Search Results (292)

Background/Objectives: Heart rate variability (HRV) is a marker of autonomic nervous system function, based on fluctuations in heartbeat intervals. Although several studies have investigated the association between frequency-domain HRV parameters and glaucoma, evidence based on large sample sizes remains limited. Therefore, the present study aimed to examine the relationship between frequency-domain HRV parameters and glaucoma subtypes, including primary open-angle glaucoma (PG) and exfoliation glaucoma (EG), using a larger sample size. Methods: Participants with primary open-angle glaucoma (PG), exfoliation glaucoma (EG), or no ocular disease other than cataract (controls) were recruited at Shimane University between June 2023 and July 2024. Frequency-domain HRV parameters (total power [TP], very-low-frequency [VLF], low-frequency [LF], high-frequency [HF], and LF/HF) were measured using a sphygmograph (TAS9 Pulse Analyzer Plus View). Group comparisons were conducted using unpaired t-tests, Fisher’s exact tests, and Tukey’s HSD test. Multivariate analyses were performed to identify factors associated with each HRV parameter. Results: A total of 809 participants were analyzed, including 522 with PG, 191 with EG, and 96 controls. The EG group showed significantly lower values across all frequency-domain HRV parameters compared to the PG group, and significantly lower LnLF values than the control group (p = 0.012). Multivariate analyses revealed that no significant associations were found between HRV measures and the presence of glaucoma or pseudoexfoliation material (PEM) deposition. Older age was significantly associated with lower values across all HRV parameters. Conclusions: In elderly glaucoma patients, age-related alterations in frequency-domain HRV parameters have been observed. Full article

Mitochondrial metabolism in the trabecular meshwork (TM) plays a critical role in maintaining intraocular pressure homeostasis by supporting the energy-demanding processes involved in aqueous humour outflow. In primary open-angle glaucoma, oxidative stress impairs mitochondrial function, leading to TM dysfunction. Therefore, understanding and targeting mitochondrial health in TM cells could offer a novel therapeutic strategy. Pyrroloquinoline quinone (PQQ) is a redox cofactor with antioxidant and mitochondrial-enhancing properties. However, its effects on human TM (HTM) cells remain largely unexplored. This study examined PQQ cytoprotective effects against H₂O₂-induced oxidative stress in HTM cells. Seahorse analyses revealed that PQQ alone improves mitochondrial respiration and ATP production. Moreover, PQQ mitigates H₂O₂-induced cellular damage and preserves mitochondrial function by normalising proton leak and increasing ATP levels. Furthermore, TEM and confocal microscopy showed that PQQ can partially alleviate structural damage, restoring mitochondrial network morphology, thereby leading to reduced cell death. Although these protective effects seem not to be mediated by changes in mitochondrial content or activation of the SIRT1/PGC1-α pathway, they may involve modulation of SIRT3, a key factor of mitochondrial metabolism and homeostasis. Overall, these results suggest that PQQ may represent a promising candidate for restoring mitochondrial function and reversing oxidative damage in HTM cells. Full article

Background: This study aimed to evaluate retinal arteriole parameters using adaptive optics (AO) rtx1™ (Imagine Eyes, Orsay, France) and peripapillary and macular vessel densities with optical coherence tomography angiography (OCTA) in eyes with different stages of primary open-angle glaucoma (POAG) compared to healthy eyes. It also investigated the associations between vascular parameters and glaucoma severity, as defined by structural (OCT) and functional (visual field) changes. Methods: Fifty-seven eyes from 31 POAG patients and fifty from 25 healthy volunteers were examined. Retinal arteriole morphology was assessed using the AO rtx1™-fundus camera, which measured lumen diameter, wall thickness, total diameter, wall-to-lumen ratio (WLR), and wall cross-sectional area. OCTA was used to measure vessel densities in superficial (SCP) and deep (DCP) capillary plexuses of the macula and radial peripapillary capillary plexus (RPCP) and FAZ area. Structural OCT parameters (RNFL, GCC, rim area) and visual field tests (MD, PSD) were also performed. Results: Glaucoma eyes showed significantly thicker arteriole walls (12.8 ± 1.4 vs. 12.2 ± 1.3 µm; p = 0.030), narrower lumens (85.5 ± 10.4 vs. 100.6 ± 11.1 µm; p < 0.001), smaller total diameters (111.0 ± 10.4 vs. 124.1 ± 12.4 µm; p < 0.001), and higher WLRs (0.301 ± 0.04 vs. 0.238 ± 0.002; p < 0.001) than healthy eyes. In glaucoma patients, OCTA revealed significantly reduced vessel densities in SCP (36.39 ± 3.60 vs. 38.46 ± 1.41; p < 0.001), DCP (36.39 ± 3.60 vs. 38.46 ± 1.41; p < 0.001), and RPCP plexuses (35.42 ± 4.97 vs. 39.27 ± 1.48; p < 0.001). The FAZ area was enlarged in eyes with glaucoma (0.546 ± 0.299 vs. 0.295 ± 0.125 mm²); p < 0.001). Positive correlations were found between vessel densities and OCT parameters (RNFL, r = 0.621; GCC, r = 0.536; rim area, r = 0.489), while negative correlations were observed with visual field deficits (r = −0.517). Conclusions: Vascular deterioration, assessed by AO rtx1™ and OCTA, correlates closely with structural and functional damage in glaucoma. Retinal microcirculation changes may precede structural abnormalities in the optic nerve head. Both imaging methods enable the earlier detection, staging, and monitoring of glaucoma compared to conventional tests. Full article

Background: This case–control study evaluated the concentrations of zinc (Zn), iron (Fe), and copper (Cu) in the aqueous humor (AH) of patients with primary glaucoma, and their relationships with clinical factors. Methods: This study enrolled 100 patients with primary glaucoma and categorized them into subtypes: acute angle-closure crisis (AACC), primary angle-closure glaucoma (PACG), and primary open-angle glaucoma (POAG). A total of 67 patients with senile cataract were enrolled as controls. Their AH samples and clinical information were obtained. Results: In primary glaucoma, Zn, Fe, and Cu concentrations increased, especially in AACC group; Zn, Fe, and Cu were positively correlated mutually; and decreased Zn/Fe and increased Fe/Cu were observed. The number of quadrants with closed anterior chamber angle on gonioscopy was positively associated with Fe and Cu levels in AACC and with Zn and Cu levels in PACG. In POAG, we found negative associations between Zn and the number of quadrants with retinal nerve fiber layer thinning on optical coherence tomography, Fe and age, and Cu and the cup-to-disc ratio. Trace metals showed high efficiency in discriminating primary glaucoma from controls. Conclusions: Zn, Fe, and Cu concentrations in patients with primary glaucoma increased and were associated with clinical factors, acting as potential biomarkers. Full article

Purpose: Standard automated perimetry (SAP) remains the gold standard functional test in glaucoma, used primarily for evaluating peripheral vision loss. Central contrast sensitivity (CCS) has emerged as a potential early functional marker of glaucomatous damage. This systematic review aimed to describe the different methods used to measure CCS in randomized controlled trials (RCT) involving glaucoma patients. Methods: We searched the MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Trials, Epistemonikos, and ClinicalTrials.gov databases on 25 January 2023, and updated the search on 12 February 2025. Eligible studies comprised RCTs that reported CCS as an outcome in patients with glaucoma, suspected glaucoma, or ocular hypertension. No restrictions were placed on age, sex, ethnicity, geography, intervention, or publication year. Abstracts and full texts were screened independently by two reviewers. Descriptive statistics were used. No formal risk of bias assessment was performed, due to the descriptive nature of the review. Results: Of 1066 records screened, 31 studies met the eligibility criteria. The study sample size ranged from 7 to 207 (median: 23), with most studies involving primary open-angle glaucoma. Interventions were diverse, mainly involving topical medications, with timolol being the most frequent. Eleven CCS test methods were identified. Five studies did not report the method used. The CSV-1000 was the most commonly used test, being applied in 11 studies. Conclusions: CCS has been measured using a wide range of methods in glaucoma RCTs, with limited standardization. Most of the included studies were small, variably reported, and conducted over 10 years ago, suggesting a decreasing interest in CCS as an outcome measure in glaucoma RCTs. Funding: This review was funded by Oslo University Hospital and the Research Council of Norway. Registration: This review was registered on the OSF. Full article

Background/Objectives: This study aims to evaluate the long-term efficacy and safety of ab interno techniques using minimally invasive glaucoma surgery (MIGS), specifically XEN gel stent implantation, by evaluating its 2-year outcomes in patients with primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG). Methods: This retrospective single-center study consecutively included 31 eyes of 31 patients with POAG or PXG who underwent XEN gel stent implantation. Patients were followed for 24 months, with assessments at multiple time points. Success was defined as achieving an IOP of less than 14 mmHg and a reduction of more than 20% from preoperative IOP without additional glaucoma surgery. Bleb morphology was evaluated using anterior segment optical coherence tomography (AS-OCT) and slit-lamp photographs. Postoperative interventions and complications were also recorded. Results: At 24 months, complete success and qualified success rates were 35.5% (11/31) and 51.6% (16/31), respectively. There was no difference in surgical success rates at 2 years based on the tip location (intraconjunctiva, intratenon, and uviform) on the 1st postoperative day. Patients with high sparse wall on AS-OCT imaging or avascular bleb morphology via slit-lamp photography at 6 months postoperatively had higher complete success rates at 2 years than those without (p = 0.007, p = 0.009, respectively). Patients with avascular bleb types at 6 months postoperatively had higher qualified success rates at 2 years compared with the vascular types (p = 0.038). Needling was performed in 32.3% of eyes, with secondary surgical procedures required in 16.1% of eyes. The most common adverse event was hypotony, occurring in 67.7% of eyes on the 1st postoperative day but resolving within 6 months. Conclusions: The ab interno XEN gel stent is an effective and minimally invasive option for managing POAG and PXG, with long-term success predicted by the AS-OCT assessment of bleb morphology at 6 months. Proactive postoperative management, emphasizing early intervention and monitoring, is crucial for maintaining optimal outcomes. Full article

Background: Systemic arterial stiffness and atherosclerosis have been increasingly recognized as potential contributors to the pathogenesis of glaucoma. Several studies have reported associations between glaucoma and various surrogate markers of vascular stiffness. However, despite the growing interest in the vascular components of glaucoma, no previous studies have specifically explored the relationship between the indices derived from acceleration plethysmography (APG) and glaucoma. This study seeks to address this gap by investigating the potential association between APG parameters and the presence of glaucoma. Methods: The subjects were 701 patients (mean age 68.6 years, 54% male) with open-angle glaucoma (primary open-angle glaucoma [POAG] or exfoliation glaucoma [EXG]), and 94 control subjects (mean age 60.1 years, 57% male) who had no eye diseases other than cataracts. The subjects were all cases in which APG was measured using a sphygmograph (TAS9 Pulse Analyzer Plus View; YKC Corp., Tokyo, Japan). The amplitude of waveform types (a, b, c, d, and e-waves) and derived vascular types (A, B, and C) of the accelerated pulse wave components were statistically compared between the cases and controls. Results: The accelerated pulse wave components (mean ± standard deviation) of the control and glaucoma groups were a-wave 785 ± 99 and 776 ± 93 (p = 0.40), b-wave −522 ± 161 and −491 ± 143 (p = 0.050), c-wave −142 ± 108 and −156 ± 105 (p = 0.24), d-wave −288 ± 144 and −322 ± 122 (p = 0.014), and e-wave 103 ± 79 and 90 ± 58 (p = 0.059), with differences between the groups being observed in the b and d-waves. For derived vascular types, compared with the controls and POAG, patients with EXG had a lower frequency of Type A and a higher frequency of Type C than the other groups (p = 0.044). Multivariate analysis showed that factors significantly associated with vascular type included age (p < 0.0001), sex (p < 0.0001), diastolic blood pressure (p = 0.021), and pulse rate (p < 0.0001), while BMI, systolic blood pressure, history of hypertension, history of diabetes, presence or absence of glaucoma, and presence or absence of pseudoexfoliation material were not significant. Conclusions: This is the first study to investigate the relationship between APG and glaucoma with a large sample size. In elderly glaucoma patients, particularly those with EXG, systemic vascular changes are often present. APG parameters may reflect vascular alterations in glaucoma. Full article

This retrospective review examines whether there is a difference in all-cause mortality in patients who required surgical intervention for neovascular glaucoma (NVG, N = 186) versus primary open-angle glaucoma (POAG, N = 190). Cox proportional hazard models compared mortality across three models: unadjusted, age-adjusted (Model 1), and age-, hypertension-, and diabetes-adjusted (Model 2). In all models, NVG patients who required glaucoma surgery had a higher all-cause mortality rate compared to those with POAG who underwent similar procedures: unadjusted (HR 2.22, (1.59, 3.10), p < 0.0001), Model 1 (HR 2.99, 95% CI (2.12, 4.22), p < 0.0001), and Model 2 (HR 1.88, 95% CI (1.27, 2.80), p < 0.0018). In Model 1, those with NVG due to PDR had a higher all-cause mortality rate after glaucoma surgery than those with NVG secondary to CRVO (HR 2.00, 95% CI (1.19, 3.45), p < 0.0095). Patients treated with CPC had higher all-cause mortality rates than those treated with tube shunt in all models: unadjusted (HR 1.82, 95% CI (1.33, 2.47), p < 0.0001), Model 1 (HR 1.91, 95% CI (1.40, 2.61), p < 0.0001), and Model 2 (HR 1.50, 95% CI (1.04, 2.16), p < 0.03). We observed a higher all-cause mortality rate among patients with NVG requiring glaucoma surgery compared to those with POAG requiring similar surgeries, which could suggest that NVG patients requiring glaucoma surgery had more compromised systemic health. Full article

Background/Objectives: Worldwide, glaucomas are the leading cause of irreversible blindness in adults. On the ocular level, they are fairly well understood; however, the functional and structural changes that occur in the brain have become a subject of great interest lately, mostly owing to improved accessibility and effectiveness of functional magnetic resonance imaging (fMRI). This, coupled with the non-invasive nature of the methodology, has contributed to an ever-growing body of research published on the topic. In this systematic review, we gather, systematize, and compare the results and methodologies reported in the literature, as pertaining to resting-state fMRI brain changes in primary open-angle glaucoma (POAG). Methods: A systematic search in PubMed, Scopus, and Web of Science was carried out, resulting in a total of 290 records identified, with 67 assessed for eligibility and 24 selected for inclusion. Results: The main findings include worse functional parameters in the early visual centers in POAG across all methodologies, reduced functional connectivity between V1 and other parts of the visual cortex, functional aberrations in higher levels of the visual system, predominantly in the ventral stream and in extravisual networks, among others. Moreover, the majority of these changes are shown to be correlated with ophthalmological measurements. Conclusions: Although studies on this matter tend to suffer from a limited sample size and a lack of methodological standardization, we nevertheless manage to present common results and conclusions regarding the effects of POAG on brain function. Full article

Purpose: We sought to evaluate the long-term effects of oral citicoline; vitamins A, B, C, and E; and blackcurrant therapy in patients with primary open-angle glaucoma (POAG) using optical coherence tomography (OCT), OCT angiography (OCTA), and microperimetry parameters. Materials and Methods: Fifteen patients with POAG (the treated group) received one soluble liquid sachet of a complementary dietary supplement containing, in a fixed combination, citicoline; vitamins A, B, C, and E; and blackcurrant (Citizin^®, Bruschettini s.r.l., Genova, Italy) daily for 20 days a month for 1 year. Fifteen age-matched patients with POAG were given a placebo and served as a control group. The patients underwent best-corrected visual acuity (BCVA) analysis, Goldmann applanation tonometry, microperimetry examination, OCT, and OCTA at the beginning of the study and then 1, 6, and 12 months later. Results: A significant improvement in the overall retinal nerve fiber layer (RNFL) thickness values (compared with the control group) was recorded at the 6- (p < 0.009) and 12 (p < 0.001)-month follow-ups in the treated group. The ganglion cell complex (GCC) increased in thickness (compared with the control group) at the 12-month follow-up (p < 0.0001) in the treated group. The mean macular vessel density (MVD) and the mean peripapillary vessel density (PVD) in the treated group were significantly higher than those in the control group at the 12-month follow-up. Microperimetry examination, BCVA, and Goldmann applanation tonometry showed no statistically significant alterations. Conclusions: A fixed combination of citicoline; vitamins A, B, C, and E; and blackcurrant administered orally may have a positive impact on RNFL, GCC, MVD, and PVD in patients with POAG. Full article

Background/Objectives: To evaluate the neuromodulative effects of oral intake of a fixed combination of citicoline 500 mg plus homotaurine 50 mg plus vitamin B3 54 mg plus pyrroloquinoline quinone (CIT/HOMO/B3/PPQ) or of citicoline 800 mg alone (CIT800) on retinal ganglion cell (RGC) function in glaucoma patients by pattern electroretinogram (PERG) and to investigate the effects on quality of life and visual function. Methods: Consecutive patients with primary open-angle glaucoma with controlled IOP (<18 mmHg) receiving prostaglandin analogues as monotherapy; with two reliable visual fields (Humphrey 24-2 SITA Standard) per year in the last 2 years; and an early to moderate visual field defect (MD < −12 dB) were randomized to: arm A. topical therapy + CIT/HOMO/B3/PPQ for 4 months, followed by 4 months of topical therapy + CIT800; and arm B. topical therapy + CIT800 for 4 months, then topical therapy + CIT/HOMO/B3/PPG for 4 months. Patients were examined at month 0, 4, and 8. Complete ocular examination, visual field test, PERG, and quality of life assessment (NEI-VFQ25) were performed at each visit. Results: Forty patients were selected and completed the study, and none developed or reported an adverse event. The overall mean age was 64.2 (±7.7) years, 27 were male. At the end of the intake period of both products, patients exhibited higher P50 and N95-wave amplitudes and shorter latencies compared to baseline. The crossover analysis found that PERG parameters were better when patients received the CIT/HOMO/B3/PQQ combination with a statistically significant shorter peak time of 1.24 ms (95% CI, 0.37 to 2.10; p = 0.006) in the central P50 wave, 1.32 ms (95% CI, 0.44 to 2.22; p = 0.004) in the inferior P50 wave, and 1.70 ms (95% CI, 0.09 to 3.31; p = 0.038) in the inferior N95 wave; and a statistically significant increase of 0.35 µV (95% CI, 0.10 to 0.60; p = 0.006) in the superior N95 amplitude. The crossover analysis did not reveal any significant differences between the intake of CIT800 and CIT/HOMO/B3/PQQ in terms of visual acuity or IOP. During the intake of CIT/HOMO/B3/PQQ, a significant improvement was observed in the total mean score (p = 0.004), in the general health scale (GH, p = 0.01), in the color vision scale (p = 0.006), and in the peripheral vision scale (p = 0.001). Conclusions: The present study has shown that the addition of CIT/HOMO/B3/PQQ in early glaucoma improves PERG parameters and quality of life, likely by slowing down RGC aging and enhancing mitochondrial function more significantly than citicoline 800 mg alone. Full article

Glaucoma remains a leading cause of irreversible blindness worldwide, with early detection crucial for preventing vision loss. This study developed and validated a novel eye-tracking algorithm to detect oculomotor abnormalities in primary open-angle glaucoma (POAG). We conducted a case–control study (March–June 2021), recruiting 16 patients with moderate POAG, 16 with preperimetric POAG, and 16 age-matched controls. The participants underwent a comprehensive ophthalmic examination and eye movement recording using a high-resolution infrared tracker during two tasks: saccades to static targets and saccades to moving targets. The patients with POAG exhibited a significantly increased saccadic latency and reduced accuracy compared to the controls, with more pronounced differences in the moving target task. Notably, preperimetric POAG patients showed significant abnormalities despite having normal visual fields based on standard perimetry. Our machine learning algorithm incorporating multiple saccadic parameters achieved an excellent discriminative ability between glaucomatous and healthy subjects (AUC = 0.92), with particularly strong performance for moderate POAG (AUC = 0.97) and good performance for preperimetric POAG (AUC = 0.87). These findings suggest that eye movement analysis may serve as a sensitive biomarker for early glaucomatous damage, potentially enabling earlier intervention and improved visual outcomes. Full article

Objectives: The objective of this study is to investigate the two-year continuous efficacy, risk factors, and safety profile of selective laser trabeculoplasty (SLT) in Japanese individuals diagnosed with normal-tension glaucoma (NTG) who underwent SLT as either a first-line or second-line treatment. Methods: A retrospective chart review was conducted of patients with NTG who underwent SLT as either an initial or secondary therapy at 26 medical institutions in Japan between January 2020 and December 2021 with a 2-year follow-up. The primary endpoint was a reduction in the rate of intraocular pressure (IOP) over 2 years after SLT. To estimate the time-varying effect of IOP reduction, a linear mixed-effects model was employed. The secondary endpoints were numerical IOP reduction, treatment success rates shown by a Kaplan–Meier analysis, and complications. Success was defined as an outflow pressure improvement rate (ΔOP) ≥ 20% (definition A) or an IOP reduction rate ≥ 20% (definition B) without further treatment. A Cox proportional hazards regression analysis was used to identify the risk factors to successful SLT treatment. The study was registered with UMIN-CTR (ID: UMIN R000064045). Results: A total of 230 eyes from 230 individuals participated in this study, with 148 eyes receiving SLT as an initial (first-line) therapy and 82 eyes undergoing SLT as a secondary (second-line) intervention. In the first-line group, the mean IOP dropped from 16.7 ± 2.3 mmHg to 13.7 ± 2.4 mmHg at two years post-treatment, reflecting a 16.8% reduction. In the second-line group, the average IOP declined from 15.9 ± 2.5 mmHg to 13.2 ± 2.0 mmHg, marking a 14.4% decrease over the same period. The treatment success rate according to definition A (ΔOP ≥ 20%) was 73.7% at 2 years. Analysis using a linear mixed-effects model identified time (p < 0.001), age (p = 0.044), baseline IOP (p < 0.001), and central corneal thickness (CCT) (p < 0.001) as statistically significant contributors to IOP reduction following SLT. However, neither the Group (first-line vs. second-line) variable (p = 0.386) nor the Time × Group interaction (p = 0.298) reached statistical significance. A lower baseline IOP and a thicker CCT were confirmed as significant predictors of SLT treatment failure. Conclusions: Both initial and secondary SLT treatments for NTG proved to be effective and safe over a two-year period, although the extent of IOP reduction was smaller in cases with a lower baseline IOP. Our findings indicate that the IOP-lowering effect of SLT in NTG is influenced by pretreatment IOP levels, aligning with previous studies on primary open-angle glaucoma and ocular hypertension. However, in contrast to those earlier findings, our research identified pretreatment central corneal thickness as a statistically significant factor influencing SLT efficacy in NTG. These results support the role of SLT as a reliable and safe therapeutic option for managing NTG. Full article

Glaucoma is an age-related neurodegenerative disease characterized by progressive optic nerve damage. Accelerated biological aging, assessed using predicted age derived from fundus images, may serve as a biomarker for glaucoma progression. This study aimed to examine fundus-derived age acceleration among patients with primary open-angle glaucoma (POAG), exfoliation glaucoma (EXG), and controls, and to explore its biochemical basis through advanced glycation end products (AGEs). Fundus photographs from 237 participants (79 POAG, 79 EXG, and 79 age- and sex-matched controls) were analyzed using a deep learning model (EfficientNet) previously trained to predict biological age. AGE accumulation was assessed by measuring skin autofluorescence (sAF). Multivariate regression analyses were conducted to identify factors influencing predicted age acceleration, with stratification into age tertiles to control for age-related effects. EXG patients demonstrated significant accelerated biological aging compared to controls (p = 0.006), particularly evident in younger and middle-aged tertiles. AGE scores were significantly elevated in EXG relative to both POAG (p = 0.009) and control groups (p = 0.003). Predicted age and AGE scores were more strongly correlated than chronological age and AGEs, especially in the middle tertile (p = 0.002). Accelerated biological aging detected via fundus images occurs prominently in EXG, potentially reflecting underlying AGE accumulation. Fundus-derived predicted age could serve as a non-invasive biomarker for assessing glaucoma progression risk and warrants further exploration in clinical applications. Full article

Background: Gonioscopy-assisted transluminal trabeculotomy (GATT) is a minimally invasive, ab interno conjunctival-sparing glaucoma surgery aimed at the trabecular meshwork and the inner wall of Schlemm’s canal. The goal of this study is to report on the success of GATT in a large group of patients with a wide variety of open- and closed-angle glaucomas with or without cataract extraction and to report on risk factors for failure. Methods: A retrospective chart review of consecutive patients with primary or secondary open- or closed-angle glaucoma who underwent GATT, with or without concomitant phacoemulsification. Demographics, baseline clinical characteristics, and postoperative outcomes were collected from patients’ medical records. Primary outcomes were success rates (IOP of 18 mmHg or lower and one of the following: IOP reduction > 30% from baseline on the same or fewer medications or an IOP ≤ baseline with fewer medications as compared to baseline) and complication rates. Intraocular pressure (IOP) and the number of glaucoma medications were secondary outcome measures. Results: GATT was performed on 126 eyes of 121 patients. Mean follow-up was 583 ± 266 days. Cumulative success at 1Y was 0.88 for GATT combined with cataract extraction, 0.96 for GATT alone, 0.88 for primary open-angle glaucoma (POAG), 0.89 for secondary open-angle glaucoma (SOAG), and 0.76 for primary angle-closure glaucoma (PACG). IOP decreased from a mean of 20.65 mmHg to 14.1 mmHg, and medication decreased from a mean of 3.47 to 1.4 at the last follow-up. Forty-four eyes (34%) were classified as failures. Factors associated with an increased risk of failure were worse preoperative corrected visual acuity (OR = 2.46, p = 0.024) and a postoperative IOP spike (OR = 2.62, p = 0.028). Twelve eyes (9.5%) required further surgery for IOP control. Risk factors for requiring further surgery for IOP control were preoperative maximal IOP (OR = 1.066, p = 0.047) and a postoperative IOP spike (OR = 4.531, p = 0.036). Conclusions: GATT achieved good surgical success with good IOP and medication reduction across a wide range of glaucomas, in combination with lens extraction or as a standalone procedure. GATT should be considered early in the treatment paradigm of medically uncontrolled glaucoma. Full article