We know that for patients with narrow angles and cataracts, the best way to address their issues is to perform cataract surgery. When we replace the 4+ mm thick cataract with a thin IOL, we allow the angle to open widely. But what about in this case where there is a history of primary angle closure glaucoma? Our guest surgeon does a great job of cataract surgery and then performs the GATT procedure (Gonioscopy Assisted Transluminal Trabeculotomy). This helps to restore aqueous outflow and controls the patient’s intra-ocular pressure. What do you think of performing phaco+GATT in cases of primary angle closure glaucoma? please comment below
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I’ve done cataract surgery in patients with CAG and depending on the degree of PAS, I decide if the eye needs a simple PI or trabeculectomy; the cut off being 270 degrees of PAS. And it works. As Dr Devgan points out that removing a 4mm thick cataract and replacing it with a less than 1mm thick IOL in itself opens up the angle but the PAS is the issue here. I have never performed GATT nor am I trained to do it, I feel it’s a safe procedure in experienced hands. Trabeculectomy has been the gold standard for glaucoma surgery for many decades and the so many new innovative procedures seen nowadays makes my head swim. I don’t know if one of the newer glaucoma procedures has replaced trabeculectomy as the gold standard procedure. Would like comments.