Early implementation of gonioscopy-assisted transluminal trabeculotomy for glaucoma in Kibagabaga District Hospital, Rwanda

Abstract

Background: Glaucoma is a progressive, vision-threatening condition that can be managed with topical treatments initially but often eventually requires surgical management.
Aim: This study aimed to review the efficacy and safety of the first gonioscopy-assisted transluminal trabeculotomy (GATT) operations in Rwanda. This is a retrospective case series.
Setting: Out of 260 consecutive surgical records dated between 01 January 2023 and 28 August 2023, 11 eyes that had undergone GATT procedures were identified and included in this study. These were the first patients to undergo GATT in Rwanda.
Methods: All available pre-operative, operative and post-operative data were collected and reported for visits through 01 February 2024. Cases were classified as either a success, a qualified success or a failure based on pre-determined criteria. Outcomes included post-operative intraocular pressure (IOP) at multiple time points, the number of glaucoma medications needed post-GATT, the number of glaucoma surgeries post-GATT, visual acuity and post-operative complications.
Results: Patients had an average IOP decrease of 13 mmHg (standard deviation = 6.8) at 3 months post-operation compared with pre-operation IOP on medical treatment. Eight eyes (73%) achieved complete success, two eyes (18%) achieved qualified success and one eye met failure criteria (9%). No patients had a decline in visual acuity at the last visit after receiving GATT. Two cases of IOP spike (18%) were noted (both resolved within 1-week post-operation), two cases of hyphema (18%) and one case each of mild corneal oedema (9%) and a small Descemet detachment (9%).
Conclusion: Gonioscopy-assisted transluminal trabeculotomy is a useful tool in the arsenal of pressure-reducing treatments with unique utility in lower-resource settings.
Contribution: This retrospective analysis of the first 11 cases of GATT in Rwanda demonstrates GATT as a safe and feasible tool for the treatment of glaucoma, with specific utility in lower-resource settings.