Three-year outcomes of gonioscopy-assisted transluminal trabeculotomy for juvenile-onset primary open-angle glaucoma: a retrospective study.

Objectives: This retrospective study evaluates the three-year efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with juvenile-onset primary open-angle glaucoma (JOAG).

Methods: A total of 26 patients (35 eyes) with juvenile-onset primary open-angle glaucoma (JOAG) were included in this single-center, retrospective study. Clinical records of patients who underwent gonioscopy-assisted transluminal trabeculotomy (GATT) were analyzed to assess intraocular pressure (IOP), the number of glaucoma medications, and complications, while anterior chamber angle changes were observed by gonioscopy. The follow-up period was up to 36 months.

Results: At the time of surgery, the median age of the cohort was 26 years (range: 4-35 years), with a mean visual field deviation (MD) of -17.03 ± 8.67 dB. The mean intraocular pressure (IOP) was reduced from 29.89 ± 9.43 mmHg preoperatively (on 2.7 ± 0.7 glaucoma medications) to 15.70 ± 4.39 mmHg at 12 months (on 0.4 ± 0.9 medications), 15.27 ± 3.24 mmHg at 24 months (on 0.3 ± 0.6 medications), and 17.33 ± 3.37 mmHg at 36 months (on 0.5 ± 0.7 medications). Gonioscopic examinations indicated that peripheral anterior synechiae (PAS) primarily formed within the first 1-3 months and were fully established by 6 months, after which the extent of peripheral anterior synechiae (PAS) remained relatively stable. Kaplan-Meier survival analysis revealed complete and qualified success rates of 73.7% and 82.6% at 12 months, 73.7% and 76.7% at 24 months, 60.3% and 69.1% at 30 months, and 51.7% and 69.1% at 36 months, respectively. The cumulative total success proportion were 90.6% at 12 months, 96.7% at 18 months, 92.3% at 24 months, 86.4% at 30 months and 73.3% at 36 months.

Conclusions: GATT is a safe and effective surgical option for JOAG, achieving sustained IOP reduction and favorable long-term success rates.