Goniotomy Viable Option for Glaucoma Patients with Previous Surgical Failure

Researchers conducted a comprehensive investigation on patients who underwent GT following one or multiple previous surgeries for glaucoma. The study aimed to assess the efficacy and safety of GT over 12 months, focusing on several critical outcome measures, including intraocular pressure (IOP) changes, visual acuity improvements, medication usage, and occurrence of adverse events.

• Their findings, based on 38 eyes of 34 patients, revealed encouraging results. A significant proportion of eyes achieved success post-GT: complete success was observed in 42.1% of the eyes, meeting the criteria of a postoperative IOP within 6–18 mmHg with a 20% reduction from baseline, without the need for ocular hypotensive medications.

• Additionally, 78.9% of the eyes attained qualified success, aligning with the criteria but allowing for postoperative medication use. Prior to the procedure, patients exhibited high baseline IOP levels, with a mean of 29.4±6.9 mmHg, which significantly decreased to 16.7±3.6 mmHg (a remarkable 43.2% reduction; P<0.001) by the 12-month mark post-surgery.

• The median number of glaucoma medications used also saw a substantial decrease, from a preoperative median of 3.0 to 2.0 at month 12 (P<0.001).

• While demonstrating promise, the study did note some associated complications post-GT, with common occurrences including hyphema (13.2%), IOP spike (7.9%), and corneal edema (5.2%). Notably, older age emerged as a contributing factor to surgical success.

This study's conclusions strongly support the efficacy and safety of GT as a viable intervention for individuals facing recurrent glaucoma despite prior unsuccessful surgeries. The findings hold promise for patients seeking alternatives in managing this challenging condition

The insights gained from this research could significantly impact clinical practice, offering a potential solution for those with a history of unsuccessful glaucoma surgeries. The study encourages further exploration and adoption of GT, providing renewed hope for better outcomes in managing this complex ophthalmologic condition.

Reference:

Lin, F., Nie, X., Shi, J., Song, Y., Lv, A., Li, X., Lu, P., Zhang, H., Jin, L., Tang, G., Fan, S., Weinreb, R. N., & Zhang, X. Safety and efficacy of goniotomy following failed surgery for glaucoma. Journal of Glaucoma,2023;32(11):942–947. https://doi.org/10.1097/ijg.0000000000002301