Highlighting the limited efficacy of gonioscopy-assisted transluminal trabeculectomy in Fuchs uveitis syndrome: a case series.

Abstract

Background: This study aimed to investigate the outcomes of gonioscopy-assisted transluminal trabeculectomy (GATT) surgery in patients with Fuchs' uveitis syndrome (FUS) related glaucoma.

Case presentation: The clinical and surgical records of 4 FUS patients who underwent GATT surgery between 2021 and 2023 were retrospectively reviewed. The preoperative process, clinical course under medical treatment, postoperative clinical course, intraocular pressures (IOP), glaucoma medication requirements, need for additional surgeries, visual outcomes, and surgical success results were evaluated for each patient GATT surgery was performed as the first intervention for glaucoma control in FUS patients under 50 years of age with IOP above 20 mm Hg despite multiple different medications. The average follow-up period after GATT surgery was 12 months. Despite reaching the maximum level of antiglaucomatous treatment in any of the patients, the target IOP was not achieved. On average, 6 months later, mitomycin-C trabeculectomy (MMC-trab) was performed as a conventional surgical option in three of the patients, and diode laser cyclophotocoagulation was applied to one patient with poor visual prognosis.

Conclusions: In FUS, which causes low-grade inflammation, has a low likelihood of synechial formation, and relatively affects a younger age group, GATT surgery, a minimally invasive glaucoma surgery (MIGS) method, was considered a good alternative as an initial surgical option. However, it was observed that the surgical success was limited.