Safety and Efficacy of Goniotomy following Failed Surgery for Glaucoma

Precis: Goniotomy (GT) is an alternative surgery for patients with prior failed surgery for glaucoma.Purpose: To evaluate the efficacy and safety of GT in patients with prior failed surgery for glaucoma.Materials and Methods: A prospective, observational multicentered study was performed for patients who underwent GT with prior single or multiple surgery for glaucoma. Outcome measures included intraocular pressure (IOP) change, best-corrected visual acuity change, ocular hypotensive medication use, and occurrence of adverse events through 12 months. Complete success was defined as a postoperative IOP within 6-18 mmHg and a 20% reduction from baseline without ocular hypotensive medications. Qualified success was the same as the definition of complete success, except for postoperative use of medication. Logistic regression models were used to investigate the potential factors for surgical success.Results: A total of 38 eyes of 34 patients were included. Twenty-three eyes had only 1 prior surgery, 13 eyes had 2 prior surgeries, 1 eye had 3 prior surgeries, and 1 eye had 4 prior surgeries. At month 12, there was complete success in 42.1% of the eyes and qualified success in 78.9% of the eyes. Preoperatively, the mean IOP was 29.4 +/- 6.9 mmHg and the median number of glaucoma medications used was 3.0 (2.0, 4.0); this decreased to 16.7 +/- 3.6 mmHg (43.2% reduction; P<0.001) and 2.0 (0.0, 3.0) (P<0.001) at month 12, respectively. The most common complications included hyphema (13.2%), IOP spike (7.9%), and corneal edema (5.2%). Older age significantly contributed to surgical success.Conclusions: GT seems to be a safe and effective procedure for patients with prior failed surgery for glaucoma.