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Review
. 2019 Dec 31:13:2617-2629.
doi: 10.2147/OPTH.S155057. eCollection 2019.

Canaloplasty in the Treatment of Primary Open-Angle Glaucoma: Patient Selection and Perspectives

Anna Byszewska  1 , Joanna Konopińska  2 , Aleksandra Kinga Kicińska  1 , Zofia Mariak  2 , Marek Rękas  1
Affiliations
Review

Canaloplasty in the Treatment of Primary Open-Angle Glaucoma: Patient Selection and Perspectives

Anna Byszewska et al. Clin Ophthalmol. .

Abstract

Canaloplasty is a surgical procedure that has undergone a number of developments since its introduction in 2005. Many thousands of canaloplasties have been performed around the world since then and is, by definition, a blebless procedure. It does not necessitate the use of any antifibrotic agents and results in safe and effective IOP reductions in patients with open-angle glaucoma (OAG) with minimal complications and no bleb-related adverse events. When considering the surgical management of patients with early and medium stages of the disease, canaloplasty can be considered as a first line option. This paper will overview the theoretical effectiveness of canal surgery, the fundamental aspects of aqueous outflow resistance with particular emphasis on the role of the trabecular meshwork, Schlemm's canal, and the collector channels, and the methods available for the clinical evaluation of the outflow pathways in relation to the ocular anatomy. Further, the paper will detail the surgical technique itself and how this has developed over time together with the clinical aspects that should be accounted for when selecting patients for this surgery.

Keywords: ABiC; aqueous outflow; canaloplasty; canaloplasty ab interno; canaloplasty modification; canaloplasty patients selection; canaloplasty qualification; glaucoma; iTrack; minicanaloplasty; schlemm's canal.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
The surgical technique of canaloplasty. (A) Peritomy and dissection of the superficial scleral flap. (B) Creation of a trabeculo-descemetic membrane and visualization of the scleral spur and Schlemm’s canal. The insertion of the iTrack catheter in the ostium of the canal. (C) After successful catheterization of the canal the iTrack catheter is seen at both ostia. (D) Bonding the Prolene suture to the distal end of the iTrack catheter. (E) Placing Prolene 10-0 suture in the canal with simultaneous viscodilatation. (F) Watertight suturing of the superficial scleral flap. Notes: Copyright ©2016. Okulistyka: Kwartalnik Medyczny. Byszewska A, Rudowicz J, Lewczuk K, Rękas M. Nowości w technikach chirurgicznych kanaloplastyki. [Update on Surgical Techniques in Canaloplasty]. 2016;3:14-19. Polish.
Figure 2
Figure 2
The surgical technique of minicanaloplasty. (A) Peritomy and dissection of the superficial scleral flap (4x1mm). (B) Dissection of a small deep scleral flap (1x1mm) in order to access Schlemm’s canal. (C) The illuminated tip enables transscleral visualization of the catheter during 360° cannulation. (D) Following successful catheterization of the canal, the iTrack catheter is seen at both ostia. (E) The viscodilatation and placement of the Prolene 10-0 suture under tension in the Schlemm’s canal are completed. (F) Closure of the conjunctiva with diathermy or with a single Vicryl 8-0 suture. Notes: Copyright ©2016. Okulistyka: Kwartalnik Medyczny. Byszewska A, Rudowicz J, Lewczuk K, Rękas M. Nowości w technikach chirurgicznych kanaloplastyki. [Update on Surgical Techniques in Canaloplasty]. 2016;3:14-19. Polish.
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