Gonioscopy-assisted transluminal trabeculotomy for intractable ocular hypertension after repeated intravitreal dexamethasone implant injections.

PURPOSE

To evaluate the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) in managing intractable ocular hypertension (OHT) following repeated intravitreal dexamethasone implant (DI) injections.

METHODS

This retrospective study included patients with steroid-induced OHT unresponsive to maximum tolerated medical therapy who underwent GATT. Primary outcome measures were intraocular pressure (IOP) reduction and surgical success (qualified and complete), number of DI injections.

RESULTS

Fourteen eyes of 14 patients (mean age: 66.2 ± 8.3 years) with steroid-induced OHT following repeated DI injections were analyzed. The mean number of DI injections before surgery was 4.2 ± 1.1 over a median period of 18.4 months (range: 12-36 months). The mean preoperative IOP was 33.6 ± 4.1 mmHg, which significantly decreased to 13.5 ± 2.9 mmHg at the first postoperative month (59.8% reduction, p < 0.001) and remained stable at 14.2 ± 3.1 mmHg at final visit. Qualified success was achieved in 100% of cases, while complete success was 71.4%. The mean number of glaucoma medications decreased from 3.1 ± 0.4 preoperatively to 0.4 ± 0.8 postoperatively.

CONCLUSION

GATT is a highly effective surgical option for treating intractable steroid-induced OHT following repeated DI injections, achieving significant and sustained IOP reduction while minimizing medication dependence.