Gonioscopy Assisted Transluminal Trabeculotomy (GATT) in Post-penetrating Keratoplasty Steroid Induced Glaucoma: A Case Report

Glaucoma following penetrating keratoplasty (PKP) remains the leading cause of blindness following PKP. Patients with post-PKP glaucoma can be managed medically and surgically. Evidence studying glaucoma surgical techniques following PKP is limited, but suggests the possibility for high risk complications, including graft failure. Minimally invasive glaucoma surgeries (MIGS) offer an alternative. We report the first case of post-PKP glaucoma managed with GATT. The patient was a 33-year-old male with a history of keratoconus who underwent PKP in his right eye. On presentation, his visual acuity was 20/60 and intraocular pressure (IOP) was 48▒mmHg OD. He underwent GATT and cataract phacoemulsification. Following 22 months of follow-up, the patient’s visual acuity was 20/30 and IOP 13▒mmHg, off all glaucoma medications. This case demonstrates GATT may be a good surgical option for post-PKP glaucoma, given the ability to perform future incisional surgery and avoidance of high risk complications associated with traditional glaucoma surgeries.