Efficacy And Safety Of Gonioscopy-assisted Transluminal Trabeculotomy For Open-angle Glaucoma

ObjectivesBy comparing the intraocular pressure(IOP)lowering effect and surgical complications of gonioscopy-assisted transluminal trabeculotomy(GATT)and trabeculectomy(TRAB)in the treatment of open-angle glaucoma(OAG)patients,to evaluate the efficacy and safety of GATT in the treatment of OAG,so as to provide a new choice for the surgical treatment of OAG.MethodsIn this retrospective study,from November 2018 to January 2022,60 OAG patients(60 eyes)who were admitted to the Department of Ophthalmology of Qilu Hospital of Shandong University were retrospectively observed and analyzed.The observation group(GATT group)included 30 OAG patients(30 eyes)who received GATT treatment.The control group(TRAB group)included 30 OAG patients(30 eyes)who received TRAB treatment.Both GATT and TRAB were performed by a clinically experienced ophthalmologist.Operation time and the incision range of trabecular meshwork in the observation group were recorded.IOP,the use of IOP-lowering drugs and postoperative complications were recorded before surgery and at 1 day,1 week,1 month,2 months,3 months,6 months and 12 months after surgery.Visual field and optical coherence tomography were re-examined and visual field mean deviation(MD)and retinal nerve fiber layer(RNFL)thickness were recorded at 12 months after surgery.Statistical analysis was carried on.Results1.IOP:There was no statistically significant difference in preoperative IOP between the two groups(P>0.05).The IOP in the TRAB group was significantly higher than that in the GATT group on the first day after surgery(P<0.01),and there were no statistically significant differences in postoperative IOP between the two groups at other follow-up times(P>0.05).At 12 months after surgery,the IOP was significantly lower than that before surgery in both groups(P<0.001),and there was no statistically significant difference in the range of IOP reduction between the two groups(P>0.05).2.The use of IOP-lowering drugs:At 12 months after surgery,the use of IOP-lowering drugs was significantly reduced than that before surgery in both groups(P<0.001).3.The value of visual field MD:There was no statistically significant difference in the value of visual field MD between the two groups before and after surgery(P>0.05).Compared with the preoperative results,there were no statistically significant differences in the value of visual field MD at 12 months after surgery in both groups(P>0.05).4.RNFL thickness:There was no statistically significant difference in the RNFL thickness between the two groups before and after surgery(P>0.05).Compared with the preoperative results,the RNFL thickness was significantly decreased at 12 months after surgery in both groups(P<0.01).5.Operation time and the incision range of trabecular meshwork:There was no statistically significant difference in operation time between the two groups(P>0.05).The history of antiglaucoma surgery had no significant effect on the operation time and the incision range of trabecular meshwork in the GATT group(P>0.05).6.Surgical success rate and surgical complications:There were no statistically significant differences in the complete and conditional surgical success rate between the two groups at 12 months after surgery(P>0.05).There was no statistically significant difference in the incidence of surgical complications between the two groups at 12 months after surgery(P>0.05).However,the types of surgical complications were different between the two groups.The main surgical complications were hyphema in the GATT group and bled-related complications in the TRAB group.ConclusionsThe clinical efficacy of GATT and TRAB in the treatment of OAG patients is similar,they can both effectively reduce the IOP,reduce the use of IOP-lowering drugs and delay the damage of visual field.The surgical success rates of the two surgery were similar at the last follow-up.Compared to TRAB,GATT is more minimally invasive,it does not destroy the conjunctiva and requires no maintenance of the bleb,therefore,it is a safe and effective new treatment option for OAG.