2963: combo GATT & drug delivery device for glaucoma
This case illustrates an innovative, stand-alone combination approach to managing open-angle glaucoma in a pseudophakic eye. While we often think of MIGS as performed at the time of cataract surgery, but we can certain use a stepwise approach instead. To achieve optimal intraocular pressure (IOP) control and reduce medication burden, our operating guest surgeon elegantly combines two distinct ab-interno mechanisms in a single operative session. First, a Gonioscopy-Assisted Transluminal Trabeculotomy (GATT) is performed using the VIA device from New World Medical to circumferentially incise and open the diseased trabecular meshwork, directly addressing the primary site of outflow resistance. Following the successful GATT procedure, an iDose TR (travoprost intracameral implant) from Glaukos is securely anchored into the same nasal angle. This provides continuous, long-term targeted drug delivery directly to the anterior chamber, eliminating the compliance issues associated with daily topical drops. This video provides an excellent template for combining a high-volume outflow procedure with advanced sustained-release drug delivery to safely maximize IOP lowering in a stand-alone glaucoma case. Do you often perform stand-alone MIGS? Please comment below.
