Gonioscopy-assisted transluminal trabeculotomy (GATT) is a new way to treat glaucoma. It’s good for kids and young adults with certain types of glaucoma. This surgery is less invasive than older methods.
Gonioscopy-assisted transluminal trabeculotomy helps by improving how fluid drains from the eye. It makes a small cut to reach the trabecular meshwork. This helps lower eye pressure.
Trabeculotomy has been around for decades, getting better over time. GATT is a newer, gentler way to do it. It’s faster, causes less damage, and keeps the eye ready for future surgeries.
Key Takeaways
- Gonioscopy-assisted transluminal trabeculotomy (GATT) is a favourable surgical technique for treating primary congenital glaucoma and juvenile open-angle glaucoma.
- GATT is a minimally invasive procedure that enhances aqueous humour drainage and reduces intraocular pressure.
- GATT offers advantages over traditional trabeculotomy techniques, including shorter procedure time, less tissue disruption, and preservation of the conjunctiva.
- GATT has demonstrated promising surgical outcomes, with significant reductions in intraocular pressure and medication dependency.
- GATT is being explored for various glaucoma types, including open-angle, juvenile, and steroid-induced glaucoma, with positive results.
Introduction to Gonioscopy-assisted Transluminal Trabeculotomy
Definition and Overview
GATT, or Gonioscopy-assisted Transluminal Trabeculotomy, is a new surgical method. It allows for a full 360-degree trabeculotomy. This is different from older methods that needed a big flap.
History of Trabeculotomy Procedures
Older trabeculotomy methods had problems. They took longer, caused more damage, and didn’t open the meshwork fully. But GATT is different. It uses two small incisions in the cornea.
This makes it less invasive and opens the drainage system better. GATT was made to improve on these old methods. It works from inside the eye, not outside. This cuts down on time, damage, and opens the meshwork more fully.
“GATT is an ab interno technique that enables a complete 360-degree circumferential trabeculotomy. It was developed as an alternative to earlier trabeculotomy procedures, which were ab externo and required creating a large conjunctival and scleral flap.”
Benefits of Gonioscopy-assisted Transluminal Trabeculotomy
Gonioscopy-assisted Transluminal Trabeculotomy (GATT) is a new way to treat glaucoma. It’s less invasive than old methods and has shown great results. It helps lower eye pressure and cut down on medication for many glaucoma patients.
Advantages over Traditional Trabeculotomy Techniques
GATT can reach the whole trabecular meshwork, something old methods can’t do. This full access helps lower eye pressure better.
- GATT has been shown to significantly lower eye pressure compared to before surgery (p
- It’s as effective as traditional trabeculectomy in controlling eye pressure, but with fewer side effects.
- GATT is also good for different types of glaucoma, not just the usual ones.
Also, GATT has fewer side effects than other surgeries. A study found only one major side effect: bleeding in the eye. This bleeding went away on its own in half the cases within 4 weeks.
| Procedure | Success Rate in IOP Control | Complication Risks |
|---|---|---|
| Trabeculectomy | ~70% | Hypotony, aqueous leakage, infections, choroidal detachment, induced astigmatism |
| Gonioscopy-assisted Transluminal Trabeculotomy (GATT) | Satisfactory success rates | Hyphema (50% resolved spontaneously within 4 weeks) |
Using a special suture technique in GATT also makes it cheaper. This makes it easier for more people to get the treatment they need.
In summary, GATT is better than old glaucoma treatments in many ways. It lowers eye pressure, needs less medication, and has fewer side effects. It’s a promising, cost-effective option for treating glaucoma.
Gonioscopy-assisted Transluminal Trabeculotomy Procedure
The Gonioscopy-assisted Transluminal Trabeculotomy (GATT) procedure is a new way to treat open-angle glaucoma. It aims to fix the eye’s drainage system and lower eye pressure. This is done without the need for surgeries that create blebs.
To do the GATT procedure, a special lens is used to see the angle of the eye. A small cut is made in the nasal angle. Then, a 5-0 prolene suture is used to go around Schlemm’s canal 360 degrees.
The suture is pulled into the front chamber of the eye. This opens the trabecular meshwork. This helps the eye drain fluid properly again.
After the procedure, the eye is made watertight. The eye is then treated with drops to prevent infection and inflammation. Patients are watched closely after surgery. They have follow-up visits to check how the surgery is working and adjust their medication if needed.
- The GATT procedure takes about 45 minutes, longer if done with cataract surgery.
- Patients might see their eye pressure drop. This could mean they need less or no glaucoma medication.
- The success of GATT is shown by how much eye pressure drops and how many glaucoma medications are needed.
“Gonioscopy-assisted Transluminal Trabeculotomy provides an alternative to bleb-forming glaucoma surgeries, offering a minimally invasive approach to lower intraocular pressure and restore the eye’s natural drainage system.”
The GATT procedure is a hopeful option for those with open-angle glaucoma. It’s especially good for those who have tried other treatments or want to use less medication.
Efficacy of Gonioscopy-assisted Transluminal Trabeculotomy
Recent studies show that Gonioscopy-assisted Transluminal Trabeculotomy (GATT) is very effective. It lowers intraocular pressure (IOP) and reduces the need for glaucoma medications. GATT is seen as a better option than traditional methods.
Intraocular Pressure Reduction
In one study, IOP dropped from 27.4 ± 8.8 mmHg before surgery to 15.3 ± 2.7 mmHg at 24 months after GATT. The number of glaucoma medications also fell, from 3.6 ± 0.7 to 0.5 ± 0.9. This shows GATT’s power to lower IOP and cut down on medication use.
Another study found that 82.1% of eyes had IOP of 18 mmHg or less at 24 months. This is up from 15.9% before surgery. Success rates for IOP ≤ 21 mmHg with ≥20% reduction were 60.9% and 84.1%, respectively. These numbers show GATT’s lasting effect on IOP.
Medication Dependency Reduction
GATT also greatly reduces the need for glaucoma medications. The number of medications needed fell from 3.6 ± 0.7 before surgery to 0.5 ± 0.9 at 24 months after GATT. Moreover, 66.7% of patients were medication-free 24 months post-GATT.
These results show GATT’s big benefits in lowering IOP and reducing medication use. It’s a great choice for those looking for effective glaucoma treatment.
Gonioscopy-assisted Transluminal Trabeculotomy for Open-Angle Glaucoma
GATT is a good treatment for open-angle glaucoma. This includes both primary open-angle glaucoma (POAG) and juvenile open-angle glaucoma. Studies show it lowers intraocular pressure (IOP) and reduces medication use.
The 360-degree opening of the trabecular meshwork and Schlemm’s canal by GATT helps a lot. It improves how fluid moves out of the eye in open-angle glaucoma cases.
In a study, 71 out of 77 patients (92.2%) finished the 12-month follow-up. The mean IOP was 19.0±5.2 mm Hg in the ABiC group and 16.0±3.1 mm Hg in the GATT group at 12 months. Also, 57.2% of ABiC patients and 77.8% of GATT patients were medication free at 12 months.
| Parameter | ABiC Group | GATT Group |
|---|---|---|
| Mean IOP at 12 months (mm Hg) | 19.0±5.2 | 16.0±3.1 |
| Medication-free at 12 months (%) | 57.2% | 77.8% |
| Mean glaucoma medications at 12 months | 0.9±1.3 | 0.6±1.2 |
| 12-month cumulative surgical success rate | 56% | 75% |
| Additional glaucoma surgery required | 3 eyes | 1 eye |
| Hyphema | 47% | 87% |
| Supraciliary effusion | 71% | 92% |
The 360-degree opening of the trabecular meshwork and Schlemm’s facilitated by GATT is very helpful. It improves how fluid moves out of the eye in open-angle glaucoma cases. Studies show good results in lowering IOP and reducing medication use.
“GATT has been shown to be an effective treatment for open-angle glaucoma, including both primary open-angle glaucoma (POAG) and juvenile open-angle glaucoma.”
Gonioscopy-assisted Transluminal Trabeculotomy for Failed Prior Glaucoma Surgery
Gonioscopy-assisted Transluminal Trabeculotomy (GATT) is effective for treating open-angle glaucoma. It works for patients who have had failed surgery, like trabeculectomy or glaucoma drainage device implantation. A study showed that in 44 eyes, GATT lowered IOP from 27.4 ± 8.8 mmHg to 15.3 ± 2.7 mmHg at 24 months.
The success rates were high, with 60.9% complete success and 84.1% qualified success. This makes GATT a good choice for managing open-angle glaucoma in eyes that didn’t respond to previous surgeries.
Outcomes in Refractory Cases
A study on GATT involved 30 eyes of 30 patients, with a mean age of 51.8±16.1 years. Twenty-one eyes had GATT, and 9 had phaco-GATT. Most eyes (27) had failed trabeculectomy, and 3 had failed glaucoma drainage device implantation.
After GATT, the mean IOP dropped from 27.1±7 to 16.9±6 mm Hg. At 1 year post-surgery, 20% of eyes had complete success for IOP criteria of both 21 and 16 mm Hg. The qualified success rate was 82% for IOP ≤21 mm Hg and 57% for IOP ≤16 mm Hg. Older age was the only risk factor for failure, with a hazard ratio (HR) of 1.03.
Complications included hyphema in 14 eyes (46%), with most resolving within 1 week. All complications were resolved by 2 weeks. No patients needed further glaucoma procedures, and no serious complications were reported.
| Parameter | Value |
|---|---|
| Mean IOP reduction | From 27.1±7 to 16.9±6 mm Hg |
| Complete success probability at 1 year | 20% for IOP ≤21 and ≤16 mm Hg |
| Qualified success probability at 1 year | 82% for IOP ≤21 mm Hg, 57% for IOP ≤16 mm Hg |
| Risk factor for failure | Older age (HR 1.03) |
| Complications | Hyphema in 46% of eyes, resolved within 2 weeks |
GATT is a valuable surgical option for managing open-angle glaucoma. It offers significant IOP reduction and is safe, even in refractory cases.
Safety Profile of Gonioscopy-assisted Transluminal Trabeculotomy
Gonioscopy-assisted Transluminal Trabeculotomy (GATT) has shown good safety in many studies. No serious eye problems have been found with this treatment. Some minor issues like temporary bleeding in the eye or slight pressure spikes can happen but are usually easy to handle.
GATT is a gentle procedure that uses small cuts in the cornea. This makes it safer than bigger surgeries for glaucoma. The data shows GATT is generally safe and has few side effects.
| Outcome Measure | GATT Group | KDB Group |
|---|---|---|
| Mean Preoperative IOP (mmHg) | 30.48 ± 12.9 | 26.08 ± 13.1 |
| Mean IOP at 3 Months (mmHg) | 15.48 ± 5.93 | 20.0 ± 10.8 |
| IOP Lowering Percentage from Baseline | 44.4% | 14.1% |
| Mean Medication Reduction at 3 Months | 2.6 ± 1.7 | 0.8 ± 1.2 |
| Proportion of Partial and Complete Success at 6 Months | 65.6% and 44.7% | 30.8% and 15.4% |
| Additional Procedures Required | 13.9% | 61.5% |
GATT is a safe and effective treatment for glaucoma. It has a low risk of problems and is safer than other surgeries. Patients who have had other treatments or have high eye pressure after surgery might not do as well. But, those who get a complete trabeculotomy have a better chance of success.
“The minimally invasive nature of GATT, involving only small corneal incisions, helps to minimise the risk of complications compared to more extensive glaucoma surgeries.”
Gonioscopy-assisted Transluminal Trabeculotomy for Specific Glaucoma Types
Gonioscopy-assisted transluminal trabeculotomy (GATT) is not just for primary open-angle glaucoma. It also works well for other glaucoma types. This makes it a valuable tool for doctors and patients.
Juvenile Open-Angle Glaucoma
GATT is a top choice for treating juvenile open-angle glaucoma. It has shown success rates close to 90% in some cases. This is because it can fully open the trabecular meshwork, which helps young patients a lot.
The good results with GATT in young patients show its wide use. It’s a minimally invasive surgery that works well.
Pseudoexfoliative Glaucoma
GATT also helps with pseudoexfoliative glaucoma, a secondary open-angle glaucoma type. It lowers IOP and cuts down on medication use. This is a big win for patients with this tough-to-manage condition.
| Parameter | Pre-operative | 1 Month | 2 Months | 6 Months | 12 Months | 24 Months | 36 Months |
|---|---|---|---|---|---|---|---|
| Average Estimated IOP (mmHg) | 24.94 | 15.33 | 14.07 | 14.49 | 14.04 | 13.1 | 13.27 |
The table shows how GATT lowers IOP for different glaucoma types. It proves GATT is a reliable, minimally invasive surgery.
“GATT has shown it can handle both juvenile open-angle glaucoma and pseudoexfoliative glaucoma. It’s a great tool for doctors to fight these tough diseases.”
As more research comes out, GATT looks like a solid choice for many glaucoma types. It can really help patients and improve their lives.
Gonioscopy-assisted Transluminal Trabeculotomy as a Minimally Invasive Glaucoma Surgery
Gonioscopy-assisted Transluminal Trabeculotomy (GATT) is a less invasive surgery for glaucoma. It has smaller incisions and doesn’t need to cut the conjunctiva. This makes it a minimally invasive glaucoma surgery (MIGS).
GATT aims to lower eye pressure and reduce the need for eye drops. It’s safe and appealing for those with early glaucoma or who don’t want big surgeries. The procedure uses a tiny catheter to open the trabecular meshwork. This improves the flow of fluid out of the eye.
Research shows GATT can lower eye pressure and reduce eye drop use in open-angle glaucoma. For example, one study found a success rate of 86.21% at 24 months. Eye pressure went from 26.40 ± 6.37 mmHg before surgery to 16.08 ± 2.38 mmHg at 24 months.
GATT also works well in cases where other surgeries have failed. Its minimally invasive nature and good safety record make it a good choice for many patients.
In summary, GATT is a valuable MIGS option for many glaucoma patients. It effectively lowers eye pressure and reduces medication use. Its safety and less invasive nature make it a preferred choice for those with early glaucoma or who prefer less invasive treatments.
Cost-Effectiveness of Gonioscopy-assisted Transluminal Trabeculotomy
Gonioscopy-assisted transluminal trabeculotomy (GATT) is not just safe and effective. It’s also a cost-effective treatment for open-angle glaucoma. Studies have looked at the costs of GATT compared to other surgeries and treatments.
These studies considered things like surgical fees, device costs, and long-term medication use. The results show GATT is a good choice because it can reduce medication and surgery needs. This makes it a great option for both healthcare systems and patients.
| Surgical Procedure | Cumulative Costs (US$) | Quality-Adjusted Life-Years (QALYs) Gained |
|---|---|---|
| Trabeculectomy | $6,045 – $13,598 | 3.33 – 6.05 |
| Ahmed Glaucoma Valve Implantation | $6,045 – $13,598 | 3.33 – 6.05 |
| Gonioscopy-assisted Transluminal Trabeculotomy | $6,045 – $13,598 | 3.33 – 6.05 |
| Ab Interno Canaloplasty | $6,045 – $13,598 | 3.33 – 6.05 |
| Maximal Medical Treatment | $3,117 – $6,458 | 3.14 – 5.66 |
The table shows how different treatments compare in cost-effectiveness. GATT and other surgeries are more cost-effective than just using medicine. They meet the cost-effectiveness standards in both rural and urban areas.
Trabeculectomy is the cheapest option over 5 years. But, GATT and ab interno canaloplasty are cheaper over 10 years in rural areas. This means GATT is a very cost-effective choice, especially for long-term benefits.
“The most cost-efficient MIGS procedure was Trabectome ($498 per 1 mmHg or 40,628 per 1 mmHg) followed by Gonioscopy-assisted Transluminal Trabeculotomy ($719 per 1 mmHg or 58,651 per 1 mmHg).”
In summary, GATT is a cost-effective treatment for open-angle glaucoma. It offers benefits like less medication and fewer surgeries. As more research is done, the financial benefits of GATT will likely become even clearer.
Conclusion
Gonioscopy-assisted Transluminal Trabeculotomy (GATT) is a new way to treat open-angle glaucoma. It’s safe and works well by improving how the eye drains fluid. This helps lower eye pressure and cuts down on the need for eye drops.
The GATT method is less invasive than older techniques. It’s quicker and doesn’t harm the conjunctiva as much. This makes it a better option for many patients.
GATT also works well for certain types of glaucoma and for those who have had surgery before. It’s safe and affordable, making it a good choice for many. This method is a valuable tool for doctors treating glaucoma.
More research is needed to fully understand GATT’s benefits. But, it’s already making a big difference in how glaucoma is managed. It’s set to become a key part of treating this condition.
FAQ
What is Gonioscopy-assisted Transluminal Trabeculotomy (GATT)?
GATT is a new way to treat open-angle glaucoma. It’s a small surgery that opens up the eye’s drainage system. This helps lower eye pressure.
How does GATT differ from traditional trabeculotomy techniques?
GATT is less invasive than old methods. It’s quicker and causes less damage. It also keeps the eye’s outer layer ready for future surgeries.
What are the key benefits of GATT?
GATT offers several advantages. It lowers eye pressure and reduces the need for eye drops. It’s also faster and less damaging. Plus, it keeps the eye ready for future surgeries.
How is the GATT procedure performed?
The surgery uses a special lens to see inside the eye. A small cut is made to reach the drainage system. A suture is then used to open it up fully. The eye is then closed with a special solution to prevent leaks.
How effective is GATT in lowering intraocular pressure and reducing medication dependence?
Studies show GATT works well. It lowers eye pressure and cuts down on medication use. In one study, eye pressure dropped from 27.4 to 15.3 mmHg, and medication use fell from 3.6 to 0.5 pills.
Can GATT be used to treat specific types of glaucoma?
Yes, GATT is effective for different types of glaucoma. It works well for juvenile glaucoma and pseudoexfoliative glaucoma. Success rates are high in these cases.
Is GATT considered a cost-effective treatment option?
Yes, GATT is cost-effective. It’s as safe and effective as other treatments but cheaper. Studies show it’s a good value compared to other options.
