-: In this video, we present a GATT procedure
with Blue Donut technique
for trabecular meshwork staining
in the juvenile glaucoma patient.
GATT provided excellent outcomes in juvenile glaucoma,
and can be challenging in patients
with less trabecular meshwork pigmentation.
Trypan blue can be used in trabecular meshwork staining.
Effects of trypan blue on a crystalline lens are not known.
We see defined Blue Donut technique
for trabecular meshwork staining,
without inadvertent staining of the lens.
Our 30-year-old male juvenile glaucoma patient's
right eye IOP
was 38 mm Hg with full medication.
On gonioscopy, no pigmentation was seen.
We recommended GATT procedure for the patient.
Suture tip is cauterized.
After site port incision, Miostat is injected for miosis,
and 3% sodium hyaluronate viscoelastic fluid
is filled into central anterior chamber
to protect the clear crystalline lens.
After the eye is pressurized,
diluted trypan blue is injected by nasal direction
and a blue donut shape is formed.
After waiting 30 seconds, trypan blue is washed out.
Anterior chamber is filled again
with clear 3% sodium hyaluronate.
Blunt tip 6-0 Prolene
is inserted into the anterior chamber.
Patient's head and microscope is tilted for angle surgery.
Nasal goniotomy anterior to blue hue is performed,
and 6-0 Prolene is easily inserted into the Schlemm canal
and advanced circumferentially.
Tip of 6-0 Prolene from opposite side
is holded.
360-degree GATT is successfully completed.
360-degree angle hemorrhage observed,
and anterior chamber washing is done.
After irrigation and aspiration, wound closure is provided.
Air is injected into the anterior chamber
for hemorrhage tamponade, and the operation is finalized.
In the last exam, patient IOP was under control,
and the crystalline lens was clear.