A System Review and Meta-Analysis of Canaloplasty Outcomes in Glaucoma Treatment in Comparison with Trabeculectomy

Abstract

Purpose. This system review studied the efficiency and safety of canaloplasty (CP) and compared the outcomes between CP and trabeculectomy (TE). Methods. Literatures were searched in PubMed and EMBASE. The meta-analysis was conducted on the postoperative outcomes in CP and then on the differences of outcomes between CP and TE. Results. In the meta-analysis, IOP decreased by 9.94 (95% CI 8.42 to 11.45) mmHg with an average AGM reduction of 2.11 (95% CI 1.80 to 2.42) one year after CP. The IOP reduction was significantly higher after TE than after CP, with an average difference of 3.61 (95% CI 1.69 to 5.53) mmHg at 12 months postoperationally. For complications, the incidence of hyphema was significantly higher in CP and the Descemet membrane detachment was just reported in CP, with an incidence of 3%. However, the incidence was significantly lower in CP of hypotony and of choroidal effusion/detachment. Meanwhile, suprachoroidal hemorrhage and bleb needling were only reported in TE. Conclusions. CP was less effective in IOP reduction than TE, but CP was able to achieve similar postoperative success rates and reduce the number of AGMs likewise. CP was also associated with lower incidence of complications. More high-quality researches are needed in the future to verify our findings in this system review.

Access to Schlemm's canal for canaloplasty: an intra‐individual comparison of two dissection techniques

“…When stronger criteria were applied to define complete success (without medications), such as an IOP below 18 mmHg or 16 mmHg, it became more evident that IOP reduction was consistently lower in the scleral block excision than in the cutdown group (93.3% versus 56.2% and 79.3% versus 25.0%, respectively). The average postoperative IOP in the scleral block excision group was 13.8 mmHg at 6 months and 14.4 mmHg at 12 months, comparable to previous canaloplasty results (mean 16.4 mmHg, range 13-18 mmHg) (Lewis et al 2007(Lewis et al , 2009 and to the findings of a recent meta-analysis (Zhang et al 2017). In a previous canaloplasty study with the canal expander, the mean IOP (without medications) at 6 months was 15.4 mmHg and at 12 months 15.4 mmHg, and the complete success rates for an IOP of 21, 18 or 16 mmHg or less after 36 months were 81%, 67.8% and 47.2%, respectively (Grieshaber et al 2016).…”

“…, ) and to the findings of a recent meta‐analysis (Zhang et al. ). In a previous canaloplasty study with the canal expander, the mean IOP (without medications) at 6 months was 15.4 mmHg and at 12 months 15.4 mmHg, and the complete success rates for an IOP of 21, 18 or 16 mmHg or less after 36 months were 81%, 67.8% and 47.2%, respectively (Grieshaber et al.…”

Estimation of risk–benefit ratio and comparison of post-operative efficacy results between trabeculectomy and canaloplasty

“…In recent meta-analyses, Lin et al 22 and Zhang et al 23 reported similar success rates between canaloplasty and trabeculectomy with fewer complications from canaloplasty but greater IOP reduction from trabeculectomy. In our study, the absolute success rate, the mean IOP reduction, and the IOP reduction per case post-operatively were better in the trabeculectomy group.…”

Canaloplasty in the Treatment of Open-Angle Glaucoma: A Review of Patient Selection and Outcomes

“…According to the meta-analysis by Zhang et al, TRAB was more effective than CP in reducing IOP by 3.65 mmHg (95% CI − 6.42; − 0.88, p = 0.01) at 12 months from surgery [ 65 ]. However, no significant difference between CP and TRAB was found regarding the reduction in medication number ( p = 0.20).…”