Can perforations of descemet’s window (DW) improve the outcome of canaloplasty in open angle glaucoma?

Pullig, Barbara; Koerber, Norbert; Dietlein, Thomas S.

doi:10.1007/s00417-019-04340-z

Cited by 4 publications

(4 citation statements)

References 21 publications

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“…First, combining manipulation of the opening of the Schlemm's canal and incision of trabeculo-Descemetic membrane (TDM) creates a direct communication between the anterior chamber and the Schlemm's canal, overcoming the major outflow resistance in the angleclosure eyes. This is supported by findings in POAG eyes, in which an additional rupture of the Descement's window enhances the outcome after canaloplasty (Pullig et al 2019). Second, peripheral iridectomy prevents obstruction of the trabecular meshwork fistula by peripheral iris.…”

Section: Discussionsupporting

confidence: 57%

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Efficacy of bleb‐independent penetrating canaloplasty in primary angle‐closure glaucoma: one‐year results

Zhang

Cheng

et al. 2021

Acta Ophthalmologica

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Purpose: To report the efficacy and safety of bleb-independent penetrating canaloplasty in the management of primary angle-closure glaucoma (PACG). Methods: This single-centre prospective interventional case series enrolled 57 eyes from 53 PACG patients with medically uncontrolled intraocular pressure (IOP) and peripheral anterior synechiae of over 270°. Penetrating canaloplasty, mainly consisted of tensioning suture-aided Schlemm's canal dilation and a trabeculectomy, was performed to create a direct communication between the anterior chamber and the Schlemm's canal. Postoperative IOP, number of glaucoma medications and procedure-related complications were evaluated. Rate of success was defined as IOP ≤ 21, ≤18 and ≤15 mmHg, and a ≥30% IOP reduction without (complete) or with/without (qualified) IOP-lowering medications. Results: A total of 45 eyes had 360°catheterization successfully completed. The mean preoperative IOP was 33.9 AE 11.7 mmHg (range, 13-59.6 mmHg), on 3.2 AE 0.8 glaucoma medications (range 2-5), which was decreased to 15.4 AE 3.7 mmHg (range, 8.6-22.5) and 0.2 AE 0.6 (range, 0-3) medications at 6 months and 14.8 AE 3.5 mmHg (range, 9-24) and 0.1 AE 0.3 (range, 0-1) medications at 12 months postoperatively. Complete success at 12 months were achieved in 78.9% (95% CI: 0.65-0.93), 71.1% (0.56-0.86) and 50.0% (0.33-0.67) eyes at IOP ≤ 21, ≤18 and ≤15 mmHg, respectively. Transient IOP elevation (>30 mmHg, 26.7%) and hyphema (11.1%) were the most common early surgical complications. Conclusion: Penetrating canaloplasty in PACG appeared to have good efficacy and safety profiles in this pilot study. Further studies are justified.

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Section: Discussionsupporting

confidence: 57%

“…This is supported by findings in POAG eyes, in which an additional rupture of the Descement’s window enhances the outcome after canaloplasty (Pullig et al. 2019). Second, peripheral iridectomy prevents obstruction of the trabecular meshwork fistula by peripheral iris.…”

Section: Discussionsupporting

confidence: 56%

Efficacy of bleb‐independent penetrating canaloplasty in primary angle‐closure glaucoma: one‐year results

Zhang

Cheng

et al. 2021

Acta Ophthalmologica

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“…The number of IOP-lowering medications decreased from 3.2 ± 0.6 preoperatively to 0.5 ± 0.8 postoperatively significantly. The number of medications was similar to or less than previous studies [ 11 , 31 ]. For high IOP after modified canaloplasty, laser goniopunture was adopted to make one or two tiny holes to increase queous humor from the anterior chamber to the scleral lake under the superficial scleral flap.…”

Section: Discussionsupporting

confidence: 84%

Modified suture-assisted canaloplasty in Asians with primary open-angle glaucoma: a prospective study with 12-month follow-up

Liang

Sun

et al. 2022

BMC Ophthalmol

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Background To evaluate the efficacy and safety of modified suture-assisted canaloplasty in Asians with primary open-angle glaucoma (POAG). Methods A prospective, consecutive cases study, evaluating a modified canaloplasty by twisted 6/0 suture was performed on Asian POAG patients. Three modifications of this canaloplasty included opening the Schlemm’s canal by viscocanalostomy, circumferential probing by a twisted 6/0 suture and loose suture of the superficial scleral flap. The twisted 6/0 suture was selected as a prober based on characteristical analysis of size and contact measurement as well as chemical composition conducted among 5/0, twisted 6/0 polypropylene sutures and the microcatheter. Success criteria were defined as intraocular pressure (IOP) ≤ 21 mmHg, 18 mmHg, 15 mmHg, and ≥ 20% reduction without (complete success) or with medications (qualified success). Efficacy was assessed by the success rate of circumferential catheterization, IOP values, the success rate of the surgery, the number of IOP-lowering medications, best-corrected vision acuity (BCVA), cup-to-disc ratio (C/D), and mean deviation (MD). Safety was evaluated by adverse events. Results Forty eyes from 40 consecutive patients were included with a mean follow-up of 14.8 ± 3.0 months. Circumferential catheterization was successfully conducted in 36 eyes (90%). Mean IOP decreased from 26.2 ± 6.9 mmHg to 14.5 ± 2.7 mmHg at 12 months postoperatively. While medication numbers were reduced from 3.2 ± 0.6 to 0.5 ± 0.8 at month 12 (both p < 0.001). Qualified success rate was 97.2% [95% confidence interval (CI) 0.92–1.03], 86.1% (95% CI 0.74–0.98) and 66.7% (95% CI 0.51–0.83) at 12 months with three criteria. BCVA, C/D and MD did not show progression at 1-year follow-up (p > 0.05). Age, baseline IOP, and spherical equivalent negatively influenced the success rate significantly (all p < 0.05). Adverse events included hyphema (30.6%), IOP spike > 25 mmHg (8.3%), and peripheral synechia to the trabecular-Descemet’s membrane (2.7%). Conclusion Twisted 6/0 suture can be an ideal material for cannulation. Modified suture-assisted canaloplasty is an effective, safe alternative with a cost-efficient feature for patients with POAG, especially in developing countries. Trial registration This trial was registered in the Chinese Clinical Trial Registry (ChiCTR1900028618, 29/12/2019).

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“…PCP combines canaloplasty with trabeculectomy, creating a window connecting the AC with the SC directly. [10,11] A small deep sclera helped keep the end of the incision of Schlemm canal open.Professor Liang and his team have reported that PCP demonstrated good safety and efficacy in eyes with primary angle-closure glaucoma, childhood glaucoma and corticosteroid-induced glaucoma. [10,[12][13][14] Here we demonstrated its good safety and efficacy in eyes with angle-closure glaucoma secondary to ICE.…”

Section: Discussionmentioning

confidence: 99%

Penetrating canaloplasty in angle-closure glaucoma secondary to iridocorneal endothelial syndrome following multiple failed filtering surgeries: A case report

et al. 2023

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Rationale: Angle-closure glaucoma secondary to iridocorneal endothelial syndrome (ICE) is challenging to treat, especially in patients who have already undergone multiple surgical procedures. Long-term success is difficult to achieve with traditional filtration surgery again. This case report describes a novel nonbleb-dependent surgery for managing such a young patient. Patient concerns: A 30-year-old male with glaucoma secondary to ICE was referred to West China Hospital, Sichuan University for uncontrolled intraocular pressure following multiple failed filtering surgeries under maximum topical antiglaucoma medications in his right eye. Diagnoses: The patient was diagnosed with angle-closure glaucoma secondary to ICE in the right eye based on a series of ophthalmic examinations. Interventions: Penetrating canaloplasty was performed to manage glaucoma secondary to ICE in the right eye. Outcomes: The patient’s visual acuity improved, the intraocular pressure was reduced to 11 to 15 mm Hg through 30 months of follow-up, and no antiglaucoma medication or additional surgical procedures were needed. Lessons: Penetrating canaloplasty could be considered as an option for the treatment of refractory angle-closure glaucoma secondary to ICE with extensive angle adhesion.

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Can perforations of descemet’s window (DW) improve the outcome of canaloplasty in open angle glaucoma?

Cited by 4 publications

References 21 publications

Efficacy of bleb‐independent penetrating canaloplasty in primary angle‐closure glaucoma: one‐year results

Efficacy of bleb‐independent penetrating canaloplasty in primary angle‐closure glaucoma: one‐year results

Modified suture-assisted canaloplasty in Asians with primary open-angle glaucoma: a prospective study with 12-month follow-up

Penetrating canaloplasty in angle-closure glaucoma secondary to iridocorneal endothelial syndrome following multiple failed filtering surgeries: A case report

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