Canaloplasty in Open-angle Glaucoma: Mid-term Results From a Multicenter Study

Abstract

Purpose: To present the mid-term results of a prospective multicenter study on canaloplasty surgery in chronic open-angle glaucoma.

Materials and methods: A total of 218 eyes from 197 patients with open-angle glaucoma under maximum tolerated medical therapy underwent canaloplasty within a time period of 42 months in 3 different Italian eye centers. All patients underwent a complete ophthalmic examination every 6 months. The follow-up ranged from 3 to 42 months.

Results: The entire procedure according to standard protocol could not be performed in 20 eyes (9.2%). A total of 198 eyes from 178 patients with a mean follow-up of 23.1±10.6 months were taken into consideration. The preoperative mean intraocular pressure (IOP) was 28.4±7.5 mm Hg. The mean IOP at the 2-year follow-up was 15.9±4.7 mm Hg (range, 6 to 40 mm Hg; paired t test; P=0.0001), with a mean reduction from baseline of 44% (range, 11.1% to 82.8%). After 2 years of follow-up, a qualified success rate based on postoperative IOP≤21, ≤18, and ≤16 mm Hg was obtained in 82 (92.1%), 75 (84.3%), and 61 (68.5%) eyes, respectively; a complete success for an IOP≤21, ≤18, and ≤16 mm Hg was obtained in 63 (70.8%), 60 (67.4%), and 53 (59.5%) eyes, respectively. The number of medications used preoperatively and at the 2-year follow-up was 3.2±0.9 and 1.1±1.3, respectively. The most frequently seen complications included: hyphema in 47 eyes (23.7%), Descemet membrane detachment in 11 eyes (5.5%), and IOP spikes >10 mm Hg in 12 cases (6.1%).

Conclusions: Canaloplasty is a quite difficult surgical technique; however, mid-term results are promising. Complications can sometimes occur, but are seldom serious. The main advantage of this promising bleb-less procedure is that physiological humor aqueous outflow is restored.