Gonioscopy-assisted transluminal trabeculotomy: A boon for challenging case scenarios

Background: Trabeculectomy is the most commonly performed filtration procedure. However, the complications either early or late after an invasive procedure has stimulated the glaucoma community to search for a novel surgical approach to the management of glaucoma. The choice of therapy between medical, laser, and filtering surgery is now bridged by minimally invasive glaucoma surgeries (MIGS), which have several perks of being an ab interno approach, high safety profile, absence of filtering bleb, and rapid recovery after surgery. Among the armamentarium of the MIGS family, gonioscopy-assisted transluminal trabeculotomy (GATT) is performed by prolene suture which cleaves the trabecular meshwork and has shown effective and promising outcomes. Purpose: The purpose of this video is to demonstrate a step-by-step GATT procedure in complex case scenarios. Synopsis: The video highlights salient preoperative measures before starting the GATT procedure, followed by a brief description of GATT surgical steps. The authors further discuss the precautions to be adopted in different and complex case scenarios by various surgical tips and tricks. GATT is usually performed in open and easily accessible angles, but in this video, GATT is demonstrated in primary open-angle, primary angle closure, secondary glaucoma, and angle dysgenesis. Highlights: GATT can be performed in complex case scenarios. It has the added advantage of conjunctival sparing and short recovery time. Video link: https://youtu.be/xfVn3qy_-L8