Gonioscopy-assisted transluminal trabeculotomy in post-bleb repair corneal patch graft

A 48-year-old patient presented with primary angle closure glaucoma (PACG) who underwent combined phacoemulsification–trabeculectomy with mitomycin C in both eyes, 7 years ago. The best-corrected visual acuity in the right eye (RE) was 6/6 and in the left eye (LE) was 6/18. Intraocular pressure was 13 and 5 mmHg in RE and LE, respectively. On anterior segment examination, RE showed a diffuse bleb and LE revealed a thin cystic leaking bleb [Figure 1] with normal anterior chamber depth (Van Herricks grade 4) and foldable intraocular lens. Dilated fundus examination showed 0.85 cupping in both eyes, with choroidal folds in LE. Bleb repair using a corneal patch graft was conducted in LE [Figure 2]. On a 2-month follow-up, BCVA was 6/9 and IOP 12 mmHg. The patient was lost to follow-up. After 1 year, the patient presented with high intraocular pressure of 26 mmHg in LE with maximum medical therapy. Gonioscopy-assisted transluminal trabeculotomy [Figures 3 and 4] was conducted for uncontrolled IOP. Thereafter, after a 2-week follow-up and on subsequent visits up to 6 months, IOP was maintained at 16 mmHg without any antiglaucoma medications.