Gonioscopy-Assisted Transluminal Trabeculotomy Combined With Intraocular Lens Fixation

To report on a combined surgical approach of IOL fixation and GATT for the treatment of subluxated IOL and increased intraocular pressure

This is a retrospective case series

Patients who underwent IOL fixation surgery combined with GATT between November 2019 and October 2021 were included.  Success was defined as a well centered IOL and an IOP of 18 mmHg or lower and either a 30% IOP reduction or a reduction of medications. Main outcome measure was surgical success at final follow up. Secondary outcome measures were IOP and medication usage. Intraoperative and post operative complications were recorded, as well as the need for reoperation for IOL or IOP.

Eight patients underwent combined GATT and IOL fixation and were included. Mean age was 80.88. The subluxation pathomechanism for all patients was PXF. Five cases underwent 6-0 prolene-flange scleral fixation, and 3 underwent iris fixation. Mean follow-up was 6.5 months. Success rates at final follow-up were 100%. Mean baseline IOP was 19.75±6.38mmHg on 3.38±0.74 medications. Mean IOP at the end of follow-up was 13.43±4.43 mmHg on 0.63±1.19 drops. No intraoperative complications occurred. Hyphema and vitreous hemorrhage, were the most common complications. All patients had a well centered stable IOL at the end of the follow-up. No patients needed any additional surgical intervention. Mean BCVA was improved from 0.62±0.7 to 0.40±0.31.

Our results indicate that GATT can be combined with IOL fixation to effectively reduce intraocular pressure and medication usage