Purpose: Gonioscopy-assisted transluminal trabeculotomy (GATT) has been shown to reduce the intraocular pressure (IOP) and medication burden in eyes with open-angle glaucoma (OAG) and congenital glaucoma; however, evidence in young and middle-aged adults remains limited. Here we report the surgical outcomes related to GATT with and without concomitant cataract surgery in young and middle-aged patients. 

Study Design: Retrospective interventional case series.

Methods: Eyes of patients between 18 and 65 years of age that underwent GATT were included. Success was defined as IOP ≤21mmHg with a reduction ≥20% compared to baseline and absence of additional glaucoma surgery or loss of light perception. Changes in IOP, medication burden, and best-corrected visual acuity (BCVA) were assessed using generalized linear models. Safety measures included adverse events and complications.

Results: 21 eyes of 18 patients with a mean age of 45.34±13.94 years and a minimum of 6-month follow-up (16 with one-year follow-up) were included. Glaucoma diagnoses included 8 primary OAG, 6 juvenile OAG, 4 uveitic glaucoma, 2 angle recession glaucoma, and 1 pigment dispersion glaucoma. 15 eyes underwent GATT and 6 received GATT combined with cataract surgery (CE-GATT). The 12-month cumulative survival was 81%. IOP decreased significantly from 28.57±10.54 mmHg to 13.11±3.70 (54% reduction, p<0.001) and 15.29±3.69 (47% reduction, p=0.004) at 6 and 12 months postoperatively, respectively. Medication use decreased from 3.62±1.07 to 1.26±1.19 (65% decrease, p<0.001) and 0.79±1.12 (78% reduction, p<0.001) at 6 and 12 months postoperatively, respectively. The most common adverse events included transient postoperative hyphema in 13 eyes, IOP spike in 11 eyes (10 of which underwent anterior chamber tap), and corneal edema in 4 eyes. Postoperative BCVA remained stable. 

Conclusions: There exists a paucity of evidence regarding the efficacy of GATT in young and middle-aged adults. Our results highlight that this surgical procedure has good one-year outcomes with an acceptable safety profile, supported by the significant IOP and medication reduction observed postoperatively. It is possible that the pathophysiology of OAG in younger patients is more localized to the trabecular meshwork, therefore making GATT a particularly suitable procedure for these patients.

Surgical outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) with and without concomitant cataract surgery in young and middle-aged adults

[Poster Abstract Booklet](https://drive.google.com/file/d/1AGitRGyG9W0FiZ2Xjz6RNO2h7C0XglOL/view)

[Surgical Video Abstract Booklet](https://drive.google.com/file/d/1B-IkojrZhXk4AgXzsEQyuE_FwPG1Lvpe/view?usp=sharing)

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