• Written By: Lisa B. Arbisser, MD
    Cataract/Anterior Segment

    This article reports three-year results of canaloplasty alone and in combination with cataract surgery in adults with open-angle glaucoma (OAG), demonstrating that the procedure safely and effectively lowers IOP and reduces medication use, with persistent IOP control through the entire postoperative period. The results also indicate that when canaloplasty is combined with cataract surgery, it is more effective than when performed alone. Late postoperative complications were infrequent compared with the well-documented long-term risks associated with trabeculectomy.

    We finally have a definitive article that says there is a better way that is as effective as trabeculectomy and vastly safer. The salutary effect of cataract surgery is maintained, and there is no decrease in final IOP control like we see when combined cataract-trabeculectomy is compared with trabeculectomy alone. It is a shame that the learning curve is so steep for cataract-canaloplasty surgery because this may prevent its widespread use. Nonetheless, I would want to undergo this operation if I was diagnosed with glaucoma.

    Subjects in the study were 157 OAG patients (157 eyes) with preoperative IOP of at least 16 mmHg and historical IOP of at least 21 mmHg. During canaloplasty, a flexible microcatheter was used to viscodilate the full circumference of the canal and place a trabecular tensioning suture.

    Three years postoperatively, the eyes included in the study had a mean IOP of 15.2 mmHg ± 3.5 (SD) and mean glaucoma medication use of 0.8 ± 0.9 compared with a baseline IOP of 23.8 ± 5.0 mmHg and 1.8 ± 0.9 medications. Eyes that underwent combined cataract-canaloplasty surgery had a mean IOP of 13.6 ± 3.6 mmHg on 0.3 ± 0.5 medications compared with a baseline IOP of 23.5 ± 5.2 mmHg on 1.5 ± 1.0 medications. IOP and medication use in all eyes were significantly decreased from baseline at every time point (P < 0.001). Late postoperative complications included cataract (12.7 percent), transient IOP elevation (6.4 percent) and partial suture extrusion through the trabecular meshwork (0.6 percent).

    The authors believe that removal of the natural lens in patients undergoing combined cataract-canaloplasty surgery improves outflow by further increasing trabecular meshwork tensioning in conjunction with canaloplasty.