Recent studies show glaucoma is most common in African patients. This highlights the need for safe and effective treatments. Viscocanalostomy is a new, non-penetrating method. It’s a safer option than traditional surgery for those in the UK and other Western countries.
Key Takeaways
- Viscocanalostomy is a modern glaucoma surgery that aims to restore the natural drainage of aqueous humour into Schlemm’s canal, reducing intraocular pressure without creating a filtering bleb.
- The procedure involves carefully dissecting and opening Schlemm’s canal to improve aqueous outflow, without penetrating the anterior chamber.
- Viscocanalostomy has gained popularity in the UK and other Western countries as a safe and effective treatment for uncontrolled glaucoma, with a lower risk of complications compared to trabeculectomy.
- Patients undergoing viscocanalostomy have experienced a significant reduction in intraocular pressure, with a mean postoperative IOP of 17 mm Hg.
- The technique offers a bleb-free glaucoma treatment option, making it an attractive alternative to traditional glaucoma surgeries.
What is Viscocanalostomy?
Viscocanalostomy is a surgery for glaucoma that helps the eye drain better. It works on Schlemm’s canal, a circle in the eye that moves aqueous humour out. But in glaucoma, this canal can get blocked, raising eye pressure.
Principles of Viscocanalostomy
The main aim of viscocanalostomy is to find a new way for aqueous humour to leave the eye. It does this by opening up Schlemm’s canal. This helps fluid flow out, lowering eye pressure without cutting the eye like old surgeries.
This surgery is safer than some others and is a type of non-penetrating glaucoma surgery. It uses microsurgical techniques to make a path for fluid to leave the eye. This lowers the chance of problems seen with more invasive surgeries.
“Viscocanalostomy has advantages over trabeculectomy, including a lower risk of cataract and infection due to the absence of an anterior chamber opening.”
Advantages of Viscocanalostomy
Lower Risk of Complications
Viscocanalostomy is safer than trabeculectomy for glaucoma patients. It doesn’t remove parts of the eye’s drainage system. This reduces the risk of lower complication rates, bleb-free, and reduced hypotony risk.
Trabeculectomy, the traditional method, can lead to serious issues. It’s known for its high risk of complications. In contrast, viscocanalostomy is a safer alternative to trabeculectomy as it keeps the eye’s natural drainage intact.
Studies reveal that open-angle glaucoma can cause blindness in about 10.2% of cases. The National Survey of Trabeculectomy found complications in around 10.8% of cases. Sudden visual loss after surgery in end-stage glaucoma was seen in about 5.3% of patients.
Viscocanalostomy, however, shows promising results. It has a success rate of about 78.5% in pseudoexfoliative and primary open-angle glaucoma. The five-year results show successful treatment in around 92% of patients. This highlights the procedure’s lower risk of complications.
| Procedure | Positive Outcomes |
|---|---|
| Viscocanalostomy (Long-term) | 78.5% |
| Viscocanalostomy (Five-year) | 92% |
| Trabeculectomy (21st Century) | 86% |
| Non-penetrating Deep Sclerectomy and Collagen Implant | 79.6% |
| Non-penetrating Filtration Surgery vs. Trabeculectomy | 75% |
Viscocanalostomy’s lower complication rates, bleb-free nature, and reduced hypotony risk make it a safer alternative to trabeculectomy for glaucoma patients.
Viscocanalostomy: The Surgical Procedure
Viscocanalostomy is a detailed microsurgical method. It aims to fix the eye’s natural drainage system for aqueous humour. This surgery has key steps to improve drainage and lower eye pressure in those with glaucoma.
- Accessing Schlemm’s Canal: The surgeon makes a small flap in the sclera. This flap lets them reach Schlemm’s canal, the main drainage route for aqueous humour.
- Dilating Schlemm’s Canal: A special substance is injected into Schlemm’s canal. This makes the canal wider, helping more humour to drain out.
- Creating a Trabeculo-Descemet’s Window: The surgeon carefully removes parts of the trabecular meshwork and Descemet’s membrane. This creates a new window for better drainage.
- Securing the Scleral Flap: The surgeon puts the scleral flap back in place. This helps keep the eye’s structure strong and the new drainage pathway open.
Viscocanalostomy stands out because it uses microsurgery and keeps the eye’s natural drainage system intact. This is different from trabeculectomy, which creates a new drainage path by going through the eye’s structures.
Viscocanalostomy targets lowering eye pressure with less risk of complications. Its goal is to manage glaucoma well and keep the patient’s vision good.
Intraocular Pressure Reduction
Viscocanalostomy aims to lower intraocular pressure (IOP) by fixing the eye’s drainage. It opens Schlemm’s canal to improve the flow of aqueous humour. This is key for glaucoma patients with high IOP.
In a study, 94 eyes from 67 patients aged 76.4 years on average were treated. Before surgery, IOP was 17.75 ± 2.19 mmHg. After 3 years, it dropped to 13.41 ± 2.22 mmHg.
By the 3-year mark, IOP was 24.4% lower. This change was significant (p
| Metric | Pre-operative | 3-year Post-surgery |
|---|---|---|
| Mean IOP (mmHg) | 17.75 ± 2.19 | 13.41 ± 2.22 |
| IOP Reduction (%) | – | 24.4% |
| Patients Requiring Laser Goniopuncture | – | 17 |
| Patients Requiring Antiglaucoma Drops | 2.66 ± 0.91 | 0.28 ± 0.58 |
| Patients Drop-free | – | 62% |
The study showed Viscocanalostomy’s success in lowering IOP. It also reduced the need for eye drops. By the 36-month follow-up, 62% of patients no longer needed drops.
“At the 3-year mark post-surgery, IOP was reduced by 24.4%, which was statistically significant (p
Complications and Risk Factors
While viscocanalostomy is safer than trabeculectomy, it still has risks. Surgeons must watch out for Descemet’s membrane perforation, hypotony, anterior chamber issues, and bleb-related problems.
Descemet’s membrane perforation is a serious issue that can happen during the procedure. It can cause high eye pressure and might need more surgery. Hypotony, or low eye pressure, can also happen early on. Issues with the front part of the eye, like shallow chambers, need quick action.
Bleb problems, like leaks or infections, are less common with viscocanalostomy. But they can still happen. It’s crucial for surgeons to keep a close eye on these issues and follow up care well.
| Complication | Prevalence | Management |
|---|---|---|
| Descemet’s membrane perforation | Rare but serious | Immediate surgical intervention to address the issue |
| Hypotony | Can occur in early postoperative period | Careful monitoring and management of intraocular pressure |
| Anterior chamber issues | May arise and require prompt management | Appropriate surgical techniques to maintain anterior chamber integrity |
| Bleb-related problems | Less common than with trabeculectomy, but can still occur | Vigilant monitoring and proper postoperative care to minimise complications |
Knowing about these risks helps surgeons prevent them. This way, they can give their patients the best results from viscocanalostomy.
Viscocanalostomy vs. Trabeculectomy
Both viscocanalostomy and trabeculectomy are good choices for treating uncontrolled glaucoma. But, they have different approaches. This means one might be better for a patient than the other.
Viscocanalostomy is a gentle method that helps fluid flow out without cutting the eye. Trabeculectomy, on the other hand, is more invasive. It makes a new path for fluid to leave the eye, lowering pressure.
Viscocanalostomy is safer because it has fewer complications than trabeculectomy. It’s less likely to cause bleb problems, low eye pressure, and infections. This makes it a safer choice for those at risk.
When it comes to IOP reduction, the results are not always clear. Some studies say trabeculectomy works better. Others find no big difference between the two.
Choosing between viscocanalostomy and trabeculectomy depends on many factors. These include the patient’s situation, the surgeon’s skill, and what the treatment aims to achieve. It’s important to talk to an eye doctor to decide the best option.
“The decision between viscocanalostomy and trabeculectomy should be based on a careful evaluation of the patient’s individual needs and risk factors, as well as the surgeon’s expertise and preference.”
Postoperative Management
After viscocanalostomy, careful care is key. The usual care for patients includes:
- Topical administration of 0.5% moxifloxacin drops to prevent infection
- A tapered schedule of 1% prednisolone acetate to manage inflammation
- Cessation of antiglaucoma medication after the surgery in all cases
Follow-up visits are set for days 1, 7, 14, and 30, then every 2 months for 2 years. These check-ups look at intraocular pressure (IOP), visual acuity, and any issues. Nd:YAG laser goniopuncture might be needed if IOP goes over 21 mmHg after surgery.
| Postoperative Outcomes | Year 1 | Year 2 | Year 3 | Year 4 | Year 5 |
|---|---|---|---|---|---|
| Mean IOP (mmHg) | 15.2 | 15.6 | 14.6 | 13.8 | 14.0 |
| Qualified Success (IOP ≤ 21 mmHg) | 94.2% | 88.1% | 92.5% | 91.1% | 92.0% |
| Complete Success (IOP ≤ 21 mmHg) | 63.8% | 37.3% | 30.2% | 22.2% | 24.0% |
| Qualified Success (IOP ≤ 15 mmHg) | 53.6% | 60.9% | 69.8% | 68.9% | 64.0% |
| Complete Success (IOP ≤ 15 mmHg) | 39.1% | 26.9% | 22.6% | 20.0% | 8.0% |
This detailed care plan, including IOP monitoring, goniopuncture, and glaucoma medication adjustments, is key to viscocanalostomy’s success in treating glaucoma.
Indications and Patient Selection
Viscocanalostomy is a modern surgery for glaucoma. It’s mainly for those with uncontrolled open-angle glaucoma. This includes primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG), and some secondary open-angle glaucoma types, like pseudoexfoliative glaucoma.
Who can have viscocanalostomy depends on several things. These include the glaucoma type, disease severity, and risk factors. Those with moderate to advanced open-angle glaucoma, who haven’t responded well to other treatments, are often good candidates.
Patient Characteristics and Indications
- Primary open-angle glaucoma (POAG) – Accounts for the majority of cases, with up to 70% of patients suitable for viscocanalostomy.
- Normal-tension glaucoma (NTG) – Patients with NTG may benefit from viscocanalostomy to lower intraocular pressure and reduce disease progression.
- Pseudoexfoliative glaucoma (PEXG) – This secondary open-angle glaucoma type makes up around 25% of suitable candidates for the procedure.
- Pigmentary glaucoma (PIGG) – A smaller proportion, around 5%, of viscocanalostomy patients have this type of open-angle glaucoma.
The success of viscocanalostomy also depends on the severity of the glaucoma. Those with moderate to advanced disease, who haven’t controlled intraocular pressure with other treatments, are often the best candidates.
Also, certain risk factors are considered. These include younger age, higher pre-operative intraocular pressure, and pseudoexfoliation. Healthcare professionals evaluate these carefully to ensure the best outcomes for each patient.
Viscocanalostomy in Different Glaucoma Types
Viscocanalostomy is a successful treatment for many glaucoma types, like open-angle glaucoma, normal-tension glaucoma, and secondary glaucoma. It helps control intraocular pressure (IOP) well in various patients.
A study showed great results with viscocanalostomy in primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PEXG). The IOP dropped significantly in both groups. In PEXG eyes, it was 14.1 mmHg, and in POAG eyes, it was 16.6 mmHg. Success rates were high, with 88.9% in PEXG and 75.9% in POAG.
Another study compared viscocanalostomy with trabeculectomy. Trabeculectomy had a higher success rate at 42% compared to viscocanalostomy’s 21%. But, viscocanalostomy needed less medication after surgery. This shows its benefits for some patients.
The studies showed viscocanalostomy works well for different patients. The average age was 70.3 years, and 56.5% were male. This proves it’s a flexible treatment for many people.
In summary, viscocanalostomy is a good choice for treating various glaucoma types. It lowers IOP and reduces medication needs. This makes it a valuable option for managing glaucoma.
Conclusion
In conclusion, viscocanalostomy is a great option for treating uncontrolled glaucoma. It’s a non-penetrating surgery that opens Schlemm’s canal. This helps the eye drain properly without making a bleb.
The results of viscocanalostomy are impressive. Before surgery, the eye pressure was 24.6 mm Hg. After, it dropped to 5.6 mm Hg at day 1 and 13.9 mm Hg at 36 months. By 60 months, 90% of patients had eye pressure under 21 mm Hg, sometimes without medication.
The surgery is also safe. Only 37% of patients needed a follow-up treatment to control eye pressure. This treatment, called Nd:YAG goniopuncture, was applied after 9.4 months on average. It lowered the eye pressure from 20.4 mm Hg to 12.6 mm Hg.
FAQ
What is viscocanalostomy?
Viscocanalostomy is a new way to treat glaucoma. It helps the eye drain fluid better. This lowers eye pressure without making a bleb.
What are the advantages of viscocanalostomy over trabeculectomy?
Viscocanalostomy is safer than the old method, trabeculectomy. It doesn’t make a hole in the eye. This means less chance of problems like low eye pressure or infections.
How does the viscocanalostomy procedure work?
It’s a detailed surgery that opens Schlemm’s canal. This helps fluid drain better, without touching the front of the eye.
What are the potential complications of viscocanalostomy?
Even though it’s safer, there are still risks. These include damage to the eye’s membrane, low eye pressure, and problems with the front chamber.
How does viscocanalostomy differ from trabeculectomy?
Both are used to treat glaucoma, but differently. Trabeculectomy makes a new path for fluid. Viscocanalostomy tries to fix the eye’s natural drainage.
What is the typical postoperative care for viscocanalostomy patients?
After the surgery, patients need close care. This includes checking eye pressure, using eye drops, and sometimes more surgery to help drainage.
What types of glaucoma are suitable for viscocanalostomy?
It’s best for open-angle glaucoma. This includes primary, normal-tension, and some secondary glaucoma types, like pseudoexfoliative glaucoma.
