Advanced Glaucoma Surgery with a Focus on Schlemm’s Canal

Abstract

New surgical strategies for open-angle glaucoma aim to re-establish the physiological aqueous outflow by directly targeting the site of maximal resistance, i.e. the juxtacanalicular meshwork and inner wall of Schlemm’s canal. Canaloplasty uses anab externoapproach, whereas Trabectome (trabeculotomy) and trabecular micro-bypass (iStent) use anab internoapproach. They all work independently of a filtering bleb and have an inherently lower complication rate than trabeculectomy. Preliminary data suggest that they lower intraocular pressure (IOP) to the mid-teens and are more efficient in combination with phacoemulsification. However, their ability to lower IOP is limited by the level of the episcleral venous pressure. Its good safety profile means that Schlemm’s canal surgery may become more popular in the near future, but the outcome of these procedures still needs to be validated in long-term randomised, controlled studies.