Complications During Prolene Suture Gonioscopy-Assisted Transluminal Trabeculotomy Surgery: Report From A Tertiary Referral Center

Minimally invasive glaucoma surgery (MIGS) has become more popular in recent years as it provides better postoperative patient rehabilitation compared to conventional glaucoma procedures. Gonioscopy-assisted transluminal trabeculotomy (GATT) is an angle based MIGS technique typically involving a 360° ab interno trabeculotomy approach by using an illuminated microcatheter or a blunt-tip suture. Although several inherent complications of this procedure have been documented, specific analysis of GATT complications still remains inconclusive. In the present report, we aimed to elaborate complication profile of prolene suture GATT technique in a relatively large cohort of patients operated in a tertiary referral center.

Karadeniz Technical University, Faculty of Medicine, Department of Ophthalmology, Trabzon, Turkey

Retrospective, observational clinical study including GATT surgeries between January 2021 and January 2025 in a tertiary referral center was conducted. Peroperative and postoperative complications during GATT procedure were noted by analysing patient files and surgical videos.

Totally 315 eyes (295 patients) with a mean age of 65.1 years were included. Peroperative complications include suture misdirection (17, 5.4%), trabeculodescemet block separation (2, 0.3%), malignant glaucoma in a pseudophakic pseudoexfoliative case (0.3%) and posterior capsule rupture in 4 combined cases (1.3%). Postoperative complications include several grades of hyphema (299, 94.9%), hyphema+clot formation (34, 10.8%), intraocular pressure spike (75, 23.8%), descemet membrane detachment (4, 1.3%), cyclodialysis cleft (4, 1.3%), choroidal detachment (2, 0.6%), malignant glaucoma (4, 1.3%), transient ciliary effusions (71/120 eyes, 59.2%), wipe-out phenomenon (2, 0.3%) and several degrees of peripheral anterior synechia formation.

We exhibited several per- and post-operative complication related to GATT surgery. To the best of our knowledge, this is the largest series, single-center study reporting complication profile of GATT technique in the literature. Most common intraoperative complication was suture misdirection during GATT. One should be vigilant of this phenomenon during learning curve. Apart from inherent complication profile of this procedure; when considering the range of complications presented here, it may be reasonable to characterize GATT surgery as a ‘moderate’ rather than ‘minimally’ invasive glaucoma surgical technique among angle-based techniques.