Bent Ab Interno Needle Goniotomy Versus Gonioscopy-Assisted Transluminal Trabeculotomy in Primary Open Angle Glaucoma: A Randomized Clinical Trial.

PRÉCIS: Gonioscopy-assisted transluminal trabeculotomy achieved a higher success rate than Bent Ab interno Needle Goniotomy in pseudophakic primary open angle glaucoma eyes at 12-months.

PURPOSE: To evaluate and compare the efficacy and safety of standalone Bent Ab interno Needle Goniotomy (BANG) and Gonioscopy-Assisted Transluminal Trabeculotomy (GATT) in pseudophakic primary open angle glaucoma (POAG) eyes.

METHODS

Parallel, double-arm, 1:1 ratio, single masked, single surgeon, randomized clinical trial. Uncontrolled mild to moderate pseudophakic POAG eyes, defined by visual field mean deviation, were enrolled. Antiglaucoma medication was washed out before surgery and at 11 months. Patients were followed for 12 months. Surgical success was defined as 6≤IOP≤18 mm Hg and 20% IOP reduction from baseline with (qualified) or without (complete) the use of medication.

RESULTS

Twenty-two eyes underwent BANG and 23 underwent GATT. At inclusion, mean IOPs were 21.18±2.87 mm Hg versus 19.87±2.34 mm Hg ( P =0.1) under 2.41±0.9 versus 2.35±0.88 medications ( P =0.71) in the BANG and GATT groups, respectively. Baseline washout IOPs were 25.55±4.9 mm Hg versus 25.43±4.98 mm Hg in the BANG and GATT groups, respectively ( P =0.92). At POD330, IOPs in GATT and BANG groups were 15.62±3.29 mm Hg (-21.38%, P =0.04) and 16.95±2.82 mm Hg (-19.97%, P <0.01), respectively ( P =0.16). At POD360, after washout, IOPs were 21.57±11.11 mm Hg (-15.17%, P =0.06) and 24.59±7.94 mm Hg (-3.75%, P =0.53) ( P =0.31 between the groups). The mean number of medications used at POD330 was 1.1±1.55 in GATT (-53.19%, P <0.01) and 1.82±1.05 in BANG eyes (-24.48%, P =0.06) ( P =0.08 between the groups). GATT eyes had higher complete (60.1% vs. 4.5%, P <0.01) and qualified success rates (64.7% vs. 22.7%, P =0.01) than BANG eyes. Transient hyphema was the most common complication following GATT (56.52%) and BANG (40.9%).

CONCLUSION

GATT eyes achieved higher success rates, lower mean IOPs and required less antiglaucoma medication than BANG eyes after 11-months.