Malignant Glaucoma Following Gonioscopy-Assisted Transluminal Trabeculotomy

Area of Science:

• Ophthalmology
• Glaucoma Research
• Surgical Outcomes

Background:

• Primary angle-closure glaucoma (PACG) poses a significant risk for vision impairment.
• Gonioscopy-assisted transluminal trabeculotomy (GATT) is a surgical option for PACG.
• Malignant glaucoma (MGL) is a rare but serious complication that can occur post-ophthalmic surgery.

Purpose of the Study:

• To report the occurrence of malignant glaucoma (MGL) following gonioscopy-assisted transluminal trabeculotomy (GATT).
• To evaluate the clinical characteristics and treatment outcomes of MGL post-GATT.
• To highlight the importance of recognizing MGL in patients with specific preoperative risk factors.

Main Methods:

• Observational case-series study of 4 consecutive patients.
• Inclusion criteria: PACG patients who underwent GATT and subsequently developed MGL.
• Data collected: Preoperative characteristics (refraction, anterior segment imaging), intraocular pressure (IOP) before and after GATT, MGL diagnosis, and treatment outcomes.

Main Results:

• Four cases of MGL (1.3% incidence) were observed after GATT in patients with PACG.
• All patients had preoperative plateau iris configuration, hypermetropia, and peripheral anterior synechiae.
• MGL was diagnosed on postoperative day 1, with IOP ranging from 19-29 mmHg. Treatments included pars plana vitrectomy and irido-zonulo-hyaloido-vitrectomy (IZHV).

Conclusions:

• Malignant glaucoma (MGL) can occur after gonioscopy-assisted transluminal trabeculotomy (GATT), particularly in patients with primary angle-closure glaucoma (PACG) and plateau iris.
• Prompt diagnosis and appropriate surgical intervention are essential for managing post-GATT MGL.
• Further research is needed to understand the precise mechanisms and optimize prevention strategies for MGL after GATT.