An amazing 85.9% success rate over three years in treating open-angle glaucoma – this is the remarkable effectiveness of canaloplasty. It’s a new surgical procedure that’s changing how we manage this chronic eye condition. Canaloplasty is a minimally invasive glaucoma surgery (MIGS). It offers a gentler, more targeted way to lower intraocular pressure (IOP) and reduce the need for medication.
Key Takeaways
- Canaloplasty is a modern, minimally invasive glaucoma surgery that aims to improve aqueous humour drainage through Schlemm’s canal
- It involves circumferential viscodilation and tensioning of the canal using a flexible microcatheter (the iTrack device)
- Canaloplasty has demonstrated impressive IOP reduction and success rates in multiple prospective studies, with an overall success rate of 87%
- The procedure offers a less invasive alternative to traditional glaucoma filtration surgeries, with the potential for lower complication rates
- Canaloplasty can be effectively integrated with cataract surgery for a combined treatment approach
Introduction to Canaloplasty
Definition and Overview
Canaloplasty is a new way to treat glaucoma. It helps the eye’s natural drainage system, called Schlemm’s canal. This method uses a special tool to open up the canal and improve drainage.
This surgery is less invasive than older methods. It aims to lower eye pressure without making a new hole in the eye. This could mean less pain and quicker recovery for patients.
| Device Market | Currently, 2 devices are available for canaloplasty: the iTrack microcatheter delivers +100 μl of OVD over 360 degrees of the canal, and the Omni Surgical System provides 5.5 μl of OVD across 180 degrees of the canal (twice for a total of 360 degrees and 11 μl). |
|---|---|
| Clinical Studies | A study showed a significant reduction in intraocular pressure (IOP) and medication usage post-canaloplasty, with 84.2% of eyes achieving IOP reductions greater than 20% from baseline and 80% being medication free. |
| Outflow Facility Improvement | The more volume of OVD injected during canaloplasty, the more stretching of the outflow system occurs, resulting in a greater improvement in outflow facility. |
| TM Impact | Canaloplasty impacts the trabecular meshwork by stretching it, possibly causing microperforations and improving outflow. |
| Hydraulic Effect | The delivery of the high-molecular-weight OVD during canaloplasty stretches the TM and collector channels, lifting adhesions and improving outflow. |
Canaloplasty is a safe and effective way to lower eye pressure for glaucoma patients. It’s a less invasive option that could help many people manage their condition better.
Indications and Patient Selection
Canaloplasty is a modern treatment for open-angle glaucoma, including primary open-angle glaucoma. It’s also used for some secondary glaucoma types like pseudoexfoliative glaucoma and pigmentary glaucoma.
It might also help those with corticosteroid-induced glaucoma or who’ve had prior incisional glaucoma surgery. But, it’s important to choose the right patients. It’s not for everyone, especially those with advanced glaucoma or big changes in the angle and Schlemm’s canal.
Research shows canaloplasty can lower intraocular pressure and cut down on medication. This makes it a good option for many glaucoma patients.
| Glaucoma Type | Suitability for Canaloplasty |
|---|---|
| Primary Open-Angle Glaucoma | Suitable |
| Secondary Glaucoma (Pseudoexfoliative, Pigmentary) | Suitable |
| Corticosteroid-Induced Glaucoma | Suitable |
| Prior Incisional Glaucoma Surgery | Suitable |
| Advanced Glaucoma | May not be suitable |
| Significant Anatomical Changes in Angle and Schlemm’s Canal | May not be suitable |
By choosing the right patients, canaloplasty can be a great treatment for many glaucoma types. It helps manage eye pressure and lowers the need for medication.
Surgical Technique
Canaloplasty is usually done using an ab-externo approach. This method involves a deep scleral dissection to reach and treat Schlemm’s canal. The main steps are:
- Creating a conjunctival and scleral flap;
- Performing a deep scleral dissection to expose Schlemm’s canal;
- Inserting a flexible microcatheter into Schlemm’s canal and advancing it 360 degrees;
- Injecting viscoelastic material through the microcatheter to dilate the canal;
- Removing the microcatheter and implanting a tensioning suture to maintain the dilation of Schlemm’s canal.
In some cases, clear cornea phacoemulsification is also done with canaloplasty.
| Complication | Incidence |
|---|---|
| Postoperative hyphema | Common, resolves within days or weeks |
| Cataract formation | May require surgical treatment in the future |
| Corneal decompensation | Very uncommon |
| Severe inflammation | Uncommon, may require prolonged treatment |
| Iris tissue damage | Very uncommonly |
| Blurred vision, vision loss | Uncommon, may be irreversible in rare cases |
| Cystoid macular oedema | Rare, may require anti-inflammatory treatment |
| Sympathetic ophthalmia | Very rare |
| Incomplete pressure control | May necessitate additional procedures |
| Increased pressure due to scarring | Rare, may require further intervention |
Though complications can happen, the risk of canaloplasty is still low. This makes it a good ab-externo method for treating glaucoma.
Canaloplasty
Canaloplasty is a surgery that helps the eye drain fluid better. It works on Schlemm’s canal, the main drainage path. This method uses viscodilation and suture tensioning without touching the inside of the eye. It aims to lower eye pressure safely.
This surgery is best for people with open-angle glaucoma. It’s good for those with clear lenses, high myopia, and aphakia. But, it’s not for everyone, especially those with certain eye problems.
The surgery starts with a small cut in the sclera. A thin microcatheter is then inserted into Schlemm’s canal. It helps widen the canal and tighten it with a suture. This improves the eye’s natural drainage of fluid.
| Procedure | Postoperative IOP | Medication Dependency | Success Rate |
|---|---|---|---|
| Viscocanalostomy | 16.1 ± 3.9 mmHg | 0.4 ± 0.5 medications | 35.7% complete success, 50% qualified success |
| Canaloplasty | 14.5 ± 2.6 mmHg | 0.3 ± 0.5 medications | 60% complete success, 86.7% qualified success |
Canaloplasty has shown great results in lowering eye pressure and reducing medication use. It can lower eye pressure by up to 30% without needing a stent. This makes it a good option for some patients.
“Canaloplasty is more technically challenging than trabeculectomy but avoids bleb-related complications and hypotony.”
Outcomes and Efficacy
IOP Reduction and Medication Dependency
Many studies show that canaloplasty is effective in lowering intraocular pressure (IOP) and reducing medication use in open-angle glaucoma patients. It has been found to lower IOP by 30-40% in some cases. This allows many patients to stop or reduce their glaucoma medications.
Long-term results of canaloplasty are also encouraging. Studies have shown it keeps IOP under control for years with good safety. This makes canaloplasty a good choice for those looking for a different treatment than traditional surgeries.
| Outcome Measure | Canaloplasty | Trabeculectomy |
|---|---|---|
| Strict Success Rate | 20.0% | 56.4% |
| Complete Success Rate | 24.3% | 66.4% |
| Qualified Success Rate | 34.3% | 73.6% |
| IOP Reduction (mmHg) | 13.7 ± 10.4 | 9.2 ± 7.9 |
| Medication Dependency | 10.7% | 50.0% |
| Revision Surgeries | 21.4% | 41.4% |
The table shows the differences between canaloplasty and trabeculectomy. Trabeculectomy had better success rates and more IOP reduction. But, canaloplasty had less medication use and fewer surgeries needed.
This suggests canaloplasty could be a good choice for those wanting a less invasive option. It has a better safety record and requires less medication over time.
Complications and Management
Canaloplasty, like any surgery, has risks, but they are lower than traditional glaucoma surgeries. Possible canaloplasty complications include hyphema, IOP spikes, Descemet’s membrane detachment, and failure to complete the 360-degree canal catheterisation.
Choosing the right patient, using precise surgical technique, and good postoperative management are key. They help reduce risks and improve results. If adverse events happen, quick action is vital to avoid bad outcomes.
Success rates for cannulating Schlemm’s canal are between 74% and 89.9%. About 3.3% of cases involve a microcatheter breaking through the canal wall into the anterior chamber or suprachoroidal space. This is a big intraoperative challenge.
Descemet’s membrane detachment is a serious intraoperative complication seen in 1.6% to 9.1% of cases. It requires careful surgery and quick recognition to manage well.
Patients who had phacocanaloplasty (cataract surgery plus canaloplasty) saw better results than those with canaloplasty alone. Up to 36% of those who had canaloplasty alone reached an IOP of 18mmHg or lower without medication. This number jumped to 70.4% for those who had phacocanaloplasty.
| Procedure | Reduction in Hypotensive Eye Drop Usage |
|---|---|
| Canaloplasty Alone | Up to 36% achieved IOP ≤18mmHg without medication |
| Phacocanaloplasty | Up to 70.4% achieved IOP ≤18mmHg without medication |
Phacocanaloplasty led to a 53% and 80% drop in hypotensive eye drop use compared to canaloplasty alone. Fewer patients needed an extra goniopuncture to reach the target IOP after phacocanaloplasty than after canaloplasty.
Comparison with Other Glaucoma Surgeries
Trabeculectomy and Other Filtering Surgeries
Canaloplasty has some benefits over traditional glaucoma surgeries like trabeculectomy. It works differently by improving the natural flow of fluid through Schlemm’s canal. This might lower the chance of complications like infections and vision problems.
Canaloplasty also seems to cause less vision loss and need for extra treatments after surgery. It might not lower eye pressure as much, but it’s a less invasive method. This can help patients use less medication.
| Procedure | IOP Reduction | Medication Dependency | Bleb-related Complications |
|---|---|---|---|
| Canaloplasty | Moderate | Reduced | Lower risk |
| Trabeculectomy | Greater | Reduced | Higher risk |
| Other Filtering Surgeries | Varied | Varied | Higher risk |
Research has shown both canaloplasty and filtering surgery can lower eye pressure. But, filtering surgery might work better for some. Canaloplasty, on the other hand, is safer for others.
Future Directions and Innovations
Canaloplasty, a new glaucoma surgery, is getting better with time. Researchers are working hard to make it more effective and use it for more conditions. They’re looking into new tools and ways to combine it with other surgeries.
They also want to understand how the eye drains fluid better. This could lead to even more precise surgeries for glaucoma.
The iTrack Advance is a new device for canaloplasty. It can go all the way around the eye in one go. This device works on three parts of the eye to help with glaucoma. It’s approved in the EU and US for treating open-angle glaucoma.
Studies show that mixing canaloplasty with other treatments can be very effective. For example, adding it to cataract surgery can lower eye pressure a lot. This means patients might need less medicine.
As we learn more about how the eye drains fluid, we’ll see even better treatments. These new methods could make glaucoma care even more effective. This is good news for people with glaucoma.
| Surgical Technique | Advantage | Limitation |
|---|---|---|
| Trabeculectomy (TE) | – Achieves significant IOP reduction – Proven long-term efficacy |
– High risk of filtering bleb scarring – Potential for intraoperative and postoperative complications (e.g., choroidal haemorrhaging) |
| Canaloplasty (CP) | – Achieves IOP reduction similar to TE – Lower complication rate than TE – Effective in treating severe glaucomas |
– Complete success (≤16 mmHg without medication) only achieved in half of patients after 3 years |
| Combined Phacoemulsification and Canaloplasty | – Significantly lower IOP levels – Reduced medication requirements compared to CP alone |
– Limited long-term data on outcomes |
The future of canaloplasty and other innovative glaucoma treatments looks bright. New tools and ways to mix surgeries are being explored. These changes aim to make glaucoma care even better.
Conclusion
Canaloplasty is a modern, minimally invasive treatment for glaucoma. It works by improving the eye’s natural drainage system. This method can lower eye pressure and reduce the need for medication in patients with open-angle glaucoma. Canaloplasty is seen as a safer alternative to traditional surgeries, offering a less invasive way to manage glaucoma in the UK.
Recent studies show promising results. They found significant drops in eye pressure and medication use. Also, many patients avoided needing more surgeries. This suggests canaloplasty is effective for both mild and advanced glaucoma cases.
As research advances, canaloplasty and similar techniques may become more crucial in treating glaucoma. They offer a chance for long-term eye pressure control and less medication use. This could greatly improve the lives of UK patients with this chronic condition.
FAQ
What is canaloplasty?
Canaloplasty is a new, less invasive surgery for glaucoma. It helps lower eye pressure by improving drainage through Schlemm’s canal.
How does canaloplasty work?
This surgery uses a special microcatheter to widen Schlemm’s canal. It helps fluid drain out without making a bleb or touching the front chamber.
What are the key indications for canaloplasty?
It’s mainly for open-angle glaucoma, including primary and some secondary types. It’s also for those with glaucoma from steroids or after other eye surgeries.
How is the canaloplasty procedure performed?
The surgery is done from the outside, with a deep cut to reach Schlemm’s canal. Steps include making a flap, exposing the canal, and placing a microcatheter and suture.
What are the potential benefits of canaloplasty?
It aims to improve natural drainage, reducing risks from traditional surgeries. It might lower the chance of vision loss and need for more treatments.
What are the potential complications of canaloplasty?
Risks include bleeding, high pressure, and detachment. Careful selection and technique are key to avoiding these issues.
How does canaloplasty compare to other glaucoma surgeries?
It’s a more precise, less invasive method than traditional surgeries. It might not lower pressure as much but has fewer complications.
What are the future developments in canaloplasty?
Research aims to improve results and expand its use. New microcatheters and combining it with other surgeries are being explored.
