Effect of Postoperative Pilocarpine Eyedrops in the Outcomes of Gonioscopy-assisted Transluminal Trabeculotomy (GATT) Surgery

Purpose: To evaluate the effect of postoperative pilocarpine use on intraocular pressure (IOP), glaucoma medications, and complications in patients undergoing Gonioscopy-assisted transluminal trabeculotomy (GATT). Methods: This retrospective study included patients with ocular hypertension or primary open-angle glaucoma who underwent stand-alone GATT or combined with cataract extraction between June 2021 and April 2023. Participants were divided into a pilocarpine group (n=28) and a control group (n=25). Pilocarpine 2% was administered twice daily for 4 weeks following surgery in the pilocarpine group. Outcomes including IOP, visual acuity, glaucoma medication use, and complications were assessed at multiple postoperative intervals up to 12 months. Results: Baseline characteristics were similar between groups. Surgical success rates at 12 months were 80.8% for the pilocarpine group and 79.2% for the control group (P=0.999). No significant differences in IOP reduction were found at any follow-up visit. Considering pilocarpine as 1 drug, the mean number of medications was higher in the pilocarpine group from day 1 to month 1 after surgery (P<0.001). However, from the third month through the 12-month follow-up, the study groups were comparable. Although postoperative complications were similar, on the first postoperative day, five patients (17.9%) in the pilocarpine group exhibited hyphema ≥25%, whereas none in the control group did (P=0.053). Conclusions: Routine postoperative pilocarpine use following GATT did not appear to significantly impact surgical outcomes or complication rates. However, given its potential association with greater hyphema extension in the early postoperative period, a rational and selective use, rather than routine administration, might be more appropriate.