Intermittent Bleeding from the Iridocorneal Angle and Subsequent Ghost Cell Glaucoma Following Gonioscopy-Assisted Transluminal Trabeculotomy: A Case Report

Abstract

Purpose: This study aims to present a case involving intermittent bleeding from the iridocorneal angle following gonioscopy-assisted transluminal trabeculotomy (GATT) surgery, followed by the development of ghost cell glaucoma (GCG). Methods: A 25-year-old man with a history of post-traumatic angle recession glaucoma underwent uneventful 360° GATT surgery. Results: Two weeks after the surgery, while the reason for the incomplete resolution of hyphema remained unclear, intermittent bleeding from the iridocorneal angle and hemorrhage in the inferior vitreous were observed during the patient’s follow-up examination. Although bleeding was controlled with intravenous tranexamic acid therapy, the patient required pars plana vitrectomy due to the development of GCG. Despite medical treatment, the patient’s intraocular pressure (IOP) remained elevated during follow-ups, leading to the decision to perform Ahmed Glaucoma Valve implantation surgery as a final intervention. At the latest evaluation, the patient’s IOP was under control without medication. Conclusion: Following GATT surgery, the possibility of intermittent bleeding from the iridocorneal angle should be considered if the hyphema persists beyond the expected duration. Hospitalization and closer patient monitoring may be necessary to detect intermittent bleeding.