Outcomes of suture-assisted gonioscopy-assisted transluminal trabeculotomy in a cohort of South African patients with primary open-angle glaucoma

Abstract

Background Gonioscopy-assisted transluminal trabeculotomy (GATT) is a minimally invasive glaucoma surgery that enhances trabecular outflow by circumferentially incising Schlemm’s canal. Internationally, studies have reported favourable outcomes, but evidence from South African patients remains limited. This study evaluated the effectiveness and safety of GATT in South African patients with primary open-angle glaucoma (POAG). Methods A retrospective cohort study was conducted at Eerste River Hospital. Patients with POAG who underwent GATT between August 2020 and November 2022 were followed for 24 months. They were divided into two groups: combined phacoemulsification and GATT (Group I) and standalone GATT (Group II). Demographic characteristics, intraocular pressure (IOP), glaucoma medication use, and postoperative complications were collected. Results Fifty-two patients (n = 52) were included. Mean preoperative IOP for the entire cohort was 23.4 ± 6.4 mmHg and decreased significantly to 13.8 ± 4.2 mmHg at 24 months (p = 0.006). Mean glaucoma medication use also decreased, from 3.5 ± 0.6 preoperatively to 2.5 ± 1.1 at 24 months (p < 0.001). The cumulative success rate at 24 months was 94.23%. Complications were mostly transient, with hyphema being the most frequent. No serious adverse events were reported. Conclusion Gonioscopy-assisted transluminal trabeculotomy, performed alone or combined with phacoemulsification, was an effective and safe option for lowering IOP in South African patients with POAG. The sustained IOP reduction, decreased medication burden and favourable safety profile support its use, particularly in resource-limited settings. Contribution This study provides region-specific evidence on the outcomes and safety of GATT in a South African POAG cohort.