Adjunctive ab-interno goniotomy in chronic angle-closure glaucoma: a retrospective proof-of-concept pilot study using doubly robust learning - Summary - MDSpire
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Adjunctive ab-interno goniotomy in chronic angle-closure glaucoma: a retrospective proof-of-concept pilot study using doubly robust learning
To assess whether an anterior segment optical coherence tomography (AS-OCT)-informed causal framework could estimate the added benefit of adjunctive ab-interno goniotomy during phacoemulsification with goniosynechialysis in chronic angle-closure glaucoma.
Approach:
Key Findings:
Adjunctive goniotomy was associated with higher 24-month qualified-failure-free survival (0.682 vs 0.425; p=0.018).
Doubly robust estimates favored adjunctive goniotomy for 24-month medication-free complete success (risk difference 0.291; 95% CI 0.105–0.478).
Hyphema occurred numerically more often with adjunctive goniotomy.
Interpretation:
Adjunctive goniotomy was associated with more favorable 24-month surgical control in this cohort. Predicted individualized benefit estimates require external validation before clinical use.
Limitations:
Retrospective design may introduce bias.
Predicted individualized benefit estimates were variable and not clinically actionable.
Conclusion:
Adjunctive goniotomy may improve surgical outcomes in chronic angle-closure glaucoma, but further validation is needed.
Justin Schweitzer, OD, FAAO, and Jessica Steen, OD, FAAO, describe emerging technologies, treatment strategies, and clinical considerations that can help eyecare professionals (ECPs) identify glaucoma earlier and better manage progression.
