Long Beach Glaucoma Treatment Options
What is the Goniotomy GATT?
GATT (Gonioscopy-assisted transluminal trabeculotomy) is a form of minimally invasive surgery to treat open-angle glaucoma. The procedure is a modern variation of a trabeculotomy, a traditional form of glaucoma surgery that has been performed by eye surgeons for over 50 years.
How Does It Work?
GATT involves a goniotomy, a surgical procedure in which the doctor creates an opening in the trabecular mesh — a network of small canals that help drain aqueous humor fluid from the eye. The tiny opening increases the flow of excess fluid, which in turn lowers eye pressure. The eye doctor also uses a gonioscope, a special lens that can be attached to a surgical microscope, to evaluate the eye’s drainage system. By examining the angle between the cornea and iris, the doctor can clearly see any areas where blockages occur.
Like most glaucoma surgeries, the purpose of GATT is to reduce dangerous levels of intraocular pressure and prevent vision loss.
What Happens During The Procedure?
Goniotomy GATT surgery is performed under local anesthesia with intravenous sedation. Some patients choose to combine the procedure with cataract surgery, but this is not a requirement.
First, the eye surgeon makes two small corneal incisions and then a small goniotomy. A micro-catheter is threaded through an incision to the Schlemm’s canal, which is part of the eye’s drainage system. The entire trabecular mesh system can be “unroofed,” or loosened, with this method. Doing so results in significant reduction of eye pressure.
What Makes The Goniotomy GATT Different From Other Glaucoma Treatments?
There are some major advantages to the Goniotomy GATT procedure over other minimally invasive procedures:
- The surgeon can access 360° of the angle between the cornea and iris. This allows removal of a larger area of the trabecular mesh, which can maximize IOP reduction.
- There is no incision or scarring of the conjunctiva, so a more complicated glaucoma surgery can be performed in the future if needed.
- No foreign body is left in the eye.
- Goniotomy GATT can be performed at the same time as cataract surgery.
- Patients can continue to wear contact lenses.
- It can be more cost-effective because it does not involve expensive devices. This is especially important for patients who may be uninsured or have large insurance co-pays.
Who Should Have This Procedure?
Originally the Goniotomy GATT surgery was successfully performed on children or young adults with congenital glaucoma. However, glaucoma specialists have adopted it for wider use on patients with mild to moderate glaucoma. It is not recommended for patients with severe glaucoma and vision loss.
Where is the Procedure Performed?
Goniotomy GATT procedures are performed at the eye ambulatory surgical center used by Long Beach surgeons. These are outpatient procedures that typically take 1-2 hours.
Is it Successful?
Yes, the procedure has successfully reduced intraocular pressure (IOP) to safe levels in many patients. Nearly all of those patients have been able to eliminate or greatly reduce the dosages of eyedrops required to manage their glaucoma.
There are some anatomical features in the eye which may affect how successful the surgery is. Your ophthalmologist can evaluate whether this surgery would be likely to work for you.
The goniotomy GATT procedure is a relatively new glaucoma surgery which has been used since 2014. Long term results in maintaining IOP and avoiding more extensive surgery are not yet known.
What are the Complications?
All glaucoma eye surgery involves some risk of complications such as infection or temporary increases in IOP. Relatively few complications have been reported by surgeons using the Goniotomy GATT technique. The most common complication is hyphemia — a condition where blood collects in the lower front of the eye. This usually resolves within a month of surgery.
Goniotomy GATT, Long Beach, CA
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