Canaloplasty in One Eye Compared With Viscocanalostomy in the Contralateral Eye in Patients With Bilateral Open-angle Glaucoma

Abstract

To compare the safety and efficacy of canaloplasty with viscocanalostomy when performed in both eyes of patients with bilateral open-angle glaucoma. This comparative case series investigated 30 eyes of 15 adult patients with bilateral primary open-angle glaucoma who had canaloplasty performed in one eye and viscocanalostomy performed in the contralateral eye. Qualifying preoperative intraocular pressures (IOP) were at least 18 mm Hg with historical IOPs of at least 21 mm Hg. In canaloplasty, a microcatheter was used to viscodilate the full circumference of Schlemm canal in conjunction with the placement of a trabecular meshwork tensioning suture. Primary outcome measures included IOP, glaucoma medication usage, and adverse events. With a follow-up period of 18 months, both the canaloplasty and viscocanalostomy groups showed statistically significant reductions in mean IOP (P<0.01) and number of supplemental medications (P<0.01) as compared with preoperative values. In the canaloplasty cohort, eyes had a mean IOP of 14.5±2.6 mm Hg on 0.3±0.5 medications at 18 months postoperatively as compared with preoperative levels of 26.5±2.7 mm Hg on 2.1±1.0 medications. In the viscocanalostomy cohort, eyes had a mean IOP of 16.1±3.9 mm Hg on 0.4±0.5 medications at 18 months as compared with preoperative levels of 24.3±2.8 mm Hg on 1.9±0.8 medications (P=0.02). No patient in either cohort experienced significant complications. Canaloplasty and viscocanalostomy were safe and effective in the surgical management of open-angle glaucoma. Canaloplasty procedures showed superior efficacy to viscocanalostomy in the reduction of IOP (P=0.02) and both procedures demonstrated excellent safety profiles.