Gonioscopy-assisted transluminal trabeculotomy for intractable ocular hypertension after repeated intravitreal dexamethasone implant injections

Purpose: To evaluate the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) in managing intractable ocular hypertension (OHT) following repeated intravitreal dexamethasone implant (DI) injections. Methods: This retrospective study included patients with steroid-induced OHT unresponsive to maximum tolerated medical therapy who underwent GATT. Primary outcome measures were intraocular pressure (IOP) reduction and surgical success (qualified and complete), number of DI injections. Results: Fourteen eyes of 14 patients (mean age: 66.2 ± 8.3 years) with steroid-induced OHT following repeated DI injections were analyzed. The mean number of DI injections before surgery was 4.2 ± 1.1 over a median period of 18.4 months (range: 12–36 months). The mean preoperative IOP was 33.6 ± 4.1 mmHg, which significantly decreased to 13.5 ± 2.9 mmHg at the first postoperative month (59.8% reduction, p < 0.001) and remained stable at 14.2 ± 3.1 mmHg at final visit. Qualified success was achieved in 100% of cases, while complete success was 71.4%. The mean number of glaucoma medications decreased from 3.1 ± 0.4 preoperatively to 0.4 ± 0.8 postoperatively. Conclusion: GATT is a highly effective surgical option for treating intractable steroid-induced OHT following repeated DI injections, achieving significant and sustained IOP reduction while minimizing medication dependence.