Clinical significance of episcleral venous fluid wave in gonioscopy-assisted transluminal trabeculotomy

AIM:To evaluate the clinical significance of checking episcleral venous fluid wave(EVFW)during gonioscopyassisted transluminal trabeculotomy(GATT)in patients with open angle glaucoma(OAG).METHODS:This retrospective case series study comprised 30 patients(45 eyes)with OAG underwent GATT.The location and extent of EVFW were examined and graded after intraoperative compression flushing of the anterior chamber angle during the operation.Patients were followed up for 1y.A complete success for surgery is defined as a postoperative intraocular pressure(IOP)<18 mm Hg without any anti-glaucoma medication.IOP<18 mm Hg with less than two anti-glaucoma medications is defined as qualified success,while the control of IOP requiring three anti-glaucoma medications is considered as unsuccess.RESULTS:The mean IOP was 35.38±7.16 mm Hg before surgery and 15.52±4.22 mm Hg 1y after surgery(P<0.01).The average number of anti-glaucoma medication was 2.8±1.2(2-4)preoperation and 0.6±1.3(0-3)1y postoperation(P<0.01).The success rate of the operation was 93.33%.Complete success rate was 66.67%,qualified success rate was 26.67%,and 6.66%of unsuccessful cases required reoperation.EVFW of all cases was grade 2-4,and the percentages of grade 2,3 and 4 were 33.33%,40.0%and 26.67%,respectively.The distribution and percentage of EVFW were inferior(36%),nasal(28%),superior(20%),and temporal(16%).The EVFW grade of complete success patients was 3.4±0.6(3-4),and that of qualified success patients was 2.6±1.0(2-4).The larger the range of EVFW,the lower the IOP,and the better the IOP reduction effect.CONCLUSION:During GATT surgery,pressurized irrigation of anterior chamber to check EVFW can reduce the outflow resistance of aqueous humor and increase the effect of postoperative IOP.The range of EVFW is negatively correlated with postoperative IOP.Therefore,EVFW may be a valuable prognostic indicator for the success of GATT surgery.

Systematic review and Meta-analysis of treating open angle glaucoma with gonioscopy-assisted transluminal trabeculotomy

●AIM:To systematically review and Meta-analyze studies of managing open angle glaucoma(OAG)with gonioscopyassisted transluminal trabeculotomy(GATT)and to evaluate its effectiveness and safety.●METHODS:Eligible studies were retrieved and screened from five main electronic databases.Mean difference(MD)was hired to show the pooled effectiveness of intraocular pressure(IOP)and medication decrease achieved by GATT.In addition,combined surgical success and reoperation rates were calculated,and complications were also summarized.●RESULTS:Ten studies were included for systematic review,but one study was not pooled for Meta-analysis due to the repeated data.The combined IOP decrease after GATT was 9.81 mm Hg(95%CI:7.98-11.63 mm Hg)which showed significant reduction from the baselines(Z=10.52,P<0.0001).Similarly,the number of medications after GATT also decreased distinctly compared with that of medication before the surgery(Z=9.09,P<0.0001),and the pooled medication decrease was 1.68(95%CI:1.31-2.04).In addition,the combined surgical success rate was 85%,while the pooled reoperation rate was 20%.Sightthreatening complications occurred scarcely,whereas the pooled occurrence rate of hyphemia was as high as 36.0%.●CONCLUSION:GATT could effectively lower IOP and decrease medications for patients with OAG.Moreover,the procedure appears to be a safe and promising treatment for OAG due to its minimally-invasive and conjunctiva-sparing nature.