Gonioscopy assisted transluminal trabeculotomy: a clinical practice review over a decade

Sánchez Reyes W.; Espinoza G.; Duarte-Bueno L.M.; Pareja A.; Fellman R.; Grover D. · Annals of Eye Science (2026) · DOI: 10.21037/aes-25-54

Resumen

Gonioscopy-assisted transluminal trabeculotomy (GATT) has matured over a decade as a conjunctival and implant sparing procedure that restores physiological outflow by cleaving open the trabecular meshwork (TM) and inner wall of Schlemm's canal (SC). A literature search was conducted using the PubMed and Scopus databases, focusing on studies assessing the safety and clinical outcomes of GATT in glaucoma patients. A standardized step-by-step surgical technique is described, emphasizing anterior chamber (AC) control, and circumferential canalization. Comparative data indicate that GATT combined with phacoemulsification (phaco) (either as GATT-phaco or phaco-GATT) yields similar 12-month outcomes, with mean intraocular pressure (IOP) reductions from 30.8 to 14.8 mmHg and medication de-escalation from 2.8 to 0.48. Regarding surgical extent, 120–180° hemi-GATT achieves IOP and medication reductions comparable to the 360° procedure; however, a full 360° incision is associated with a larger initial IOP drop at the expense of more frequent hyphema and early IOP spikes. GATT demonstrates high efficacy across primary and secondary glaucomas (pseudoexfoliative, pigmentary, steroid-induced, and post-keratoplasty), typically achieving a 30–60% IOP reduction. The most common postoperative events are transient hyphema (27–80%) and early IOP spikes (22–37%), which are generally self-limiting. Contemporary evidence supports GATT as a safe, cost-efficient, and broadly applicable ab interno procedure that complements, rather than replaces, filtering surgery in appropriately selected eyes. © AME Publishing Company. Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.