FAQs / Are you dilating then performing GATT or just straight viscodilation?

August 30, 2018

QUESTION:

Are you dilating then performing Gonioscopy Assisted Transluminal Trabeculotomy (GATT) or just straight viscodilation?

via Email

ANSWER:

With regard to leaving or removing the trabecular meshwork (TM), I leave it intact as the literature is supportive of the TM as having an active role in the regulation of aqueous outflow (more of a pump than a grate or flow restrictor). Additionally, once the TM is removed (or torn, as is the case in all GATTs other than Kahook Dual Blade or Trabectome) the benefit will wear off in a year or so once the leaflets scar down and occlude the canal (this is why trabeculotomy was abandoned decades ago as a treatment of adult glaucoma).

I firmly believe that the surgical treatment of glaucoma is heading into a multiple MIGS direction. Surgeons are already performing both ABiC and iStent or Endocyclophotocoagulation (and shortly, Hydrus) at the same time. From a physiologic point of view dilating both the canal and collector channel system prior to placing a permanent scaffold into the canal is the logical best approach. Even if we are not placing stents or scaffolds at the time of ABiC, leaving that option available for the future is prudent.

So, I leave Kahook Dual Blade (KDB) for last after ABiC and stenting of the canal.

Warm regards,
David Richardson, MD
Patient-Focused Ophthalmologist

San Marino Eye
2020 Huntington Drive
San Marino, CA 91108
626.289.7856

Patient-Focused Websites:
New-Glaucoma-Treatments.com
About-Eyes.com

Posted in: Canaloplasty, Other Concerns, What Is Canaloplasty?