Younger children, those who do not receive anti-inflammatories at risk for GATT failure
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Younger patients, patients who do not receive anti-inflammatory medications postoperatively and those who undergo non-circumferential angle surgery are at a higher risk for failure after gonioscopy-assisted transluminal trabeculotomy.
“Risk of IOP spike is greater when no anti-inflammatory is used postoperatively compared to NSAIDs or steroids in children. Risk of failure is higher with non-circumferential angle surgery, use of postoperative steroids and younger age,” Ann V. Quan, MD, said at the virtual American Academy of Ophthalmology meeting.
Quan presented results of the first study to examine the postoperative course, including complications and medication regimen, and its relationship to failure after gonioscopy-assisted transluminal trabeculotomy (GATT) in the pediatric population. Researchers attempted to identify risk factors for postoperative IOP spikes and failure of GATT.
Quan said IOP spikes were defined as an increase in IOP at any postoperative visit at or before 3 months. Failure was defined as a necessary additional glaucoma surgery, IOP greater than 21 mm Hg or less than 5 mm Hg after postoperative month 3, or the absence of at least 20% reduction in IOP from baseline.
The retrospective chart review included 69 eyes of 57 patients, with primary congenital glaucoma being the most common diagnosis in the cohort at 29%. Mean IOP was 32 mm Hg with 2.5 medications preoperatively compared with mean IOP of 16.8 mm Hg with 1.3 medications postoperatively.
Quan said 33.3% of patients experienced a postoperative IOP spike and 56.5% of patients experienced failure.
Patients who did not use any anti-inflammatory medication postoperatively had a higher risk for postoperative IOP spikes compared with those who did use NSAIDs or corticosteroids. When comparing steroids and NSAIDs, there was a trend toward IOP spikes with steroids, but the relationship was not statistically significant.
Patients who experienced an IOP spike trended toward future failure, but the trend was not statistically significant. Additionally, patients who used postoperative steroids after GATT were more likely to fail compared with those who used topical NSAIDs. Patients who had less than 360° of angle treatment were also more likely to fail.
“Older patients are also less likely to fail. The average age for failure was 5.8 years. For every increase in age by 5 years, the risk of failure goes down by roughly 27% with a significant P value,” she said.
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Quan AV. Factors associated with complications and failure of gonioscopy-assisted transluminal trabeculotomy (GATT) in children. Presented at: American Academy of Ophthalmology annual meeting; Nov. 13-15, 2020 (virtual meeting).
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