Bent Ab interno Needle Goniotomy versus Gonioscopy-Assisted Transluminal Trabeculotomy in Primary Open Angle Glaucoma: A Randomized Clinical Trial.

Prcis: Gonioscopy-Assisted Transluminal Trabeculotomy achieved a higher success rate than Bent Ab interno Needle Goniotomy in pseudophakic primary open angle glaucoma eyes at 12-months.

Purpose: To evaluate and compare efficacy and safety of standalone Bent Ab interno Needle Goniotomy (BANG) and Gonioscopy-Assisted Transluminal Trabeculotomy (GATT) in pseudophakic primary open angle glaucoma (POAG) eyes.

Methods: Parallel, double-arm, 1:1 ratio, single masked, single surgeon, randomized clinical trial. Uncontrolled mild to moderate pseudophakic POAG eyes, defined by visual field mean deviation, were enrolled. Antiglaucoma medication was washed-out before surgery and at 11-months. Patients were followed by 12 months. Surgical success was defined as 6≤IOP≤18 mm Hg and 20% IOP reduction from baseline with (qualified) or without (complete) the use of medication.

Results: Twenty-two eyes underwent BANG and 23 underwent GATT. At inclusion, mean IOPs were 21.18±2.87 mm Hg versus 19.87±2.34 mm Hg (P=0.1) under 2.41±0.9 versus 2.35±0.88 medications (P=0.71) in the BANG and GATT groups, respectively. Baseline washout IOPs were 25.55±4.9 mm Hg versus 25.43±4.98 mm Hg in the BANG and GATT groups, respectively (P=0.92). At POD330, IOPs in GATT and BANG groups were 15.62±3.29 mm Hg (-21.38%, P=0.04) and 16.95±2.82 mm Hg (-19.97%, P<0.01), respectively (P=0.16). At POD360, after washout, IOPs were 21.57±11.11 mm Hg (-15.17%, P=0.06) and 24.59±7.94 mm Hg (-3.75%, P=0.53) (P=0.31 between the groups). The mean number of medications used at POD330 was 1.1±1.55 in GATT (-53.19%, P<0.01) and 1.82±1.05 in BANG eyes (-24.48%, P=0.06) (P=0.08 between the groups). GATT eyes had higher complete (60.1% vs. 4.5%, P<0.01) and qualified success rates (64.7% vs. 22.7%, P=0.01) than BANG eyes. Transient hyphema was the most common complication following GATT (56.52%) and BANG (40.9%).

Conclusion: GATT eyes achieved higher success rates, lower mean IOPs and required less antiglaucoma medication than BANG eyes after 11-months.