Canaloplasty: popularity growing

Canaloplasty with tensioning suture placement is growing in popularity owing to a combination of factors, including a successful training programme, an improved reimbursement picture, and favourable long-term data, said Richard A. Lewis, MD.

Canaloplasty is a nonpenetrating procedure performed under a scleral flap in which a microcatheter (iTrack; iScience) is used with an ophthalmic viscosurgical device (Healon GV; AMO) to viscodilate the canal prior to passing a tensioning suture through the circumference of Schlemm's canal. The procedure is indicated for the treatment of open-angle glaucoma, especially in patients expected to be at high risk for trabeculectomy failure or in those where there is increased concern about further loss of vision, said Dr Lewis, a private practitioner in Sacramento, US.

Recently published clinical results from a prospective study including 168 patients showed that at baseline, mean IOP was 23.9 mmHg with a mean of 1.9 medications used per patient. At 24 months, the mean IOP was reduced by 36% to 15.2 mmHg with patients on an average of 0.6 medications. Although complications occurred, there were no cases of flat or shallow anterior chambers, infections, wound leaks, or choroidal effusion.

So far, 150 surgeons in the United States and 70 surgeons internationally have been trained in the procedure, and more than 1,500 procedures have been performed worldwide.

"This procedure has progressed to a stage where surgeons have begun to innovate beyond the initial technique," Dr Lewis said. "Additional surgical tools will continue to expand microcatheter clinical indications and treatment options for glaucoma surgery, and the power of microcatheter-based drug delivery is a particularly exciting and promising technique for all of ophthalmology."

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ASCRS 2008 meeting highlights.