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Phaco-canaloplasty offers sustained IOP reduction and low complication rate

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Louis D. Nichamin

Phaco-canaloplasty controls IOP, reduces glaucoma medication use and offers a high safety profile, a speaker said.

"It's been a real boon to our practice so far. I would ask you to consider canaloplasty in the future," Louis D. "Skip" Nichamin, MD, said at Hawaiian Eye 2011.

Traditional glaucoma therapies encompass IOP-lowering medications, laser surgery, filtration surgery and ocular implants, but many of these treatments involve high complication rates and low efficacy, Dr. Nichamin said.

Trabeculectomy, with or without mitomycin C, reduces IOP but often involves complex postoperative management and unpredictable complication rates, Dr. Nichamin said.

Phaco-canaloplasty, performed after cataract extraction and IOL implantation, involves the insertion of a 10-0 Prolene suture into Schlemm's canal via a scleral flap. The suture is tensioned to dilate Schlemm's canal, restoring natural aqueous flow and reducing IOP. The technique eliminates the need for a bleb.

Phaco-canaloplasty involves a shallow learning curve, especially for surgeons experienced in trabeculectomy.

"I was surprised canaloplasty procedures incorporated so easily into my practice," Dr. Nichamin said.

Results of a clinical study showed that at 3 years postop, phaco-canaloplasty reduced mean IOP from baseline by 45% and mean daily medication use by 81%. Canaloplasty alone reduced mean IOP by 34% and mean medication use by 53%.

In addition, nearly all early complications were resolved within 24 hours to 72 hours. Late complication rates were low; no vision-threatening complications were reported.

The procedure is eligible for private health insurance and Medicare coverage, Dr. Nichamin said.

• Disclosure: Dr. Nichamin has a financial interest in Abbott Medical Optics, Allergan, Bausch + Lomb, Glaukos, Harvest Precision, iScience, 3-D Vision, LensAR, PowerVision, RevitalVision and WaveTec Vision.

Hawaiian Eye and Retina 2012 will be held January 15-20 at the Grand Wailea Resort & Spa in Maui. Learn more at OSNHawaiianEye.com or RetinaMeeting.com.