Advertisement

Canaloplasty

Chapter

Abstract

Canaloplasty is a non-penetrating glaucoma procedure that adopts an ab externo approach to improve aqueous outflow through the conventional pathway. Using a microcatheter with fiber-optic light guidance, a nonabsorbable suture is passed throughout the entire Schlemm’s canal and is tightened to put the trabecular meshwork on stretch, thereby maintaining canal patency and enhancing outflow. Potential complications are similar to those encountered in traditional penetrating procedures such as trabeculectomy, but given that no patent ostium or iridectomy is required, canaloplasty has lower risks of potentially devastating complications such as hypotony, choroidal effusion, or suprachoroidal hemorrhage. Studies have shown the efficacy of canaloplasty to be better than modest; thus, patients with mild to moderate open-angle glaucoma who require mid-teens target IOP are suitable candidates. Though a technically demanding procedure, canaloplasty’s excellent safety profile makes it a valuable surgical alternative in patients where early surgery is favorable and/or in high-risk cases.

Keywords

Anterior Chamber Trabecular Meshwork Scleral Flap Glaucoma Drainage Device Deep Sclerectomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Cairns JE. Trabeculectomy. Preliminary report of a new method. Am J Ophthalmol. 1968;66(4):673–9.PubMedGoogle Scholar
  2. 2.
    Molteno AC. New implant for drainage in glaucoma. Clinical trial. Br J Ophthalmol. 1969;53(9):606–15.PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Krupin T, Podos SM, Becker B, Newkirk JB. Valve implants in filtering surgery. Am J Ophthalmol. 1976;81(2):232–5.PubMedGoogle Scholar
  4. 4.
    Lloyd MA, Baerveldt G, Heuer DK, Minckler DS, Martone JF. Initial clinical experience with the baerveldt implant in complicated glaucomas. Ophthalmology. 1994;101(4):640–50.PubMedCrossRefGoogle Scholar
  5. 5.
    Coleman AL, Hill R, Wilson MR, et al. Initial clinical experience with the Ahmed Glaucoma Valve implant. Am J Ophthalmol. 1995;120(1):23–31.PubMedGoogle Scholar
  6. 6.
    Borisuth NS, Phillips B, Krupin T. The risk profile of glaucoma filtration surgery. Curr Opin Ophthalmol. 1999;10(2):112–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Gedde SJ, Herndon LW, Brandt JD, et al. Postoperative complications in the Tube Versus Trabeculectomy (TVT) study during five years of follow-up. Am J Ophthalmol. 2012;153(5):804–14.e1.PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Epstein E. Fibrosing response to aqueous. Its relation to glaucoma. Br J Ophthalmol. 1959;43:641–7.PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Krasnov MM. Externalization of Schlemm’s canal (sinusotomy) in glaucoma. Br J Ophthalmol. 1968;52(2):157–61.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Hara T. Deep sclerectomy with Nd:YAG laser trabeculotomy ab interno: two-stage procedure. Ophthalmic Surg. 1988;19(2):101–6.PubMedGoogle Scholar
  11. 11.
    Sanchez E, Schnyder CC, Sickenberg M, Chiou AG, Hediguer SE, Mermoud A. Deep sclerectomy: results with and without collagen implant. Int Ophthalmol. 1996;20(1–3):157–62.PubMedGoogle Scholar
  12. 12.
    Stegmann R, Pienaar A, Miller D. Viscocanalostomy for open-angle glaucoma in black African patients. J Cataract Refract Surg. 1999;25(3):316–22.PubMedCrossRefGoogle Scholar
  13. 13.
    Lewis RA, von Wolff K, Tetz M, et al. Canaloplasty: circumferential viscodilation and tensioning of Schlemm’s canal using a flexible microcatheter for the treatment of open-angle glaucoma in adults: interim clinical study analysis. J Cataract Refract Surg. 2007;33(7):1217–26.PubMedCrossRefGoogle Scholar
  14. 14.
    Moses RA, Grodzki Jr WJ, Etheridge EL, Wilson CD. Schlemm’s canal: the effect of intraocular pressure. Invest Ophthalmol Vis Sci. 1981;20(1):61–8.PubMedGoogle Scholar
  15. 15.
    Goldsmith JA, Ahmed IK, Crandall AS. Nonpenetrating glaucoma surgery. Ophthalmol Clin North Am. 2005;18(3):443–60, vii.PubMedCrossRefGoogle Scholar
  16. 16.
    Smit BA, Johnstone MA. Effects of viscoelastic injection into Schlemm’s canal in primate and human eyes: potential relevance to viscocanalostomy. Ophthalmology. 2002;109(4):786–92.PubMedCrossRefGoogle Scholar
  17. 17.
    Marchini G, Marraffa M, Brunelli C, Morbio R, Bonomi L. Ultrasound biomicroscopy and intraocular-pressure-lowering mechanisms of deep sclerectomy with reticulated hyaluronic acid implant. J Cataract Refract Surg. 2001;27(4):507–17.PubMedCrossRefGoogle Scholar
  18. 18.
    Balazs EA, Denlinger JL. Clinical uses of hyaluronan. Ciba Found Symp. 1989;143:265–75; discussion 75–80, 81–5.PubMedGoogle Scholar
  19. 19.
    Abdelrahman AM. Trabeculotome-guided deep sclerectomy. A pilot study. Am J Ophthalmol. 2005;140(1):152–4.PubMedCrossRefGoogle Scholar
  20. 20.
    Argento C, Sanseau AC, Badoza D, Casiraghi J. Deep sclerectomy with a collagen implant using the excimer laser. J Cataract Refract Surg. 2001;27(4):504–6.PubMedCrossRefGoogle Scholar
  21. 21.
    Verges C, Llevat E, Bardavio J. Laser-assisted deep sclerectomy. J Cataract Refract Surg. 2002;28(5):758–65.PubMedCrossRefGoogle Scholar
  22. 22.
    Geffen N, Ton Y, Degani J, Assia EI. CO2 laser-assisted sclerectomy surgery, part II: multicenter clinical preliminary study. J Glaucoma. 2012;21(3):193–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Choudhary A, Wishart PK. Non-penetrating glaucoma surgery augmented with mitomycin C or 5-fluorouracil in eyes at high risk of failure of filtration surgery: long-term results. Clin Experiment Ophthalmol. 2007;35(4):340–7.PubMedCrossRefGoogle Scholar
  24. 24.
    Barnebey HS. Canaloplasty with intraoperative low dosage mitomycin C: a retrospective case series. J Glaucoma. 2013;22(3):201–4.PubMedCrossRefGoogle Scholar
  25. 25.
    Robert MC, Harasymowycz P. Hemorrhagic descemet detachment after combined canaloplasty and cataract surgery. Cornea. 2013;32(5):712–3.PubMedCrossRefGoogle Scholar
  26. 26.
    Jaramillo A, Foreman J, Ayyala RS. Descemet membrane detachment after canaloplasty: incidence and management. J Glaucoma. 2012. Epub ahead of print.Google Scholar
  27. 27.
    Grieshaber MC, Schoetzau A, Flammer J, Orgul S. Postoperative microhyphema as a positive prognostic indicator in canaloplasty. Acta Ophthalmol. 2013;91(2):151–6.PubMedCrossRefGoogle Scholar
  28. 28.
    Bull H, von Wolff K, Korber N, Tetz M. Three-year canaloplasty outcomes for the treatment of open-angle glaucoma: European study results. Graefes Arch Clin Exp Ophthalmol. 2011;249(10):1537–45.PubMedCrossRefGoogle Scholar
  29. 29.
    Lewis RA, von Wolff K, Tetz M, et al. Canaloplasty: three-year results of circumferential viscodilation and tensioning of Schlemm canal using a microcatheter to treat open-angle glaucoma. J Cataract Refract Surg. 2011;37(4):682–90.PubMedCrossRefGoogle Scholar
  30. 30.
    Grieshaber MC, Fraenkl S, Schoetzau A, Flammer J, Orgul S. Circumferential viscocanalostomy and suture canal distension (canaloplasty) for whites with open-angle glaucoma. J Glaucoma. 2011;20(5):298–302.PubMedCrossRefGoogle Scholar
  31. 31.
    Shingleton B, Tetz M, Korber N. Circumferential viscodilation and tensioning of Schlemm canal (canaloplasty) with temporal clear corneal phacoemulsification cataract surgery for open-angle glaucoma and visually significant cataract: one-year results. J Cataract Refract Surg. 2008;34(3):433–40.PubMedCrossRefGoogle Scholar
  32. 32.
    Grieshaber MC, Pienaar A, Olivier J, Stegmann R. Comparing two tensioning suture sizes for 360 degrees viscocanalostomy (canaloplasty): a randomised controlled trial. Eye (Lond). 2010;24(7):1220–6.CrossRefGoogle Scholar
  33. 33.
    Grieshaber MC, Pienaar A, Olivier J, Stegmann R. Canaloplasty for primary open-angle glaucoma: long-term outcome. Br J Ophthalmol. 2010;94(11):1478–82.PubMedCrossRefGoogle Scholar
  34. 34.
    Fujita K, Kitagawa K, Ueta Y, Nakamura T, Miyakoshi A, Hayashi A. Short-term results of canaloplasty surgery for primary open-angle glaucoma in Japanese patients. Case Rep Ophthalmol. 2011;2(1):65–8.PubMedCentralPubMedGoogle Scholar
  35. 35.
    Bindlish R, Condon GP, Schlosser JD, D’Antonio J, Lauer KB, Lehrer R. Efficacy and safety of mitomycin-C in primary trabeculectomy: five-year follow-up. Ophthalmology. 2002;109(7):1336–41; discussion 41–2.PubMedCrossRefGoogle Scholar
  36. 36.
    Ayyala RS, Chaudhry AL, Okogbaa CB, Zurakowski D. Comparison of surgical outcomes between canaloplasty and trabeculectomy at 12 months’ follow-up. Ophthalmology. 2011;118(12):2427–33.PubMedCrossRefGoogle Scholar
  37. 37.
    Koerber NJ. Canaloplasty in one eye compared with viscocanalostomy in the contralateral eye in patients with bilateral open-angle glaucoma. J Glaucoma. 2012;21(2):129–34.PubMedGoogle Scholar
  38. 38.
    Lavin MJ, Wormald RP, Migdal CS, Hitchings RA. The influence of prior therapy on the success of trabeculectomy. Arch Ophthalmol. 1990;108(11):1543–8.PubMedCrossRefGoogle Scholar
  39. 39.
    Migdal C, Gregory W, Hitchings R. Long-term functional outcome after early surgery compared with laser and medicine in open-angle glaucoma. Ophthalmology. 1994;101(10):1651–6; discussion 7.PubMedCrossRefGoogle Scholar
  40. 40.
    Shaarawy T, Flammer J, Haefliger IO. Reducing intraocular pressure: is surgery better than drugs? Eye (Lond). 2004;18(12):1215–24.CrossRefGoogle Scholar
  41. 41.
    Nouri-Mahdavi K, Hoffman D, Coleman AL, et al. Predictive factors for glaucomatous visual field progression in the Advanced Glaucoma Intervention Study. Ophthalmology. 2004;111(9):1627–35.PubMedCrossRefGoogle Scholar
  42. 42.
    Chiou AG, Mermoud A, Jewelewicz DA. Post-operative inflammation following deep sclerectomy with collagen implant versus standard trabeculectomy. Graefes Arch Clin Exp Ophthalmol. 1998;236(8):593–6.PubMedCrossRefGoogle Scholar
  43. 43.
    Egrilmez S, Ates H, Nalcaci S, Andac K, Yagci A. Surgically induced corneal refractive change following glaucoma surgery: nonpenetrating trabecular surgeries versus trabeculectomy. J Cataract Refract Surg. 2004;30(6):1232–9.PubMedCrossRefGoogle Scholar
  44. 44.
    Ahmed II, Khan BU. Non-penetrating glaucoma surgery. In: Yanoff M, Duker JS, editors. Ophthalmology. 3rd ed. Philadelphia: Mosby Elsevier; 2009. p. 1247–60.Google Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Division of Ophthalmology, Department of SurgeryMcMaster UniversityKitchenerCanada
  2. 2.Department of Ophthalmology and Vision SciencesUniversity of TorontoTorontoCanada

Personalised recommendations