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Wiens et al. Mini-invasive Surg 2021;5:8 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2020.105

Case Report Open Access

Reticular patterned episcleral venous plexus and
360-degree episcleral venous fluid wave after hemi-

gonioscopy assisted transluminal trabeculotomy

Julia Wiens , Malcolm Gooi , Matt Schlenker , Teong Lam Gooi , Danielle Wentzell , Patrick Gooi 2,4
3
2
1
2
2
1 Max Rady College of Medicine, University of Manitoba, Winnipeg R3E 0W2, Canada.
2 Cloudbreak Eye Care, Calgary T2H 0C8, Canada.
3 Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto M5T 3A9, Canada.
4 Division of Ophthalmology, Department of Surgery, University of Calgary, Calgary T2V 1P9, Canada.
Correspondence to: Dr. Patrick Gooi, Cloudbreak Eye Care, Suite 315-5340 1st ST SW, Calagry, Alberta T2H0C8, Canada.
E-mail: Patrick.gooi@cloudbreak.ca
How to cite this article: Wiens J, Gooi M, Schlenker M, Gooi TL, Wentzell D, Gooi P. Reticular patterned episcleral venous plexus
and 360-degree episcleral venous fluid wave after hemi-gonioscopy assisted transluminal trabeculotomy. Mini-invasive Surg
2021;5:8. http://dx.doi.org/10.20517/2574-1225.2020.105

Received: 15 Nov 2020 First Decision: 7 Dec 2020 Revised: 31 Dec 2020 Accepted: 8 Jan 2021 Published: 3 Feb 2021
Academic Editor: Kazuyuki Hirooka Copy Editor: Xi-Jun Chen Production Editor: Yue-Yue Zhang

Abstract
We describe a method for eliciting an episcleral venous fluid wave (EVFW) in eyes presenting with reticular
patterned episcleral venous plexus, after a hemi-gonioscopy assisted transluminal trabeculotomy (hemi-GATT).
To reduce the risk of post-operative hyphema and reduce intraoperative tissue manipulation, a hemi-GATT
(targeting 180-degrees of Schlemm’s canal) was performed. Post-hemi-GATT, the ability to inject balanced salt
solution and obtain an EVFW in both the treated (inferior) and untreated (superior) sectors of the eye supports the
surgical success of the technique, and demonstrates an enhanced fluid outflow and subsequent vessel blanching.
The pre-operative intraocular pressure of 20/21 mmHg in a single subject decreased to 18-, 12- and 15-mmHg
after one day, one month and 3 months post-op, respectively, and the subject was rendered medication-free.
This method of performing a hemi-GATT to effectively obtain an EVFW provides evidence for novel treatment
algorithms in patients with a reticular episcleral venous plexus where identification of major outflow vessels is less
apparent.

Keywords: Gonioscopy assisted transluminal trabeculotomy, micro-invasive glaucoma surgeries, glaucoma
surgery, episcleral venous fluid wave

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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