Study Reports Safety, Efficacy of GATT for Glaucoma at Five Years

In a cohort of patients with three to seven years of follow-up, researchers found GATT to be an effective alternative to traditional glaucoma surgeries. Photo: Vanathi M. Indian J Ophthalm. Vol. 5(3) July-Sep 2025. Click image to enlarge. Gonioscopy-assisted transluminal trabeculotomy (GATT) is a minimally invasive procedure to treat glaucoma that employs a clear corneal incision to cannulate and dissect the trabecular meshwork while preserving the conjunctiva for potential future interventions. Previous studies have demonstrated the safety and efficacy of GATT through 48 months, and now, longer-term data show that the treatment effect is sustained through five years. Published recently in the Journal of Glaucoma, the new study assessed clinical outcomes of GATT in a heterogeneous glaucoma cohort at a tertiary glaucoma center in the UK. Included were 111 eyes of 95 patients who had at least three years of follow-up (median: 5.1 years). Most cases involved primary glaucoma (61.3%), while 38.7% of patients had secondary glaucoma, most commonly uveitic (18%). Nearly half of patients (45.9%) underwent GATT with cataract surgery, while the remainder underwent the procedure on its own.Results revealed a significant decrease in mean intraocular pressure (IOP), dropping from 30.3mm Hg at baseline to 17.5mm Hg by the final follow-up. Patients also experienced a reduction in the average number of anti-glaucoma medications required, from 3.8 to 2.2. The qualified and complete surgical success rates were determined to be 57.7% and 20.7%, respectively, with an overall failure rate of 42.3% during the study period. The researchers identified a few risk factors for surgical failure, notably in patients of Afro-Caribbean descent and those experiencing early postoperative IOP spikes (at one month). Non-360-degree GATT also increased surgical failure. The average time to failure was 1.6 years, with 21.4% of failures occurring during the first postoperative year.Limitations of this study include its retrospective design and the involvement of multiple surgeons, which may lead to variability in surgical techniques and postoperative care. On the other hand, a strength of the research is its reflection of real-world clinical practices, which enhances the generalizability of the results. “Overall, GATT provides a minimally invasive, effective alternative to traditional surgeries, with stable visual outcomes and a manageable reoperation rate, supporting its role in advanced glaucoma management,” the study authors concluded in their paper. They added, “It is important to conduct randomized trials of GATT comparing its safety and efficacy to conventional blebforming procedures to define its relative efficacy and safety in various glaucoma subtypes.”Click here for the journal source. Aluzri H, Soomro S, Richardson J, et al. Long-term outcomes of GATT for glaucoma: ≥3 year follow-up at a UK tertiary center. J Glaucoma. 2026;35:123-30. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.