Intraocular Pressure Spikes After Gonioscopy-Assisted Transluminal Trabeculotomy (Gatt)

Intraocular pressure (IOP) spikes (IOP >30 mmHg or >10 mmHg above baseline IOP) are a common and worrisome complication of goniotomy assisted transluminal trabeculotomy (GATT).  The purpose of this study is to identify risk factors for IOP spikes and to describe their characteristics, management, and clinical course in a large cohort of patients. 

A retrospective, single center study

 349 consecutive eyes of patients that underwent GATT between December 2019 to April 2023 with follow-up of at least 90 days.

IOP spikes occurred in 80 of 349(22.9%) eyes.Patients were divided into 2 groups,one with continuation of preoperative medication postoperatively (206 eyes, 17% spikes) and the second without postoperative glaucoma medications (143 eyes, 31% spikes).Spikes were diagnosed at a mean of 9.8±17.4 days after surgery.The mean duration of a spike was 5±7  days.Younger age and higher maximal IOP were significant risk factors for IOP spike after surgery (P=0.003 and P<0.001; respectively). Continuation of preoperative IOP lowering medications after surgery were 2.5 times less likely to develop a spike as compared to patients who discontinued their medications (P=0.004). Spikes were found to be a risk factor for failure of GATT.

IOP spikes are a common occurrence after GATT. They most commonly appear during the first two post-operative weeks and usually resolve with topical and systemic IOP lowering treatment. Younger age and higher maximal IOP are risk factors for IOP spikes after GATT. The continuation of IOP lowering medications after GATT is recommended to lower the risk of IOP spikes.