The report on 4 eyes that were initially treated with phacoemulsification and iStent trabecular microbypass (Glaukos Corporation). In these patients, the iStent was removed, and gonioscopy-assisted transluminal trabeculotomy (GATT) using the iTrack catheter was performed successfully to treat recurrent glaucoma (Ellex Medical Lasers Ltd). In 3 of the cases, an iStent from the 1st generation (G1) was already in place, and in 1 case, a G2 iStent was also in place. This sequence of cases shows that an additional angle method in the shape of a GATT can prove effective and durable over the medium term in a subset of situations. The intraocular pressures (IOPs) of all 4 of the patients were under control 1 year after GATT, 2 while using IOP-lowering medication, and 2 without. In the first few days after surgery, 3 patients experienced temporary hyphema, and 2 had elevated intraocular pressure (IOP). After undergoing surgical treatment, not a single patient reported an improvement in their eyesight after having it fixed. As far as it is possible to determine, no previously published literature discussed this surgical method. This series demonstrates that GATT may be a workable alternative in the event that a first iStent microtrabecular bypass is unsuccessful.
