Five-year results of illuminated microcatheter-assisted gonioscopy-assisted transluminal trabeculotomy in the Indian population - A retrospective study.

PURPOSE: To assess 5-year outcomes regarding the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) using an illuminated microcatheter in glaucoma patients in India.

METHODS

This retrospective study analyzes clinical records of 110 primary and secondary glaucoma patients treated with either GATT or GATT combined with cataract surgery (GATT+CS) from August 1, 2014 to July 31, 2019 at a single clinical center by one surgeon. The main postoperative outcomes assessed included changes in intraocular pressure (IOP), the use of anti-glaucoma medications (AGMs), the occurrence of complications, and surgical success over a 5-year follow-up period. Absolute success was characterized by an intraocular pressure of ≤18 mmHg, without AGM, and a 30% reduction from baseline.

RESULTS

The average IOP and AGM reduced from 26.46 ± 9.97 mmHg and 2.60 ± 1.27 preoperatively to 13.02 ± 2.01 mmHg and 1.16 ± 1.28 five years after the procedure. The visual acuity improved from 0.89 ± 0.58 to 0.34 ± 0.6 two months after surgery. The absolute and qualified success rates were 50% and 96.55%, respectively, at the 5-year follow-up. Kaplan-Meier analysis showed a 5-year survival rate of 89.46% (95% CI: 82.82-96.12%). A comparison between POAG and PACG showed 5-year survival probabilities of 73.8% and 94.4%, respectively. Although the number of secondary glaucoma eyes was small, they were retained to represent real-world clinical diversity; results are interpreted with caution. Complications observed included transient hyphema (94.5%), vitreous hemorrhage (1.8%), peripheral Descemet's detachment (2.7%), and blood behind the intraocular lens (1.8%). All complications except hyphema took place during the early phase of the study (2014-2015), and none resulted in vision loss at the 3-month follow-up.

CONCLUSIONS

Both GATT and GATT+CS are safe and effective surgical treatments for different types of glaucoma. These findings provide long-term evidence on the efficacy and safety of illuminated microcatheter-assisted GATT in Indian eyes.