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Gonioscopy-assisted transluminal trabeculotomy for MYOC-associated juvenile open angle glaucoma: a case series of eight eyes over 2.2-4.1 years
Journal article   Peer reviewed

Gonioscopy-assisted transluminal trabeculotomy for MYOC-associated juvenile open angle glaucoma: a case series of eight eyes over 2.2-4.1 years

Erin A. Boese, Wallace L.M. Alward and John H. Fingert
Ophthalmology. Glaucoma, Vol.8(5), pp.466-473
09/2025
DOI: 10.1016/j.ogla.2025.03.011
PMCID: PMC12724723
PMID: 40188877
url
https://pmc.ncbi.nlm.nih.gov/articles/PMC12724723/View
Open Access

Abstract

Or purpose Mutations within the myocilin (MYOC) gene are the first known single gene cause of both primary open angle glaucoma (POAG) and juvenile open angle glaucoma (JOAG). Subsequent studies have shown these mutations cause trabecular meshwork dysfunction, resulting in markedly elevated intraocular pressures (IOPs) at young ages. Angle-based procedures, like gonioscopy-assisted transluminal trabeculotomy (GATT), bypass the trabecular meshwork, and as such, are hypothesized to be particularly effective in this angle-based disease. The purpose of this case series is to evaluate the efficacy of GATT for MYOC-associated JOAG. A retrospective chart review was performed evaluating patients under the age of 18 years with known MYOC-associated JOAG who underwent GATT. A total of eight eyes of four children are included. All participants had a strong family history of MYOC glaucoma. All patients underwent a thorough clinical evaluation, including visual acuity, slit lamp examination, optic nerve fundoscopy, and intraocular pressure (IOP) measurements by Goldmann applanation. Most patients also underwent 24-2 SITA standard Humphrey visual fields, fundus photography, and all patients had retinal nerve fiber layer optical coherence tomography (OCT). Main outcome measures include IOP and number of medications. Additional measures include visual acuity, optic nerve photos, visual field testing, and OCT. Following 360-degree GATT, all eight eyes of four children had mean drop in IOP of 26 mmHg (68%), and all were able to stop glaucoma medications entirely. Our patients were followed up between 2.2 and 4.1 years with no evidence of decreasing efficacy or glaucomatous progression. All patients maintain 20/20 visual acuity or better in both eyes, and glaucoma had stabilized on all available ancillary testing (OCT, HVF, optic nerve photos). One patient (Patient 4) had notable reversal of cupping. In MYOC-associated JOAG, the pathology is concentrated at the TM, lending itself well to angle-based surgeries, especially GATT. GATT is particularly effective in children with MYOC JOAG, allowing them to avoid, or at least delay, the need for more invasive surgeries like trabeculectomy and tube shunt surgeries with over four years of follow-up. To date, this is the first genetically-directed glaucoma surgery available
 gonioscopy-assisted transluminal trabeculotomy (GATT) juvenile open-angle glaucoma (JOAG) MYOC Myocilin

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