Canaloplasty with Stegmann's Canal Expander® for open‐angle glaucoma

Abstract

PurposeTo evaluate the surgical outcome of canaloplasty using Stegmann's canal expander in open‐angle glaucoma (OAG).MethodsProspective, non‐comparative, interventional study. We recruited patients with uncontrolled OAG. All cases were operated by the same surgeon using a standardized canaloplasty procedure with 360‐degrees dilatation of Schlemm's canal (SC) using a flexible ophthalmic microcannula followed by the insertion of the expander into both surgically created SC ostia. Primary outcomes: mean change in intraocular pressure (IOP) and number of glaucoma medications following surgery. Secondary outcomes: complication rates; percentage of eyes with successful insertion of the expander in SC.Results44 eyes of 42 consecutive patients included. 38 (86%) were Caucasians; 32 (73%) female; primary‐, pseudoexfoliative‐, pigmentary‐ OAG had 25 (57%), 17 (39%), 2 (4%) respectively; 30 (68%) were pseudophakic; mean age (±SD) was 77 ± 8 years. All patients reached month‐6 follow‐up visit (range: 6–24). Mean IOP decreased from 22.4 ± 7.8 mmHg before surgery to 8.4 ± 4.2, 12.05 ± 3.59, 11.07 ± 4.08, 11.3 ± 3.51, 11.2 ± 2.6, 11.1 ± 2.7, 11.6 ± 2.3 at day‐1, week‐1, month‐1, ‐3, ‐6, ‐12, ‐24 respectively (p < 0.01). Mean number of glaucoma medications reduced from 3.36 ± 0.74 before surgery to 0.15 ± 0.47 at the last recorded visit (p < 0.01, Wilcoxon). No complication was recorded in 20 eyes (45%); a spontaneously‐resolving hyphema in 14 (32%); a choroidal detachment in 4 eyes (9%); a Descemet's membrane detachment and anterior uveitis each in 3 eyes (7%). Uneventful insertion was achieved in 29 eyes (66%). The stent was trimmed in 2 eyes (4.5%) due to some resistance during insertion and it was inserted only in one side in 8 eyes (18%).ConclusionsCanaloplasty with Stegmann's expander appears to reduce IOP in OAG with minor and self‐limited complications.