A System Review and Meta-Analysis of Canaloplasty Outcomes in Glaucoma Treatment in Comparison with Trabeculectomy.

Bing Zhang,Xiaoming Chen,Jie Kang

doi:10.1155/2017/2723761

Bing Zhang, Xiaoming Chen + Show 1 more

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https://doi.org/10.1155/2017/2723761

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Abstract

Purpose. This system review studied the efficiency and safety of canaloplasty (CP) and compared the outcomes between CP and trabeculectomy (TE). Methods. Literatures were searched in PubMed and EMBASE. The meta-analysis was conducted on the postoperative outcomes in CP and then on the differences of outcomes between CP and TE. Results. In the meta-analysis, IOP decreased by 9.94 (95% CI 8.42 to 11.45) mmHg with an average AGM reduction of 2.11 (95% CI 1.80 to 2.42) one year after CP. The IOP reduction was significantly higher after TE than after CP, with an average difference of 3.61 (95% CI 1.69 to 5.53) mmHg at 12 months postoperationally. For complications, the incidence of hyphema was significantly higher in CP and the Descemet membrane detachment was just reported in CP, with an incidence of 3%. However, the incidence was significantly lower in CP of hypotony and of choroidal effusion/detachment. Meanwhile, suprachoroidal hemorrhage and bleb needling were only reported in TE. Conclusions. CP was less effective in IOP reduction than TE, but CP was able to achieve similar postoperative success rates and reduce the number of AGMs likewise. CP was also associated with lower incidence of complications. More high-quality researches are needed in the future to verify our findings in this system review.

Highlights

Intraocular pressure (IOP) is the most proven treatable factor in glaucoma, and lowering IOP has long been associated with slowing the damages by glaucoma [1, 2]
Studies which met the following criteria were considered eligible: (1) participants diagnosed with glaucoma regardless of age, sex, or race, studies limited in patients with another failed antiglaucoma surgery were excluded; (2) interventions, included but not limited to CP, with or without phacoemulsification; (3) research types, both prospective and retrospective studies, excluding case reports and reviews; (4) outcomes: included but not limited to IOP, the follow-up was at least 6 months; (5) for literatures with overlapping data, only the one with the largest sample and the longest follow-up was included
TE was shown to be more efficient in IOP control than in CP, with 3.61 mmHg more IOP reduction at 12 months postoperationally

Summary

Introduction

Intraocular pressure (IOP) is the most proven treatable factor in glaucoma, and lowering IOP has long been associated with slowing the damages by glaucoma [1, 2]. Trabeculectomy (TE), since firstly being introduced in the 1960s, has remained the standard surgery of IOP control in glaucoma [3]. The relatively high incidence of complications of TE [3, 4] has encouraged the development of new surgery methods. Canaloplasty (CP) was a nonpenetrating surgery (NPS) performed with a microcatheter (iTrack; iScience Surgical Corp.). CP has been performed as one major NPS in open-angle glaucoma treatment for years. No system review of CP to evaluate its efficiency and complications in the treatment of glaucoma has been published as far as we know.

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