6 vs. 66.6 ± 17.2; P < 0.01) and had a lower maximal intraocular pressure (IOP) (28.6 ± 10.3 vs. 34.7 ± 11; P < 0.01). There were no differences between the AT and NAT groups in rates of microhyphema and layered hyphema (85% vs. 89%; P = 0.3), duration of hyphema (7.98 ± 8.4 vs. 8.7 ± 8.6; P = 0.4), and presence of anterior chamber clots (22.2% vs. 24%; P = 0.7). There was also no difference in the incidence of IOP spikes (23.9% vs. 21.6%; P = 0.6), or in overall surgical success (77.6% vs. 77.3%; P = 0.5) on last follow-up. Patients in the AT group underwent fewer additional surgeries to control IOP compared to the NAT group (4.3% vs. 10.1%; P = 0.04).

CONCLUSIONS

There were no significant differences in bleeding prevalence or duration between patients receiving antithrombotic therapy and those not receiving it prior to GATT. These results suggest that continuation of antithrombotic therapy during GATT may be reasonable in selected patients, following individualized assessment of systemic and ocular risk.