Early Clinical Outcomes Of Endoilluminator-Guided Combined Gonioscopy-Assisted Transluminal Trabeculotomy And Deep Sclerectomy (The Gazi Technique)

To evaluate the early safety and intraocular pressure (IOP)–lowering efficacy of a novel endoilluminator-guided combined gonioscopy-assisted transluminal trabeculotomy (GATT) and deep sclerectomy technique designed to restore both proximal and distal aqueous outflow within a controlled closed-system configuration.

Retrospective interventional case series including 17 eyes of 17 patients with medically uncontrolled open-angle glaucoma undergoing the combined procedure.

The surgical technique consisted of circumferential ab interno GATT using a preplaced intracanalicular 5-0 Prolene suture left in situ, followed by endoilluminator-guided deep sclerectomy to precisely localize and unroof the outer wall of Schlemm’s canal. The superficial scleral flap was securely closed prior to activation of the trabeculotomy, thereby maintaining a closed-system configuration. Mitomycin C was applied intraoperatively in all cases. IOP was recorded preoperatively and at postoperative day 1, week 1, month 1, and month 3. Primary outcomes were mean IOP reduction and proportion of eyes achieving ≥20% IOP reduction. Secondary outcomes included change in number of antiglaucoma medications and early postoperative complications.

Mean preoperative IOP was 34.7 ± 5.3 mmHg on 3.4 ± 1.1 medications. IOP decreased substantially in the immediate postoperative period to 7.1 ± 1.7 (4-11) mmHg on day 1 and 9.3 ± 1.2 mmHg at week 1. At 1 month, mean IOP was 10.8 ± 1.9 mmHg (68.9% reduction, p<0.001), remaining stable at 11.5 ± 2.7 mmHg at 3 months (p<0.001 vs baseline). A ≥20% IOP reduction was achieved in 100% of eyes at both 1 and 3 months. Mean medication use decreased from 3.4 ± 1.1 to 0.6 ± 0.7 at 3 months. Transient hyphema occurred in all eyes and resolved within 2 weeks. No postoperative IOP spikes exceeding 25 mmHg were observed. Mild postoperative hypotony developed in 6 eyes; however, in all cases, IOP returned to physiological levels within the first week.

The combined endoilluminator-guided GATT and deep sclerectomy technique demonstrated significant early IOP reduction with favorable safety profile. The closed-system configuration and intrascleral reservoir may contribute to early postoperative pressure stability and reduction of IOP spikes. This approach may represent an effective intermediate surgical strategy in primary glaucoma surgery.