title: Gonioscopy-assisted transluminal trabeculotomy, ab interno trabeculotomy: technique report and preliminary results.
abstract: OBJECTIVE
  To introduce a minimally invasive, ab interno approach to a circumferential 360-degree trabeculotomy and to report the preliminary results.
  
  
  METHODS
  Retrospective, noncomparative cases series.
  
  
  METHODS
  Eighty-five eyes of 85 consecutive patients who sought treatment at Glaucoma Associates of Texas with uncontrolled open-angle glaucoma and underwent gonioscopy-assisted transluminal trabeculotomy (GATT) for whom there was at least 6 months of follow-up data.
  
  
  METHODS
  Retrospective chart review of patients who underwent GATT by 4 of the authors (D.S.G., D.G.G., O.S., R.L.F.) between October 2011 and October 2012. The surgery was performed in adults with various open-angle glaucomas.
  
  
  METHODS
  Intraocular pressure (IOP), glaucoma medications, visual acuity, and intraoperative as well as postoperative complications.
  
  
  RESULTS
  Eighty-five patients with an age range of 24 to 88 years underwent GATT with at least 6 months of follow-up. In 57 patients with primary open-angle glaucoma, the IOP decreased by 7.7 mmHg (standard deviation [SD], 6.2 mm Hg; 30.0% [SD, 22.7%]) with an average decrease in glaucoma medications of 0.9 (SD, 1.3) at 6 months. In this group, the IOP decreased by 11.1 mmHg (SD, 6.1 mmHg; 39.8% [SD, 16.0%]) with 1.1 fewer glaucoma medications at 12 months. In the secondary glaucoma group of 28 patients, IOP decreased by 17.2 mmHg (SD, 10.8 mmHg; 52.7% [SD, 15.8%]) with an average of 2.2 fewer glaucoma medications at 6 months. In this group, the IOP decreased by 19.9 mmHg (SD, 10.2 mmHg; 56.8% [SD, 17.4%]) with an average of 1.9 fewer medications (SD, 2.1) at 12 months. Treatment was considered to have failed in 9% (8/85) of patients because of the need for further glaucoma surgery. The cumulative proportion of failure at 1 year ranged from 0.1 to 0.32, depending on the group. Lens status or concurrent cataract surgery did not have a statistically significant effect on IOP in eyes that underwent GATT at either 6 or 12 months (P > 0.35). The most common complication was transient hyphema, seen in 30% of patients at the 1-week visit.
  
  
  CONCLUSIONS
  The preliminary results and safety profile for GATT, a minimally invasive circumferential trabeculotomy, are promising and at least equivalent to previously published results for ab externo trabeculotomy.
authors.affiliation: Glaucoma Associates of Texas, Dallas, Texas. Electronic address: dgrover@glaucomaassociates.com.
authors.forename: Davinder S
authors.initials: DS
authors.lastname: Grover
authors.affiliation: Glaucoma Associates of Texas, Dallas, Texas.
authors.forename: David G
authors.initials: DG
authors.lastname: Godfrey
authors.affiliation: Glaucoma Associates of Texas, Dallas, Texas.
authors.forename: Oluwatosin
authors.initials: O
authors.lastname: Smith
authors.affiliation: Bascom Palmer Eye Institute, University of Miami, Miami, Florida.
authors.forename: William J
authors.initials: WJ
authors.lastname: Feuer
authors.affiliation: Unidad Oftalmologica Montego c.a, Barquisimeto, Venezuela.
authors.forename: Ildamaris
authors.initials: I
authors.lastname: Montes de Oca
authors.affiliation: Glaucoma Associates of Texas, Dallas, Texas.
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Fellman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000175:diagnosis / Q000601:surgery*; D006068:Gonioscopy / Q000379:methods*; D006801:Humans; D007429:Intraocular Pressure; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011183:Postoperative Complications; D012189:Retrospective Studies; D014065:Tonometry, Ocular; D014129:Trabecular Meshwork / Q000473:pathology / Q000601:surgery*; D014130:Trabeculectomy / Q000379:methods*; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
chemical_list: D000959:Antihypertensive Agents