2972: after GATT why the vitreous prolapse?
We have a true surgical mystery in this case, and we need the collective expertise of the global ophthalmic community to help solve it. As shown in this video, what began as a seemingly textbook, routine Gonioscopy-Assisted Transluminal Trabeculotomy (GATT) procedure took an unexpected turn when vitreous prolapsed into the anterior chamber despite the anatomy initially looking normal. Did an area of occult zonular weakness allow vitreous to migrate anteriorly, or did the prolapse originate from a micro-cyclodialysis cleft or an inadvertent iridodialysis created during canal cannulation? Could anomalous anatomy or unrecognized prior issues with the original cataract surgery play a role here? Please watch the full surgical video closely, analyze the intraoperative tissue dynamics, and leave your theories and insights in the comments below to help the community understand and manage this highly unusual GATT complication. Together, we can figure this out.
Probably there was a problem during original cataract surgery maybe unrecognised
In this video, the rhexis edge or other parts of the capsule and bag are not visible, so I think that the complication of vitreous prolapse is related to the initial operation of complicated phaco surgery, and the patient’s glaucoma was probably caused
or aggravated after the initial surgery.
In this video, the rhexis edge or other parts of the capsule and bag are not visible, so I think that the complication of vitreous prolapse is related to the initial operation of complicated phaco surgery, and the patient’s glaucoma was probably caused
or aggravated after the initial surgery.
mortezamortazavifard@yahoo.com
I agree with the other comments thus far: GATT looked smooth and vit prolapse was likely related to sequelae of the original cataract surgery. However, there is more we can learn from this case. To reduce the risk of a “vitreous surprise” after a well executed standalone GATT on a pseudophakic eye, giving pilo in pre-op may be worth a try. This should shrink the pupil and make it harder for vitreous to come forward. Keeping incision size to a minimum also promotes AC stability during every maneuver. I would advocate for bimanual I&A so that you’d only need two or three 1.0-1.2mm side ports rather than opening up a main incision. Thanks for sharing this and helping us stay vigilant!