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

BACKGROUND: Trabeculectomy is still the most frequently performed glaucoma surgery. But being an invasive procedure, it has numerous vision-threatening complications along with bleb-related complications like cystic bleb, overhanging bleb blebitis, or endophthalmitis. The choice of therapy between medical laser and filtering surgery is now bridged by minimally invasive glaucoma surgeries (MIGS), which are conjunctiva-sparing procedures with adequate intraocular pressure (IOP)-lowering effects and good safety profiles. Among the armamentarium of MIGS procedures, gonioscopy-assisted transluminal trabeculotomy (GATT) is a frontrunner safe procedure. The procedure is a blebless and sutureless procedure in which a readily available Prolene suture is used to cleave the entire trabecular meshwork. An ab interno approach also allows direct visualization of a so-called trabecular shelf that, when present, indicates an open, cleaved collector system commonly associated with a positive postoperative outcome. Thus, it not only saves the eye from various postoperative complications of other previous penetrating procedures, but is also an effective glaucoma surgery that can be performed with very low costs, which would have big economic implications for glaucoma care in developing countries. PURPOSE: The purpose of this video is to illustrate transluminal novel trabeculotomy technique and video-based skill transfer to a novice surgeon. SYNOPSIS: This video depicts detailed steps of GATT surgery in a patient with primary open angle glaucoma and in a case of silicon oil induced secondary open angle glaucoma. The authors also share their experience regarding possible intraoperative problems and solutions with some tips and tricks to make the surgery easy. HIGHLIGHTS: GATT can be performed with cataract surgery with minimal patient morbidity and a short recovery time with preserving healthy conjunctiva. There is no risk of post op hypotony or bleb related complications, with a short surgical learning curve. ONLINE VIDEO LINK: https://youtu.be/gk1of38EX1g