Intraocular pressure spikes after trabecular meshwork strip peeling during hemi-GATT

Abstract

Purpose: To evaluate the effect of trabecular meshwork strip peeling (TP) during hemi-gonioscopy-assisted transluminal trabeculotomy (hemi-GATT) on the frequency of early postoperative intraocular pressure (IOP) spikes and surgical success. Methods: This retrospective study included 42 eyes of patients with primary open-angle or pseudoexfoliative glaucoma who underwent hemi-GATT with TP (n = 14) or standard hemi-GATT without TP (n = 28) at a tertiary glaucoma center. Hemi-GATT was intentionally selected as a planned primary surgical strategy and was not performed as a secondary procedure following failed circumferential GATT. An IOP spike was defined as postoperative IOP > 30 mm Hg or an increase of ≥ 10 mm Hg from the previous visit. Surgical success was defined as qualified (IOP ≤ 21 mm Hg and ≥ 30% reduction from baseline with or without medication) or complete (without medication). The primary outcome was the incidence and predictors of early IOP spikes; secondary outcomes included surgical success rates and related risk factors. Results: An IOP spike occurred in 11/42 eyes (26.2%) at 7.1 ± 4.8 days postoperatively, lasting 6.7 ± 5.1 days; mean peak IOP during spikes was 26.2 ± 5.0 mm Hg. All patients with an IOP spike experienced a decrease in IOP to ≤ 21 mm Hg within the first postoperative month. Spike frequency was lower with hemi-GATT + TP than with standard hemi-GATT (1/14 [7.1%] vs. 10/28 [35.7%]; p = 0.048). On multivariable analysis, higher baseline IOP increased spike risk (odds ratio [OR], 1.48; 95% CI, 1.08–2.01; P = 0.013), whereas TP reduced it (OR, 0.01; 95% CI, 0.01–0.38; P = 0.014). The mean follow-up period was 7.71 ± 2.03 months (range: 6–13 months). Qualified and complete success did not differ (92.9% vs. 89.3%, P = 0.769; 42.9% vs. 35.7%, p = 0.714). Conclusion: TP during hemi-GATT significantly decreases early postoperative IOP spikes and enhances early IOP control, while maintaining surgical success.