Gonioscopy-assisted transluminal trabeculotomy: Passing the right way decoding suture.

Area of Science:

• Ophthalmology
• Surgical Innovation
• Glaucoma Management

Background:

• Trabeculectomy, a common glaucoma surgery, carries risks of vision-threatening and bleb-related complications.
• Minimally invasive glaucoma surgeries (MIGS) offer a safer alternative, bridging the gap between medical/laser therapy and traditional surgery.
• Gonioscopy-assisted transluminal trabeculotomy (GATT) is a prominent MIGS procedure known for its safety and efficacy.

Purpose of the Study:

• To demonstrate the transluminal novel trabeculotomy technique.
• To facilitate video-based skill transfer for novice surgeons in GATT procedures.

Main Methods:

• Detailed surgical steps of GATT are depicted for primary open-angle glaucoma and secondary glaucoma.
• The ab interno approach allows visualization of the trabecular meshwork and collector system.
• A Prolene suture is used to cleave the entire trabecular meshwork in a sutureless, blebless manner.

Main Results:

• GATT is a blebless and sutureless procedure with adequate intraocular pressure-lowering effects.
• The procedure preserves healthy conjunctiva and avoids bleb-related complications and postoperative hypotony.
• Positive postoperative outcomes are associated with the visualization of an open collector system (trabecular shelf).

Conclusions:

• GATT is a safe and effective glaucoma surgery with a short learning curve.
• It can be combined with cataract surgery, minimizing patient morbidity and recovery time.
• The cost-effectiveness of GATT has significant implications for glaucoma care, especially in developing countries.