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Canaloplasty, trabeculectomy yield similar reductions in IOP, medication use
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BOSTON — Canaloplasty and trabeculectomy yielded similar reductions in IOP and medication use at 1 year, but canaloplasty proved somewhat safer, a speaker said here.
Diamond Y. Tam, MD, presented results of a head-to-head trial comparing the two procedures at the American Society of Cataract and Refractive Surgery meeting.
"Nonpenetrating Schlemm's canaloplasty can be considered in the appropriate patient with open angles to be a possible alternative [to] trabeculectomy and may provide patients with a potentially safer option with avoidance of a bleb," Dr. Tam said.
The retrospective, comparative, randomized study included 101 eyes of 93 patients. Fifty eyes underwent canaloplasty, and 51 eyes underwent trabeculectomy with intraoperative mitomycin C. Both groups had similar mean preoperative IOP and medication use.
Glaucoma severity and best corrected visual acuity were assessed preoperatively and 1, 3, 6 and 12 months postoperatively.
Results showed that at 1 year, canaloplasty lowered IOP to a mean 13.4 mm Hg and reduced medication use to 0.6. Trabeculectomy reduced IOP to a mean 12.3 mm Hg and lowered medication use to 0.7. The differences were statistically insignificant at all follow-up points.
However, recovery of BCVA was faster in the canaloplasty group. The canaloplasty group also had better BCVA than the trabeculectomy group at 1 year postop.
Eight eyes in the trabeculectomy group and none in the canaloplasty group had shallow anterior chambers, Dr. Tam said.
This retrospective comparative study of MMC trabeculectomy and canaloplasty (often augmented with postop laser goniopuncture), with good numbers, found statistical IOP equivalence between both groups and similar success rates. Visual acuity seemed to return quicker after canaloplasty, with better mean vision at 1 year. Reasons for failure in the trabeculectomy group were typically from complications like hypotony, while reasons for failure in the canaloplasty group were more related to lack of efficacy, meaning that IOP was not lowered enough.
I think this study supports the use of canaloplasty as an effective approach to surgically lowering pressure in open-angle glaucoma with a reduction in potentially serious complications compared to trabeculectomy. So basically, bottom line is that it’s a reasonable procedure to use and worth the effort. Canaloplasty can lower IOP to levels similar to trabeculectomy, but with less serious complications.
– Ike K. Ahmed, MD, FRCSC
OSN Glaucoma
Board Member
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