Título

BANG VERSUS GATT IN PSEUDOPHAKIC EYES WITH PRIMARY OPEN ANGLE GLAUCOMA: A RANDOMIZED CLINICAL TRIAL

Objetivo

To compare the efficacy and safety of Bent Ab interno Needle Goniotomy (BANG) and Gonioscopy-Assisted Transluminal Trabeculotomy (GATT) in primary open angle glaucoma (POAG).

Método

Parallel, double-arm, 1:1 ratio, single masked randomized clinical trial. Mild to moderate pseudophakic POAG eyes, defined by visual field mean deviation (VFMD), with age between 40-80 years and intraocular pressure (IOP)≥18mmHg were included. Antiglaucoma medication was washed-out before surgery and at 12-months. Patients were randomized to BANG or GATT. Follow-up visits were 1, 7, 30, 90, 180, 330 and 360 post-operative days (POD). Primary outcome was mean IOP reduction. Surgical success was defined as IOP≤18mmHg and 20% IOP reduction from baseline without the use of medication. Qualified success followed the same parameters, but allowing the use of medication.

Resultado

Twenty-two eyes underwent BANG and 23 underwent GATT. At inclusion, in the BANG and GATT groups, respectively, mean ages were 72.27±5.63 vs 72.96±5.08 years (p=0.29), visual acuities (LogMAR) were 0.28±0.26 vs 0.14±0.22 (p=0,04), VFMDs were -4.98±2.28 vs -4.68±2.99dB (p=0.71), mean IOPs were 21.18±2.87 vs 19.87±2.34mmHg (p=0.1) under 2.41±0.9 vs 2.35±0.88 medications (p=0.71). Mean IOPs after washout were 25.55±4.9 vs 25.43±4.98mmHg (p=0.92). Following surgery, IOPs in the BANG and GATT groups were 16.23±5.43 vs 14.22±6.0mmHg (p=0.24) at POD1, 16.91±7.35 vs 13.48±4.9mmHg (p=0.07) at POD7, 23.95±7.33 vs 19.91±11.85mmHg (p=0.17) at POD30, 17.95±3.6 vs 17.32±7.15mmHg (p=0.71) at POD 90, 17.82±2.82 vs 15.14±4.14mmHg (p=0.01) at POD180 and 16.75±2.86 vs 15.33±3.18mmHg (p=0.16) at POD330. After POD360 washout, IOPs were 24.7±8.26 vs 21.0±11.38mmHg (p=0.25). The number of medications used at POD90, 180 and 330 in the BANG and GATT groups were 1.05±0.89 vs 0.32±0.78 (p<0.01), 1.41±1.09 vs 0.59±1.0 (p<0.01) and 1.8±1.1 vs 1.22±1.62 (p=0.2). GATT had a higher rate of complete (55.2% vs 4.5%, p<0.01) and qualified success (59.7% vs 27.3%, p=0.01) than BANG.

Conclusão

GATT eyes achieved a higher success rate than BANG eyes at 12-months.