The impact of trabeculotomy degree on surgical success in gonioscopy-assisted transluminal trabeculotomy surgery

ABSTRACT

PURPOSE: To evaluate the impact of varying degrees of trabeculotomy during gonioscopy-assisted transluminal trabeculotomy surgery on postoperative intraocular pressure reduction and surgical success.
METHODS: Patients who underwent gonioscopy-assisted transluminal trabeculotomy (at least 90°) for open-angle glaucoma and had a follow-up period of at least 12 months were included. Patients were grouped according to trabeculotomy degree (Group 1: 90°<θ≤180°; Group 2: 180°<θ<360°; Group 3: θ=360°). Ophthalmic examination findings, intraocular pressure measurements, number of antiglaucoma medications, and complications were recorded. Surgical success was defined as intraocular pressure <15 mmHg with at least a 20% reduction; surgical failure was defined as failure to meet this criterion or the need for additional surgery.
RESULTS: A total of 100 patients were included: 20 in Group 1, 24 in Group 2, and 56 in Group 3. Intraocular pressure levels differed significantly only in the first postoperative month (p=0.013). At 12 months, intraocular pressure levels, percentage reduction in intraocular pressure, and mean number of antiglaucoma medications did not differ significantly (p>0.05). No correlation was found between trabeculotomy degree and percentage intraocular pressure reduction (p=0.173). At 12 months, surgical success rates were similar (60.0%, 58.3%, and 64.3% for Groups 1, 2, and 3, respectively). Complication rates were also comparable among the groups.
CONCLUSION: The degree of trabeculotomy did not affect surgical success over a 12-month follow-up period. Although early intraocular pressure reduction may differ with 360° trabeculotomy, a complete 360° incision may not be necessary to achieve optimal pressure reduction.

Keywords: Gonioscopy; Trabeculotomy; Glaucoma, open-angle; segmental GATT antiglaucoma agents; Intraocular pressure

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