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Angle Closure Glaucoma: Treatment01:28

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Angle-closure glaucoma, or closed-angle glaucoma, is an eye condition where the iris bulges out and blocks the iridocorneal angle, resulting in a buildup of aqueous humor and increased intraocular pressure. Immediate medical attention is necessary due to the sudden onset of symptoms. The treatment for angle-closure glaucoma includes short-term and long-term approaches. Short-term treatment involves using eye drops like pilocarpine to lower intraocular pressure by increasing aqueous humor...
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In open-angle glaucoma, the iridocorneal angle remains open, but the trabecular meshwork becomes stiff, slowing down the outflow of aqueous humor. This causes a buildup of aqueous humor in the anterior chamber, leading to a sudden increase in intraocular pressure. The treatment for open-angle glaucoma focuses on reducing the elevated intraocular pressure by either decreasing the secretion of aqueous humor or increasing its outflow.
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Gonioscopy-Assisted Transluminal Trabeculotomy Following Failed iStent Surgery.

Mark Sigona1, Amrita Saravanan, Spyros Pipis

  • 1Birmingham Midland Eye Centre, SWBH NHS Trust, Birmingham Institute of Glaucoma Research, University Hospitals Birmingham NHS Foundation Trust, Birmingham, England.

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|June 3, 2022
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Summary

Gonioscopy-assisted transluminal trabeculotomy (GATT) effectively treated eyes where iStent trabecular micro-bypass surgery failed. This glaucoma surgery approach showed medium-term efficacy and durability in selected cases.

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Area of Science:

  • Ophthalmology
  • Glaucoma Surgery
  • Minimally Invasive Glaucoma Surgery (MIGS)

Background:

  • Phacoemulsification with iStent trabecular micro-bypass is a common MIGS procedure.
  • Some patients require additional glaucoma surgery after iStent implantation due to insufficient intraocular pressure (IOP) control.

Purpose of the Study:

  • To evaluate the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) as a secondary surgical procedure after iStent failure.
  • To describe a novel surgical strategy for managing refractory glaucoma after initial MIGS.

Main Methods:

  • A case series of 4 eyes initially treated with phacoemulsification and iStent (1st or 2nd generation).
  • Subsequent surgical intervention involved iStent removal followed by GATT using the iTrack catheter.
  • Patient outcomes were assessed based on IOP control, need for IOP-lowering medications, best-corrected visual acuity (BCVA), and postoperative complications.

Main Results:

  • All 4 patients achieved controlled IOP at 1-year post-GATT, with 2 on medication and 2 medication-free.
  • Three patients experienced transient hyphema, and 2 had transiently high IOP postoperatively.
  • No decrease in BCVA was observed in any patient.

Conclusions:

  • GATT can be an effective and durable secondary surgical option for eyes with failed iStent trabecular micro-bypass.
  • This surgical approach offers a potential solution for refractory glaucoma after initial MIGS.
  • Further studies are warranted to confirm the long-term efficacy and safety of GATT in this context.