Real-world outcomes and predictors of failure of gonioscopy-assisted transluminal trabeculotomy in a large glaucoma cohort: a multicenter study

This retrospective, comparative, multicenter study aimed to evaluate the real-world outcomes and predictors of failure of Gonioscopy-assisted transluminal trabeculotomy (GATT) at 12 months in glaucoma patients. Predictors of failure of absolute success in bilateral cases (422 eyes of 308 patients) included pre-operative intraocular pressure (IOP; IRR = 1.02; p = 0.01), and pre-operative mean deviation (IRR = 0.98; p = 0.007). The significant predictors of failure of relative success included binocularity (IRR = 4.05; p = 0.001) and pre-operative IOP (IRR = 1.04; p = 0.022). Only one eye per patient (308 eyes) was included in the second analysis. IOP reduced from 21.84 ± 7.96 mmHg to 11.97 ± 2.89 mmHg at 12 months; the number of hypotensive eye drop medications decreased from 3.07 ± 1.04 to 1.06 ± 1.08 (p < 0.001 for both). The pre-operative IOP was a predictive factor for failure of absolute (IRR = 1.02; p = 0.026) and relative successes (IRR = 1.05; p = 0.014). The preoperative number of hypotensive medications only affected absolute success (IRR = 1.25; p = 0.004). The Kaplan-Meier graph revealed relative and absolute success in 88.9% and 43.9% of cases, respectively. In conclusion, GATT is a safe and effective treatment option for diverse forms of open-angle glaucoma with varying severity. Pre-operative number of medications and IOP, race, and the outcomes of the contralateral eye (if applicable) were identified as predictors of failure of the procedure.