Mini-canaloplasty as a modified technique for the surgical treatment of open-angle glaucoma

Marek Rękas,Joanna Konopińska,Zofia Mariak,Anna Byszewska

doi:10.1038/s41598-020-69261-y

Abstract

Authors present a modified surgical technique for canaloplasty without preparing the classical trabeculo-Descemet’s membrane (TDM) and having to close sutures. Twelve patients with open-angle glaucoma (OAG) (aged 58–77 years) received the modified technique, which does not require the deep scleral flap to be excised, an intrascleral lake to be created, or TDM dissection. After accessing the Schlemm’s canal (SC), cannulation and placement of the sutures are made similar to those in the classical canaloplasty. The conjunctiva is closed via bipolar diathermy. The mean intraocular pressure (IOP) before surgery was 18.0 ± 8 mmHg, and the mean number of anti-glaucoma medications taken was 3 ± 1. Mean IOP at the end of the observation period (18.0 ± 6.0 months) was reduced by 23% (15.5 ± 4.1 mmHg), while the mean number of medications taken was reduced to 0.25 ± 1.0. In all eyes, the SC was successively opened, with no cheese-wiring. Adverse events included microhyphaema, mild corneal oedema, and folds in the TDM. The eyes recovered spontaneously within a few days after the procedure. The mini-canaloplasty technique may reduce the risk of complications associated with classical canaloplasty while effectively lowering the IOP in patients with OAG.

Highlights

Authors present a modified surgical technique for canaloplasty without preparing the classical trabeculo-Descemet’s membrane (TDM) and having to close sutures
Classified as a non-penetrating anti-glaucoma procedure alongside deep sclerectomy, it enables the reduction of intraocular pressure (IOP) while avoiding many clinically significant complications related to the formation of a filtering bleb in fistular procedures
The mean IOP before the procedure was 18.0 ± 8 mmHg, and the patients were on an average of 3 ± 1 anti-glaucoma medications

Summary

Introduction

Authors present a modified surgical technique for canaloplasty without preparing the classical trabeculo-Descemet’s membrane (TDM) and having to close sutures. Classified as a non-penetrating anti-glaucoma procedure alongside deep sclerectomy, it enables the reduction of intraocular pressure (IOP) while avoiding many clinically significant complications related to the formation of a filtering bleb in fistular procedures. It is favourable for patients with a high risk of hypotony, scarring, and inflammation. The procedure ensures safety and minimal interruption in the eye’s structure, which results in quicker recovery and less burden for the patients[4] It has limitations; the preparation of the classical trabeculo-Descemet’s membrane (TDM) in the clear cornea is technically challenging and bears the risk of a TDM rupture with iris prolapse. We describe this modified technique and the preliminary results of 12 cases to support the proposed method

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Conclusion