Gonioscopy-Assisted Transluminal Trabeculotomy in Uveitic Glaucoma Secondary to Juvenile Idiopathic Arthritis.

Gonioscopy-Assisted Transluminal Trabeculotomy (GATT) is a minimally invasive ab interno procedure, performed with guidance of an illuminating micro-catheter device (iTrack). The pathophysiology of raised intraocular pressure (IOP) in uveitic glaucoma is commonly due to increased resistance at the trabecular meshwork-Schlemm's canal. By removing this resistance, GATT can potentially control the IOP. In addition, the ab interno approach avoids violating the conjunctiva and reduces the risk of complications including infection, leak and hypotony. In this series, we discuss three uveitic glaucoma cases secondary to juvenile idiopathic arthritis (JIA) that underwent GATT. Case 1 was a 16-year old phakic female with a pre-operative IOP of 25-33▒mmHg had 360-degree GATT; her IOP remained stable at 6-10▒mmHg over 14 months. Case 2 was a 23-year old pseudophakic female with a pre-operative IOP of 28-34▒mmHg had 180-degree GATT; her IOP reduced to 8▒mmHg over 10 months. Case 3 was an 8-year old aphakic male with a pre-operative IOP of 21-32▒mmHg had 360-degree GATT; his IOP remained stable at 13-15▒mmHg over 21 months. In our limited case series, GATT is very successful in controlling IOP in young uveitic patients with JIA by surgically targeting the underlying pathophysiology.