Canaloplasty improves aqueous outflow without penetrating the eye

LAS VEGAS — Canaloplasty appears to be effective in improving circumferential outflow in patients with primary open-angle glaucoma, according to a surgeon speaking here.

Richard A. Lewis, MD, described his experience using the iTrack Microcatheter (iScience) to improve outflow through Schlemm's canal during Glaucoma Subspecialty Day preceding the American Academy of Ophthalmology meeting.

Canaloplasty is a nonpenetrating, blebless surgical technique in which a suture is passed through Schlemm's canal with the help of the microcatheter and tied with a small amount of tension to reopen the canal, according to Dr. Lewis.

After the initial challenge of locating the canal, which Dr. Lewis says can be alleviated with some instruction, the surgeon inserts the iTrack device into the eye and uses a viscoelastic to dilate the entire 360° of the canal. The tube is then navigated through the canal, which is facilitated by a lighted, flashing beacon included in the iTrack.

Once canalization is complete, a suture is threaded through the canal and tied off, Dr. Lewis said.

In a multicenter, prospective study in 92 patients, canaloplasty reduced mean IOP from 23.3 mm Hg at baseline to 14 mm Hg at 1 day postop, he said.

"I think this procedure provides an interesting and unique opportunity to work in a space that glaucoma surgeons have not worked in, not only to provide surgical control of glaucoma, but also to provide medical treatment as well, in a long-term example," Dr. Lewis said.

Six-month results of the trial are pending, Dr. Lewis said.