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GATT lowers IOP in steroid-induced glaucoma patients
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Gonioscopy-assisted transluminal trabeculotomy effectively decreases IOP and medication burden in patients with steroid-induced glaucoma, a recent study suggests.
“GATT is thought to lower IOP by fracturing the trabecular meshwork, making it a reasonable surgical option for SIG,” the authors wrote. “Given the safety and efcacy, GATT is considered as an early surgical treatment of this subset of patients.”
Researchers conducted a retrospective chart review of 13 patients who underwent the Gonioscopy-assisted transluminal trabeculotomy (GATT) procedure and were diagnosed with steroid-induced glaucoma (SIG) between March 1, 2015, and March 30, 2018, at the University of Michigan’s W.K. Kellogg Eye Center. Patients were included if they were on steroids at the time of surgery, were currently on steroids, had at least 3 months of postoperative follow-up and were at least 18 years of age at the time of analysis. Individuals with narrow or angle-closure glaucoma or mixed mechanism glaucoma where the predominant mechanism was not steroid-induced were excluded. Number of IOP-lowering medications, IOP and topical steroid dosing during follow-up were the primary outcomes.
An average IOP decrease of 16.4 mm Hg (55%) to 19.5 mm Hg (63%) was observed between 3 and 24 months, with all patients experiencing an IOP reduction of greater than 20% at 24 months. Medication prescription also decreased after GATT, with a drop in mean medications from 3.1 to 0.8 at final follow-up. More than 67% of patients required continued steroid use at all postoperative visits, with transient hyphema the most common postoperative complication at 38%. None of the participants required anterior chamber washout or repeat glaucoma surgery.
“As a small retrospective review, the follow-up timing is inconsistent and limited to 24 months,” the researchers wrote. “Moving forward, it would be interesting to perform a randomized control trial of GATT versus other incisional glaucoma procedures with longer-term follow-up data.” – by Eamon Dreisbach
Disclosures : The authors report no relevant financial disclosures.
Perspective
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Lisa M. Young, OD, FAAO
GATT, Omni (Sight Sciences), iStent (Glaukos), Xen (Allergan), Kahook (New World Medical), Trabectome (NeoMedix). If any of these sound familiar, it’s because they are part of the ever-growing MIGS movement. These minimally invasive procedures are all striving to lower IOP through a less invasive approach, allowing for a faster recovery, minimal impact on refractive error and preservation of the conjunctival tissue should incisional surgery be warranted down the road.
GATT can be done in conjunction with cataract surgery or as a standalone procedure. It is performed through a clear corneal incision with a suture or microcatheter to cleave the trabecular meshwork, thereby increasing aqueous drainage through the conventional outflow pathway.
GATT is being used primarily to lower IOP in patients with primary open angle glaucoma, but Boese and colleagues have potentially found a new subset that could benefit: Patients with steroid-induced glaucoma. A small, retrospective review of this procedure demonstrated an average IOP decrease of 55% and a significant decrease in topical therapy (from three to one medications) for these patients.
These new surgical options have changed the way we manage glaucoma, and I’m eagerly awaiting prospective, long-term data to support their clinical indications.
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