Clinical Ophthalmology (Dec 2019)
Canaloplasty in the Treatment of Primary Open-Angle Glaucoma: Patient Selection and Perspectives
Abstract
Anna Byszewska,1 Joanna Konopińska,2 Aleksandra Kinga Kicińska,1 Zofia Mariak,2 Marek Rękas1 1Department of Ophthalmology, Military Institute of Medicine, Warsaw 04-141, Poland; 2Department of Ophthalmology, Medical University of Białystok, Białystok 15-276, PolandCorrespondence: Anna ByszewskaDepartment of Ophthalmology, Military Institute of Medicine, Ul. Szaserów 128, Warsaw 04-141, PolandTel +48-500-285-890Email [email protected]: Canaloplasty is a surgical procedure that has undergone a number of developments since its introduction in 2005. Many thousands of canaloplasties have been performed around the world since then and is, by definition, a blebless procedure. It does not necessitate the use of any antifibrotic agents and results in safe and effective IOP reductions in patients with open-angle glaucoma (OAG) with minimal complications and no bleb-related adverse events. When considering the surgical management of patients with early and medium stages of the disease, canaloplasty can be considered as a first line option. This paper will overview the theoretical effectiveness of canal surgery, the fundamental aspects of aqueous outflow resistance with particular emphasis on the role of the trabecular meshwork, Schlemm’s canal, and the collector channels, and the methods available for the clinical evaluation of the outflow pathways in relation to the ocular anatomy. Further, the paper will detail the surgical technique itself and how this has developed over time together with the clinical aspects that should be accounted for when selecting patients for this surgery.Keywords: glaucoma, aqueous outflow, canaloplasty, minicanaloplasty, canaloplasty ab interno, ABiC, schlemm’s canal, canaloplasty modification, canaloplasty patients selection, iTrack, canaloplasty qualification
