Malignant glaucoma following gonioscopy-assisted transluminal trabeculotomy: a case report

Background: To report a case of malignant glaucoma that developed after gonioscopy-assisted transluminal trabeculotomy (GATT). Case presentation: An 85-year-old male pseudophakic patient afected by pseudoexfoliative glaucoma (PEXG), unresponsive to medical glaucoma treatment, underwent uneventful GATT surgery. On the frst day after surgery, the eye showed a shallow central and peripheral anterior chamber (AC) with a raised intraocular pressure (IOP) measured at 55mmHg. Optical coherence tomography and ultrasound biomicroscopy confrmed the diagnosis of malignant glaucoma. Laser iridotomy, posterior capsulotomy and hyaloidotomy were performed, and the patient was treated with atropine sulphate 1%, maximum topical and systemic ocular hypotensive drugs with no improvement in the IOP. Subsequently, the patient underwent pars plana anterior vitrectomy, resulting in deepening of the AC with opening of the iridocorneal angle and decrease of the IOP. No further postoperative complications were recorded, and the IOP remained controlled 12months after surgery without antiglaucoma medications. Conclusions: Despite the minimally invasive profle of GATT, malignant glaucoma may develop after this procedure. Early recognition and prompt treatment are mandatory for preventing permanent visual loss.