Comparing two tensioning suture sizes for 360° viscocanalostomy (canaloplasty): a randomised controlled trial

Grieshaber, Matthias C.; Pienaar, Ané; Olivier, Jan; Stegmann, Robert

doi:10.1038/eye.2009.317

Cited by 45 publications

(25 citation statements)

References 31 publications

(43 reference statements)

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“…Specifically, a mean reduction of 4.8 mmHg (25.3 % decrease rate) was found at 6 months after surgery. This decrease rate is somewhat lower than those reported by other authors [2,[4][5][6][7][8][9][10]. Lewis et al (2011) [6] in their 3-year international multicentre prospective study compared glaucoma patients having canaloplasty and combined cataract-canaloplasty surgery.…”

Section: Discussioncontrasting

confidence: 81%

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Fluorescein channelography in canaloplasty: quantitative approach

Körber

Hermann

Peckar

et al. 2016

Spektrum Augenheilkd.

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Fluorescein channelography in canaloplasty: quantitative approach 23 1 3 SummaryPurpose To evaluate the 6-month intraocular pressure (IOP) reduction achieved after canaloplasty in primary open-angle glaucoma (POAG) eyes and to assess the potential value of fluorescein channelography result as a predicting factor for the surgery outcome.Methods Prospective consecutive study including 82 Caucasian eyes of 75 patients aged between 39 and 89 years. All eyes had POAG and underwent canaloplasty surgery for lowering IOP in the Augencentrum Köln (Cologne, Germany). Channelography was performed to evaluate the aqueous outflow by analysing the amount of diffuse scleral staining, areas of superficial staining, the number of visible superficial connections to collector channels, the trabecular permeability and the number of micro-ruptures of the trabecular meshwork. Postoperatively, IOP was monitored during a 6-month follow-up, and the change from baseline was recorded.Results Mean IOP changed from a preoperative value of 19.0 ± 5.1 mmHg to a 6-month postoperative value of 14.2 ± 4.5 mmHg (p < 0.01). A strong and statistically significant correlation of the 6-month IOP change from baseline with the preoperative IOP was found (r = − 0.70, p < 0.01). Additionally, the IOP change from baseline correlated significantly with the level of superficial staining (r = − 0.27, p = 0.02) and the number of visible superficial connections to collectors (r = − 0.37, p < 0.01) observed in channelography. Transient hyphaema was observed in 9.8 % of eyes and filtering bleb in 4.9 % of eyes. Medical treatment for lowering IOP was required at 6 months postoperatively in 12 eyes (14.6 %).Conclusions Canaloplasty is an effective surgical method for lowering IOP in POAG eyes, providing more significant IOP reduction in cases showing more superficial staining and visible superficial connections to collector channels during fluorescein channelographic examination.

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Section: Discussioncontrasting

confidence: 81%

“…Several authors have reported successful outcomes after canaloplasty in terms of IOP and anterior segment integrity [2,[4][5][6][7][8][9][10]. Peckar and Koerber published a new method of channalography in 2008 for evaluating the outcome achieved with canaloplasty [11].…”

Section: Introductionmentioning

confidence: 99%

Fluorescein channelography in canaloplasty: quantitative approach

Körber

Hermann

Peckar

et al. 2016

Spektrum Augenheilkd.

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“…Another advantage is that hypotony is practically eliminated by the intrinsic resistance of the distal physiological outflow system including episcleral venous pressure. 21,23 In the current study, no cases displayed bleb-associated complications (blebitis, endophthalmitis), or other serious complications such as extreme hypotony and detachment of the ciliary body or choroid. The 360-degree ST also decreases the learning curve of viscocanalostomy and canaloplasty, because the same surgical steps are performed when creating the superficial and deep scleral flaps and exposing the trabeculodescemet membrane.…”

Section: Discussionmentioning

confidence: 93%

Efficacy of Modified 360-degree Suture Trabeculotomy for Pseudoexfoliation Glaucoma

Hepşen

Güler

Kumova

et al. 2016

Journal of Glaucoma

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Purpose: In this prospective study, we aimed to investigate the success and safety of a modified 360-degree suture trabeculotomy (ST) technique in patients with pseudoexfoliation glaucoma (XFG).Patients and Methods: The modified 360-degree ST was performed on 15 eyes of 15 patients with XFG resistant to maximal topical treatment. In 6 patients, ST was combined with phacoemulsification. Main outcome measures were the surgical success rate, mean postoperative intraocular pressure (IOP), the number of antiglaucoma medications, and the operative complications.Results: The mean follow-up period was 8 months (range 6 to 12 mo). Baseline IOP decreased from 27.53 ± 9.38 mm Hg on 3.26 ± 0.70 medications to 12.86 ± 2.72 mm Hg (P = 0.01) on 0.20 ± 0.56 medications (P = 0.01) at 6 months postoperatively accounting for a 52.82% reduction. The complete and qualified success rates were 77% and 100%, respectively, at the sixth month. The entire circumference of the Schlemm canal was successfully opened in all cases. Hyphema (in all cases), intraoperative iris prolapse (in 3 cases), transient elevation of the IOP (in 1 case), posterior synechia (in 2 phakic cases), and peripheral anterior synechia (in 1 case) were noted. There was not a trend for lower IOP after combined phacomodified 360-degree ST in this small group.Conclusions: The modified 360-degree ST appears to be a valuable option for the surgical treatment of XFG. Future studies are needed to explore the remote side effects and the long-term effects of this procedure on IOP.A s a filtering surgery, trabeculectomy with adjunctive mitomycin C is associated with a high incidence of postoperative complications such as bleb leaks, blebitis, shallow anterior chambers, choroidal detachments, hypotensive maculopathy, cataract progression, and unpredictable postoperative intraocular pressure (IOP) levels. 1 Schlemm canal (SC) surgeries (eg, trabeculotomy, viscocanalostomy, and canaloplasty) are a valuable alternative to glaucoma filtration surgery. 2,3 They target the abnormally high resistance to outflow in the trabecular meshwork (TM) and enhance outflow through the patient's own natural drainage system. 4 It is common knowledge that trabeculotomy ab externo is effective for management of congenital glaucoma, but its efficacy for adult glaucoma is less known. A 360-degree trabeculotomy technique using a 6-0 polypropylene suture was reported by Beck and Lynch 5 in 1995 for congenital glaucoma, with high surgical success rates compared with conventional trabeculotomy with metal trabeculotomes. The only study evaluating the 360-degree suture trabeculotomy (ST) in adult patients with open-angle glaucoma was reported by Chin et al. 6 They found that 360-degree ST ab externo was significantly more effective than metal trabeculotomy in lowering IOP in adult primary and secondary open-angle glaucomas. They also modified the 360-degree ST by making a deep scleral flap that allowed clearly identifying SC, and showed a success rate of 84% for adult open-angle glaucoma. However, the study ...

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“…Persistent SC dilation is also used in glaucoma by tensioning a suture placed within the entire circumference of SC. 44 The effects of pressure-induced reversal have, in addition, been studied in the laboratory and shown to cause marked changes in SC structural relationships. 32 Devices currently being inserted into SC in the operating room to bypass the TM are thought to achieve their best effect when placed near CCO; at the same time, efforts are made to avoid damage to or occlusion of CCO.…”

Section: Discussionmentioning

confidence: 99%

Platform to investigate aqueous outflow system structure and pressure-dependent motion using high-resolution spectral domain optical coherence tomography

et al. 2014

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Abstract. The aqueous outflow system (AOS) is responsible for maintaining normal intraocular pressure (IOP) in the eye. Structures of the AOS have an active role in regulating IOP in healthy eyes and these structures become abnormal in the eyes with glaucoma. We describe a newly developed system platform to obtain high-resolution images of the AOS structures. By incorporating spectral domain optical coherence tomography (SD-OCT), the platform allows us to systematically control, image, and quantitate the responses of AOS tissue to pressure with a millisecond resolution of pulsed flow. We use SD-OCT to image radial limbal segments from the surface of the trabecular meshwork (TM) with a spatial resolution of ∼5 μm in ex vivo nonhuman primate eyes. We carefully insert a cannula into Schlemm's canal (SC) to control both pressures and flow rates. The experimental results demonstrate the capability of the platform to visualize the unprecedented details of AOS tissue components comparable to that delivered by scanning electron microscopy, as well as to delineate the complex pressure-dependent relationships among the TM, structures within the SC, and collector channel ostia. The described technique provides a new means to characterize the anatomic and pressure-dependent relationships of SC structures, particularly the active motion of collagenous elements at collector channel ostia; such relationships have not previously been amenable to study. Experimental findings suggest that continuing improvements in the OCT imaging of the AOS may provide both insights into the glaucoma enigma and improvements in its management.

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Comparing two tensioning suture sizes for 360° viscocanalostomy (canaloplasty): a randomised controlled trial

Cited by 45 publications

References 31 publications

Fluorescein channelography in canaloplasty: quantitative approach

Fluorescein channelography in canaloplasty: quantitative approach

Efficacy of Modified 360-degree Suture Trabeculotomy for Pseudoexfoliation Glaucoma

Platform to investigate aqueous outflow system structure and pressure-dependent motion using high-resolution spectral domain optical coherence tomography

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