A review of canaloplasty

Abstract

Canaloplasty is a method of lowering intraocular pressure (IOP) by which a flexible, beacon-tipped microcatheter equipped with an ophthalmic viscosurgical device (OVD) delivery system is used to catheterize and introduce a suture into Schlemm's canal. Ligation of this suture provides tension on the canal and facilitates aqueous outflow. Canaloplasty is designed to be a blebless procedure that requires no antifibrotic agents and has been shown to safely and effectively lower IOP in patients with open-angle glaucoma (OAG) with minimal complications. Most importantly, no bleb-related adverse events are associated with this procedure. When contemplating surgical management of OAG, canaloplasty may be considered.

Trabeculectomy versus canaloplasty (TVC study) in the treatment of patients with open‐angle glaucoma: a prospective randomized clinical trial

“…Canaloplasty is a relatively novel surgical method which aims at restoring the natural pathway of aqueous humour outflow via Schlemm's canal using circumferential viscodilation and a tension suture to permanently distend the trabecular meshwork without inducing a filtering bleb (Godfrey et al 2009;Harvey & Khaimi 2011;Grieshaber 2012;Klink et al 2012). As prospective randomized clinical trials comparing canaloplasty to the current gold standard of trabeculectomy have been lacking and only a limited number of centres are able to offer both techniques, we were compelled to address this issue.…”

“…Severe adverse events and the need for an intensive postoperative treatment regimen have encouraged glaucoma surgeons to develop less invasive nonpenetrating procedures avoiding filtering blebs (Godfrey et al 2009;Francis et al 2011;Grieshaber 2012;Jampel et al 2012;Bettin & Di Matteo 2013;Wallin et al 2013;Yamamoto et al 2013). Canaloplasty is a non-filtering, bleb-free method combining viscocanalostomy with the placement of a 360°i ntracanalicular tension suture within Schlemm's canal, thus allowing aqueous humour outflow through the natural pathway (Godfrey et al 2009;Harvey & Khaimi 2011;Grieshaber 2012). Previous studies comparing non-penetrating with penetrating glaucoma surgeries have reported that although canaloplasty may not be as effective as filtering surgery in lowering IOP without medication, complication rate and risk of serious vision-threatening adverse events are low (Ayyala et al 2011;Brusini & Tosoni 2012;Bruggemann et al 2013;Matlach et al 2013).…”

Fluorescein channelography in canaloplasty: quantitative approach

“…As expected, transient hyphaema was found to be a complication, in the early postoperative period in some cases (9.8 %, 1 day after surgery). Transient hyphaema is the most common post-canaloplasty complication according to the previous peer-reviewed literature, with a reported incidence ranging from 6.1 to 70 % [1]. As in previous series [1], all transient hyphaema resolved within 1 week after surgery.…”

“…Canaloplasty is an ab externo Schlemm's canal surgical procedure for lowering intraocular pressure (IOP) in primary open-angle glaucoma (POAG) eyes, utilising a viscocanalostomy surgical dissection to insert a flexible, beacon-tipped microcatheter, equipped with an ophthalmic viscosurgical device (OVD) delivery system, to catheterise, dilate and introduce a tension suture into Schlemm's canal [1,2]. This suture is aimed at providing enough circumferential tension to distend the canal and consequently to increase the aqueous outflow and decrease IOP [1].…”

“…This suture is aimed at providing enough circumferential tension to distend the canal and consequently to increase the aqueous outflow and decrease IOP [1]. Specifically, this surgical procedure has been shown to be capable of reducing IOP around 40 % or even more if combined with cataract surgery [3,4].…”