In this video, Surgeon Peter Chang demonstrates the GATT procedure, focusing on managing resistance during the operation. He begins by inserting a microcatheter through a clear corneal incision and using a goniotomy needle to create an incision in the trabecular meshwork. As the microcatheter is advanced into Schlemm’s canal, he highlights the potential for resistance and the importance of backing out and reorienting the catheter when necessary. The procedure culminates in the successful advancement of the catheter, ultimately opening the trabecular meshwork at a full three hundred and sixty degrees.
Surgeon: Dr. Daniel Neely, Ophthalmologist, Indiana University School of Medicine, USA
Transcript
In this video, surgeon Peter Chang will demonstrate what to do if the GATT procedure encounters resistance or is unable to be passed to a full three hundred and sixty degrees.
The microcatheter has been inserted through the peripheral clear corneal incision, and now we’ll use a goniotomy needle with the gonio lens to make a small incision in the trabecular meshwork on the opposite side of the anterior chamber.
This small incision will give us access to Schlemm’s canal for the catheter insertion.
After creating the incision, now the microcatheter is being inserted into Schlemm’s canal, and you can see the micro forcep is being used to grasp small sections and steadily advance it forward.
Again, with the goal of going all the way around.
However, you’ll find that occasionally, the catheter will stop advancing, that resistance will be encountered or that it will start to go off course.
And this video demonstrates what one should do in those cases.
You don’t wanna just keep pushing forward, but rather if you cannot pass it easily, the best thing to do is to back it out, and then we will simply reapproach this through the same incision, but going in the opposite direction.
So to do that, we went to orient our catheter. So it’s approaching from the opposite side. So a new pair of synthesis is made, And now we will reinsert our catheter.
The micro forcep is grasping the tip of the catheter, and then the gunial lens will go back into place.
The micro catheter is inserted through the same incision back into Schlimbs canal, but this way, going in the opposite direction, slow, steady advancement, short segments with with each grasp, monitoring the lighted tip of the microcatheter as it advances around.
We’re about three quarters of the way around now. So it will soon be approaching our original incision through the tracheal meshwork.
And here it comes.
Once it’s back around, now the forceps are used to grasp the lighted end, and the lasso will be pulled by placing force on both ends of the catheter, which will pull it through the trabecular meshwork. And here it goes across so that we have just opened at three hundred and sixty degrees.