Gonioscopy-Assisted Transluminal Trabeculotomy as an Option in a Young Myopic Patient with Progressive Glaucoma

A 30-year-old man with a history of juvenile open angle glaucoma (JOAG) presented with a complaint of decreased visual acuity (VA) in his right eye in the setting of elevated intraocular pressure (IOP). An optical coherence tomography (OCT) scan and visual field test were performed, with each test showing extensive retinal fiber layer (RNFL) thinning and visual field deficits respectively. Upon ocular examination, both optic nerve heads were found to have significant cupping with significant peripapillary atrophy and high cup to disc ratios. Due to the man’s young age and profound visual field defects, aggressive treatment was suggested and he underwent gonioscopy-assisted transluminal trabeculotomy (GATT) on his right eye. The procedure successfully lowered his IOP by greater than 30% from baseline, and his visual acuity returned to baseline in the right eye. This is significant considering IOPlowering is the basis for glaucoma treatment and with the advent of this effective new conjunctival-sparing procedure, long-term adverse effects and the need for further glaucoma surgery is reduced.