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The Scientific World Journal
Volume 2014, Article ID 469609, 7 pages
http://dx.doi.org/10.1155/2014/469609
Clinical Study

Canaloplasty in Open-Angle Glaucoma Surgery: A Four-Year Follow-Up

Department of Ophthalmology, Santa Maria della Misericordia Hospital, Piazzale S. Maria della Misericordia 15, 33100 Udine, Italy

Received 13 August 2013; Accepted 29 October 2013; Published 16 January 2014

Academic Editors: M. Acharya, T. Kubota, F. J. Muñoz-Negrete, and L. E. Pablo

Copyright © 2014 Paolo Brusini. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Canaloplasty is a new nonperforating surgical technique for open-angle glaucoma, in which a microcatheter is inserted within Schlemm’s canal for the entire 360 degrees. A 10-0 prolene suture, which is tied to the distal tip of the microcatheter, is then positioned and left tensioned in Schlemm’s canal, thus facilitating aqueous outflow through natural pathways. A small amount of viscoelastic agent is delivered in Schlemm’s canal while the catheter is withdrawn. The mid-term results are very promising. Based on our cohort of 214 patients, the percentages of eyes that obtained postoperative IOP 21 mmHg, 18 mmHg, and 16 mmHg with or without medical therapy after 2 and 3 years were 88.7%, 73.7%, and 46.2% (2 years); 86.2%, 58.6%, and 37.9% (3 years), respectively. The most frequent complications observed included hyphema; descemet membrane detachment; IOP spikes; and hypotony. The advantages of canaloplasty over trabeculectomy include (1) no subconjunctival bleb; (2) no need for antimetabolites; (3) fewer postoperative complications; and (4) a simplified follow-up. The disadvantages include the following: (1) a long and rather steep surgical learning curve; (2) the need of specific instruments; (3) average postoperative IOP levels tend not to be very low; and (4) impossibility to perform the entire procedure in some cases.