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Intraocular pressure spikes after trabecular meshwork strip peeling during hemi-GATT
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DOI：10.1007/s00417-026-07182-8.png)
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Abstract
En 中文
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.
Keywords:
Hemi-GATT
Trabecular meshwork peeling
IOP spike
Open-angle glaucoma
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