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. 2025 Apr 19:19:1331-1337.
doi: 10.2147/OPTH.S508611. eCollection 2025.

Real-World Outcomes of Combined Phacoemulsification and STREAMLINE® Canaloplasty: Interim Analysis of a Longitudinal Single-Center Retrospective Study

Joseph Stanke  1 , Don Nguyen  2
Affiliations

Real-World Outcomes of Combined Phacoemulsification and STREAMLINE® Canaloplasty: Interim Analysis of a Longitudinal Single-Center Retrospective Study

Joseph Stanke et al. Clin Ophthalmol. .

Abstract

Purpose: To report the clinical outcomes of a novel ab interno minimally invasive procedure with the STREAMLINE® Surgical System for creation of incisional goniotomies and canaloplasty in eyes with primary open-angle glaucoma (POAG).

Methods: In a retrospective analysis of all consecutive cases performed and followed for up to 12 months, 51 eyes of 51 subjects with mild, moderate, and severe primary open-angle glaucoma (POAG) underwent canaloplasty and incisional goniotomy following phacoemulsification cataract extraction. The procedure was performed according to the manufacturer's instructions for use. However, in contrast to other studies where the technique involved solely incisional goniotomy during viscoelastic delivery, in this study, a 1-2 clock hour goniotomy was created with the cannula after 3-6 injections of viscoelastic into Schlemm's canal. Outcomes in this interim analysis included mean reduction in IOP and medications through month 12, as well as the proportion of eyes achieving IOP reduction ≥20% from baseline.

Results: Mean preoperative IOP was 16.9 mmHg using a mean of 1.2 medications (n = 51). At 30 days post-op, mean IOP was 15.3 mmHg using a mean of 0.2 medications; 21.6% (11/51) had IOP reduction ≥20% from baseline; 90.2% (46/51) were medication-free. At 6 months post-op, mean IOP was 15.6 mmHg using a mean of 0.2 medications; 21.6% (11/51) had IOP reduction ≥20% from baseline; 90.2% (46/51) were medication-free. At 12 months post-op, mean IOP was 17.0 mmHg using a mean of 0.2 medications, 37.3% (19/51) had IOP reduction ≥20% from baseline; 88.2% (45/51) were medication-free. No adverse events were reported. No secondary surgical interventions were required in any patient.

Conclusion: Canaloplasty and incisional goniotomy combined with phacoemulsification safely and effectively reduced dependence on IOP-lowering medications while adequately managing IOP in eyes with primary open-angle glaucoma through 12 months of follow-up.

Keywords: MIGS; canaloplasty; glaucoma; goniotomy; trabecular meshwork; viscodilation.

Plain language summary

This study examined the real-world outcomes of a device called the STREAMLINE Surgical System. The device was used in combination with cataract surgery to treat glaucoma patients. The study followed 51 eyes of patients with mild to severe primary open-angle glaucoma for 12 months to assess how well the procedure reduced IOP and the need for glaucoma medications. The results showed that the surgery was safe and effective. On average, patients experienced a significant reduction in their need for medications, with nearly 90% of participants medication-free for up to 12 months after surgery while maintaining stable intraocular pressure. Additionally, no serous adverse events or additional surgeries were required during the study period. These findings provide valuable insights into how this technique can be used in real-world clinical settings to improve patient outcomes.

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Conflict of interest statement

Don Nguyen has financial interests and/or receives consulting fees from New World Medical, AbbVie, and Alcon. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Mean IOP at each time point.
Figure 2
Figure 2
Mean medications at each time point.
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