Topical, non-steroidal anti-inflammatory drugs (NSAIDS) without corticosteroids may decrease the risk of gonioscopy-assisted transluminal trabeculotomy (GATT) failure in children, according to research published in the American Journal of Ophthalmology. Eyes experiencing intraocular pressure (IOP) spikes and eyes without hyphema also posed a higher risk for failure.
Investigators reviewed medical records of children who underwent GATT (74 eyes of 57 patients, mean age 7.1 years) between December 2014 and October 2020 at a single center. Procedures involved ab interno incision of the trabecular meshwork and cleavage of the meshwork with filament or a retractable filament device. Clinicians tended to prescribe NSAIDs 4 times daily for 3 weeks or corticosteroids 4 times daily for 1 week before tapering for 3 weeks.
The researchers noted that 36 eyes experienced failure (IOP >21 mm Hg or <5 mm Hg, absence of at least 20% IOP reduction, performance of additional IOP-lowering surgery, or loss of light perception vision) for a median follow-up duration of 28.5 months. A total of 25 eyes experienced IOP spikes, which more than doubled the risk of failure (HR 2.17; P =.0207). Postsurgical hyphema development was associated with an increased risk of IOP spike (HR, 4.13; P =.003), but not failure. The team also determined that IOP spike was lowest in eyes treated with NSAIDs (HR, 0.27; P =.001) while administration of topical corticosteroids significantly increased the risk of failure (HR, 5.72; P =.0005). Among eyes without hyphema, IOP spike was associated with failure (HR 7.04 P =.0002) and eyes with IOP spikes that had hyphema had a 5 times lower risk of failure.
“GATT is reasonably effective as a surgical treatment for glaucoma in children,” according to the researchers. The team reports “future studies are needed to characterize the mechanism of IOP spikes and failure in trabeculotomy, to compare the outcomes of various techniques of performing ab interno trabeculotomy, and prospectively to compare pediatric patients with similar diagnoses and ages to avoid confounding factors.”
Study limitations include a lack of randomization of surgical intervention options and failure to consider the variety of childhood glaucomas.
Quan AV, Chen J, Wang YE, et al. Factors associated with gonioscopy-assisted transluminal trabeculotomy (GATT) complications and failure in children. Am J Ophthalmol. Published online May 8, 2022. doi:10.1016/j.ajo.2022.04.023