(623) 878-3939
Request Appointment
Patient PortalGATT & KDB Goniotomy & iVEnt
A minimally invasive procedure that opens your eye's natural drain (trabeculum) using a special catheter.
What is GATT, KDB Goniotomy or iVEnt?
GATT (Gonioscopy-Assisted Transluminal Trabeculotomy) and KDB (Kahook Dual Blade) are minimally invasive procedures that directly remove obstruction from your eye's trabecular meshwork. Using specialized instruments and a gonioscope for direct visualization, your surgeon carefully opens the trabecular tissue that has become blocked. This allows fluid to drain naturally through your eye's original drainage system.
Unlike bypass stents or creating new openings, goniotomy restores your original drainage pathway. This is direct tissue removal — mechanically unblocking what has become clogged. Results are good in patients with reasonable trabecular tissue quality.
iVEnt is a newer less invasive version in which trabecular tissue is preserved and NOT removed. Instead a fine blade is used to disinsert the taut trabecular meshwork allowing it to function more easily improving outflow of aqueous fluid.
When is GATT/KDB appropriate? GATT or KDB is indicated for patients with mild to moderate glaucoma and normal trabecular anatomy. It works best when there is no severe scarring or previous angle surgery. It can be performed on one or multiple quadrants of the angle. Patients with good trabecular tissue have better outcomes.
What to Expect — Before, During, and After
Before the procedure: You will receive general anesthesia or IV sedation. A special viewing lens (gonioscope) will be placed on your eye to allow direct visualization of your trabecular meshwork.
During the procedure: The surgeon uses a specialized cutting instrument (either GATT catheter or KDB blade) to carefully remove tissue and open the trabeculum. The goniotomy is performed under direct visualization, making it precise and controlled. Total time is about 15 minutes.
After the procedure: You may experience mild soreness and blurred vision. You will use antibiotics and anti-inflammatory drops for a few weeks. Some heme reflux (bleeding into the anterior chamber) is expected in the first few weeks. Avoid leaning your head forward or lying face-down for the first week.
Recovery timeline
- Day 1: Mild discomfort and blurriness possible. Use prescribed antibiotics and anti-inflammatory drops. Avoid head-down activities (yoga, leaning over) for 1 week. Limit strenuous activities.
- Week 1: First postop visit. Heme reflux (blood in the anterior chamber) is expected and normal. Do not perform head-down activities as this may increase hyphema.
- 1 month: Second postop exam. Heme reflux typically clears by this time. Evaluate pressure response and trabecular opening.
- 3 months: Final postop assessment. Pressure response should be evident. A hypertensive phase may occur and can be managed medically. Return to routine glaucoma schedule.
Important postop precautions: Avoid head-down activities (bending forward, yoga inversions, leaning over a sink) for the first week after goniotomy. These activities increase pressure and can worsen hyphema (blood in the chamber). Keep your head upright to allow blood to settle toward the bottom of the eye naturally.
Your Follow-up Schedule
GATT/KDB requires regular early follow-up to monitor the goniotomy opening and pressure response. Heme reflux management is part of normal healing.
What we monitor
- Goniotomy opening and patency
- Heme reflux clearance (normally clears in 2-4 weeks)
- Intraocular pressure response
- Inflammation and healing
- Any hypertensive phase
- Trabecular tissue response
Our Outcomes — What EPSAZ Patients Experience
Here is what we see with GATT and KDB goniotomy in patients with appropriate trabecular anatomy:
Why this matters: Goniotomy directly treats the root problem: tissue obstruction in your original drainage pathway. Success depends on good patient selection — preserved trabecular tissue and reasonable angle anatomy produce the best results.