Combined Gonioscopy-Assisted Transluminal Trabeculotomy (GATT) with Ab Interno Canaloplasty (ABiC) in Conjunction with Phacoemulsification: 12-Month Outcomes

Ahmed Al Habash,1 Muath Alrushoud,2 Omar Al Abdulsalam,3 Abdulaziz Ismail Al Somali,4 Mohanna Aljindan,1 Adel Salah Al Ahmadi5 1Department of Ophthalmology, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 2Eye Specialist Hospital, Ministry of Health, Dhahran, Saudi Arabia; 3Ophthalmology Division, King Abdulaziz Hospital, Ministry of National Guard Health Affairs, Al Ahsa, Saudi Arabia; 4Ophthalmology Department, King Faisal University, Al Hofuf, Saudi Arabia; 5Ministry of Health, Madinah, Saudi ArabiaCorrespondence: Ahmed Al HabashKing Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaTel +966 507017777Email ahmedalhabash@gmail.comPurpose: To report the surgical outcomes of combined gonioscopy-assisted transluminal trabeculotomy (GATT) with ab interno canaloplasty (ABiC) in conjunction with phacoemulsification for primary open-angle glaucoma (POAG).Patients and Methods: This prospective, interventional, non-comparative case series included POAG patients who underwent combined GATT and ABiC in conjunction with phacoemulsification performed between January 2018 and August 2018. Main outcome measures include surgical success rate, changes in intraocular pressure (IOP), number of antiglaucoma medications, corrected distance visual acuity (CDVA), and complications.Results: We enrolled twenty eyes of 19 patients in our study. The mean age was 61.2 ± 6 years, and all the patients completed a 12-month follow-up. The overall success rate was 100%. The mean baseline IOP was 19.75 ± 4.68 mmHg, and at 12 months, the mean IOP was 13.30 ± 1.30 mmHg (IOP reduction of 32.7%). The baseline number of antiglaucoma medications was 3.4 ± 0.6 (range: 2 to 4 medications), and after 12 months follow-up, the number was reduced to 1.1 ± 1.0 (range: 0 to 2 medications). The CDVA for all 20 eyes was 0.85± 0.58 LogMAR at baseline, and 0.16± 0.30 LogMAR at 12-month follow-up. Only six eyes developed hyphaema, which had cleared by the first postoperative month, and three eyes needed medical treatment for postoperative IOP spikes.Conclusion: The 12-month results of our study suggest that combined GATT with ABiC in conjunction with phacoemulsification is a safe and effective alternative in decreasing the IOP and number of antiglaucoma medications in POAG patients.Keywords: primary open-angle glaucoma, Minimally Invasive Glaucoma Surgery, Gonioscopy-Assisted Transluminal Trabeculotomy, Ab Interno Canaloplasty, Schlemm’s Canal, glaucoma medication