Gonioscopy-assisted transluminal trabeculotomy in the management of uncontrolled Posner-Schlossman syndrome: a retrospective study

To explore the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) in the treatment of Posner-Schlossman syndrome (PSS).

A retrospective review was conducted on participants diagnosed with PSS and uncontrolled intraocular pressure (IOP) who underwent GATT between 2023 and 2024. Clinical outcome measures including visual acuity, IOP, gonioscopic findings, complications, and relapses were collected for postoperative visits: 1d, 1wk, 1, 3, 6mo and 1y.

Eleven participants (mean age 43.00±13.82y, 5 females and 6 males) were enrolled. Nine participants were followed up for 12mo after the surgery, 1 participant underwent trabeculectomy to decrease the uncontrolled IOP, another participant was followed up for 6mo because of loss of follow-up. The mean IOP before GATT was 33.64±6.21 mm Hg (range: 23–46 mm Hg). The mean number of antiglaucoma medications prior to surgery was 2.73±0.66. At 6mo after the surgery, the mean IOP decreased to 17.36±6.17 mm Hg (47.15%±17.35% reduction). Nine participants were followed up for 12mo, and their mean IOP decreased to 16.22±2.49 mm Hg, with an average IOP reduction of 46.83%±16.93% (P<0.01). The number of anti-glaucoma medications significantly decreased to 0.91±0.83 at the last follow-up (P<0.05). Two eyes were considered treatment failures due to reintervention and uncontrolled IOP. The preoperative IOP of qualified success cases were significantly lower than that of failed cases. The most common complications were intraoperative anterior chamber blood reflux (100%) and IOP spikes (45.45%), both of which resolved within 1wk. During the follow-up period, 7 participants experienced recurrent attacks of PSS. Nevertheless, peak IOP during relapse was significantly reduced compared to preoperative values (P<0.05).

GATT seems to be a reliable and effective method for the management of PSS with uncontrolled IOP. Higher preoperative IOP maybe the factor of surgical failure. Although it may not prevent relapse of PSS, it might potentially reduce the peak IOP. Longer-term follow-up and a larger sample size are recommended for more in-depth analysis.