Causes of Immediate and Early IOP Spikes After Circumferential Gonioscopy-Assisted Transluminal Trabeculotomy Using ASOCT

Aparna Rao,* Sardar Mohd Khan,* Sujoy Mukherjee Glaucoma Service, LV Prasad Eye Institute, Bhubaneswar, Odisha, 751024, India*These authors contributed equally to this workCorrespondence: Aparna Rao, Glaucoma Service, LV Prasad Eye Institute, MTC Campus, Bhubaneswar, Odisha, 751024, India, Tel +91 674 2653001, Fax +91 674 2653130, Email aparna@lvpei.org; vinodini10375@yahoo.comPurpose: To report the early postoperative causes of intraocular pressure (IOP) spikes after complete circumferential gonioscopy-assisted transluminal trabeculotomy (GATT) using anterior segment optical coherence tomography (ASOCT).Methods: This was retrospective interventional case series of patients who underwent circumferential GATT by a single surgeon (APR) from 2021 to 2022 at a tertiary eye care in East India and who developed IOP spikes at 1 day-2 weeks (immediate) or early (> 2 weeks– 2 months) after GATT. The intraocular pressure (IOP), glaucoma medications, and angle evaluation by ASOCT at 1 week, and 1 month were compared between the two groups.Results: Thirty-two eyes of 32 consecutive patients, aged 40± 20.1 years (20 exfoliation glaucoma, 9 juvenile open-angle, and 3 developmental glaucoma), that developed IOP spikes between immediate (n=20) or early (n=12) IOP spikes after GATT, were included. Immediate postoperative spikes were seen in 20 eyes due to retained viscoelastic (n=8), hyphema (n=8) in uncontrolled hypertension, and peripheral anterior synechiae (PAS) (n=6) of which only one eye required medication at 2 months. Causes of immediate IOP spikes on ASOCT included an inverted/reattached trabecular shelf, iris strands in eyes with abnormal iris in developmental glaucoma, and PAS in 1– 2 quadrants. Causes of early IOP spikes included PAS > 3 quadrants (n=8), and hyperreflective fibrotic tissue over TM (n=4) with 50% requiring medications at 2 months. The ASOCT features predicting the need for medications were PAS > 3 quadrants (OR=8.4[2.