Background: Gonioscopy-assisted transluminal trabeculotomy (GATT) is a minimally invasive, ab interno conjunctival-sparing glaucoma surgery aimed at the trabecular meshwork and the inner wall of Schlemm’s canal. The goal of this study is to report on the success of GATT in a large group of patients with a wide variety of open- and closed-angle glaucomas with or without cataract extraction and to report on risk factors for failure. Methods: A retrospective chart review of consecutive patients with primary or secondary open- or closed-angle glaucoma who underwent GATT, with or without concomitant phacoemulsification. Demographics, baseline clinical characteristics, and postoperative outcomes were collected from patients’ medical records. Primary outcomes were success rates (IOP of 18 mmHg or lower and one of the following: IOP reduction > 30% from baseline on the same or fewer medications or an IOP ≤ baseline with fewer medications as compared to baseline) and complication rates. Intraocular pressure (IOP) and the number of glaucoma medications were secondary outcome measures. Results: GATT was performed on 126 eyes of 121 patients. Mean follow-up was 583 ± 266 days. Cumulative success at 1Y was 0.88 for GATT combined with cataract extraction, 0.96 for GATT alone, 0.88 for primary open-angle glaucoma (POAG), 0.89 for secondary open-angle glaucoma (SOAG), and 0.76 for primary angle-closure glaucoma (PACG). IOP decreased from a mean of 20.65 mmHg to 14.1 mmHg, and medication decreased from a mean of 3.47 to 1.4 at the last follow-up. Forty-four eyes (34%) were classified as failures. Factors associated with an increased risk of failure were worse preoperative corrected visual acuity (OR = 2.46, p = 0.024) and a postoperative IOP spike (OR = 2.62, p = 0.028). Twelve eyes (9.5%) required further surgery for IOP control. Risk factors for requiring further surgery for IOP control were preoperative maximal IOP (OR = 1.066, p = 0.047) and a postoperative IOP spike (OR = 4.531, p = 0.036). Conclusions: GATT achieved good surgical success with good IOP and medication reduction across a wide range of glaucomas, in combination with lens extraction or as a standalone procedure. GATT should be considered early in the treatment paradigm of medically uncontrolled glaucoma.

Introduction: This retrospective chart review aims to report a combined surgical approach of intraocular lens (IOL) fixation and gonioscopy-assisted transluminal trabeculotomy (GATT) for the treatment of subluxated IOLs and glaucoma or ocular hypertension. Methods: Charts of patients who underwent IOL fixation combined with GATT between November 2019 and July 2023 were reviewed. The main outcome measure was surgical success, defined as a well-centered IOL and an IOP of 18 mmHg or lower and either a 30% IOP reduction or a reduction in medications as compared to baseline. Complications and the need for reoperation were recorded. Results: Eleven patients who underwent GATT with IOL fixation were included. The mean age was 80.45 years (range: 73–90). IOL subluxation was associated with pseudoexfoliation in all cases. Seven patients underwent scleral fixation, and four underwent iris fixation. The mean follow-up was 15.36 (range: 2.7–26.6) months. The success rate was 72.73%. The mean baseline IOP was 20.63 ± 6.56 mmHg on 2.81 ± 1.53 medications. Four patients were on oral carbonic-anhydrase inhibitor (CAI) before surgery. The mean IOP at the end of the follow-up was 13.86 ± 3.5 mmHg on 1.36 ± 1.57 medications, and none were on oral CAIs. No intraoperative complications occurred, and transient hyphema and vitreous hemorrhage were the most common postoperative complications. All patients had a well-centered IOL. No patients needed additional surgery for IOL position or IOP control. The mean corrected distance visual acuity was 0.634 ± 0.62 logMAR at baseline and 0.36 ± 0.38 at the end of follow-up. Conclusions: GATT can be combined with IOL fixation to the sclera or iris to effectively reduce IOP and medication usage.

Background/Objectives: this study aims to assess the safety of ciliary sulcus-placed hydrophilic acrylic intraocular lenses (IOLs). Methods: In this retrospective cohort study, consecutive patients who underwent phacoemulsification with implantation of IOLs into the ciliary sulcus without suture fixation between 2014 and 2016 at the Meir Medical Center were included. Clinical outcomes were compared between one-piece (1P) hydrophilic acrylic IOLs (Seelens AF, Hanita Lenses, Kibbutz Hanita, Israel) and three-piece hydrophobic acrylic IOLs with PMMA haptics (3P) (MA60AC, Alcon Laboratories, USA). Results: Thirty-eight eyes met the inclusion criteria and had ciliary sulcus IOLs implanted, twenty-three eyes with 1P hydrophilic (60.52%) and fifteen (39.47%) with 3P hydrophobic IOLs. Mean follow-up was 47.36 ± 7.25 months for the 1P group and 46.54 ± 9.82 months for the 3P group (p = 0.87). The mean peak IOP was higher in the 3P group (p = 0.038). No differences in the incidence of anterior uveitis or cystoid macula edema (CME) were detected between the groups (p > 0.05). None of the patients in our study developed uveitis, bleeding episodes, or required treatment for increased intraocular pressure, and no patient was diagnosed with uveitis-glaucoma-hyphema (UGH) syndrome. Post-operative corrected distance visual acuity (CDVA) was similar between the groups (p = 0.66). Conclusions: Hydrophilic IOLs can be safely placed in the ciliary sulcus and are non-inferior to the implantation of three-piece hydrophobic IOLs in the sulcus. In our cohort, with an average follow-up of approximately four years, no UGH was diagnosed, and none of the lenses were explanted.

Background Gonioscopy assisted transluminal trabeculotomy (GATT) is a minimally invasive, ab interno conjunctival sparing glaucoma surgery aimed at the trabecular meshwork and the inner wall of Schlemm’s canal. The goal of this study is to report on the success of GATT in a large group of patients with a wide variety of open and closed angle glaucomas with or without cataract extraction, and to search for risk factors for failure. Methods A retrospective chart review of consecutive patients with primary or secondary open or closed angle glaucoma who underwent GATT, with or without concomitant phacoemulsification. Demographics, baseline clinical characteristics and postoperative outcomes were collected from patients' medical records. Primary outcomes were success and complication rates. IOP and the number of glaucoma medications were secondary outcome measures. Results GATT was performed on 127 eyes of 121 patients. Mean follow up was 8.7 ± 4.6 months (Range 3–23 months). Cumulative success at 6 months was 0.85 for GATT combined with cataract extraction, 0.92 for GATT alone, 0.9 for both POAG and SOAG and 0.73 for PACG. IOP decreased from a mean of 20.65 mmHg to 13 mmHg and 13.7 mmHg at 12 and 18 months, respectively. Medication decreased from a mean of 3.47 to 1.47 and 1.44 at 12 and 18 months, respectively. Twenty-five eyes (19.5%) were classified as failures. Pre-operative factors associated with an increased risk of failure requiring further surgery for pressure control were: preoperative maximal IOP (p = 0.001, OR: 1.177), post-operative IOP spike (p = 0.012, OR: 16.25), and prior incisional glaucoma surgery (p = 0.002, OR: 0.016). Conclusion GATT achieved good surgical success with good IOP and medication reduction across a wide range of glaucomas, in combination with lens extraction or as a standalone procedure. Gatt should be considered early in the treatment paradigm of medically uncontrolled glaucoma.

Purpose – To report on a combined surgical approach of IOL fixation and GATT for the treatment of subluxated IOLs and glaucoma.Methods – In this retrospective cohort, Charts of patients who underwent IOL-fixation combined with GATT between November 2019 and October 2021 were reviewed. Main outcome measure was surgical success, defined as a well-centered IOL and an IOP of 18mmHg or lower and either a 30% IOP reduction or a reduction in medications as compared to baseline. Complications and need for reoperation were recorded.Results – 8 patients who underwent GATT with IOL-fixation were included. Mean age was 80.88 years (range 73-90). The pathomechanism of subluxation for all patients was pseudoexfoliation. 5 cases underwent scleral-fixation, and 3 underwent iris-fixation. Mean follow-up was 6.5 months. The success rate was 100%. Mean baseline IOP was 19.75±6.38 mmHg on 3.38±0.74 medications. 3 patients were on an oral carbonic-anhydrase inhibitor (CAI) prior to surgery. Mean IOP at the end of follow-up was 13.43±4.43 mmHg on 0.63±1.19 medications, and none were on oral CAIs. No intraoperative complications occurred, transient hyphema and vitreous hemorrhage were the most common postoperative complications. All patients had a well-centered IOL. No patients needed any additional surgery. Mean BCVA was 0.62±0.7 at baseline and 0.40±0.31 at the end of follow-up. One patient with advanced glaucoma did not recover her VA, while other patients’ BCVA was either retained or improved.Conclusions – GATT can be combined with IOL-fixation to effectively reduce IOP and medication usage.