Novel Single-Surgeon Technique for 360° GATT

For Glaucoma Physician’s Surgical Pearls video series, Rupak Dhoot, MD, presents a technique for performing 360° gonioscopy-assisted transluminal trabeculotomy (GATT) using the iTrack surgical system (Nova Eye Medical). Transcript of the narration follows below:

This video demonstrates a novel variation of the 360° gonioscopy-assisted transluminal trabeculotomy (GATT) performed by Rupak Dhoot, MD, with editing and narration by Sravya Jayam. Two cases are presented to illustrate this technique.

In this first case, the patient underwent creation of a small trabeculotomy with a sinsky to access Schlemm’s canal. With a gonioprism providing visualization of the angle, the iTrack microcatheter was advanced circumferentially through Schlemm’s canal using the injector’s slider. The illuminated catheter tip was observed progressing around the limbus. As the catheter traversed the canal, viscoelastic was intermittently delivered to perform viscodilation and canaloplasty.

The critical modification in this technique is that, once the catheter has completed its 360° pass, one end of the catheter is transected and allowed to internalize into the anterior chamber. Micro-forceps introduced through the side-port wound are then used to grasp both the cut end and the leading end of the catheter and externalize them in a single, fluid motion, thereby completing the trabeculotomy. Importantly, this allows the nondominant hand to maintain stable gonioprism positioning throughout the maneuver, eliminating the need for an assistant. This contrasts with other methods, in which the surgeon must simultaneously secure the catheter tip and retract the injector—an approach that typically requires an assistant to complete the procedure.

The second case further demonstrates the reproducibility of this approach, again highlighting the efficiency of this single-surgeon technique for completing the 360° trabeculotomy with handheld slider-based catheters. GP

Rupak Dhoot, MD, is a glaucoma specialist at Texoma Retina and Glaucoma in the North Texas area servicing the area between Oklahoma City and Dallas in Allen and Sherman, Texas. He completed his residency at UT Houston and his fellowship at Cleveland Clinic Cole Eye Institute. Reach him at rdhoot01@gmail.com.

Sravya Jayam, OMS-IV, is a fourth-year medical student at Michigan State University College of Osteopathic Medicine. Her interests include glaucoma, cataract surgery, and surgical education through video editing. She plans to pursue ophthalmology residency training.

Mary Qiu, MD,, the editor of this series, is a glaucoma and cataract surgeon who completed her glaucoma fellowship at the Cole Eye Institute at Cleveland Clinic and her ophthalmology residency training at the Wilmer Eye Institute at Johns Hopkins. Her special interests include neovascular glaucoma; tube revisions and exchanges; optimizing technique and outcomes for nonvalved tubes, goniotomy, and canaloplasty; surgical education for trainees; and creating and sharing her surgical videos. Reach her at mary.qiu@gmail.com.