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N. S. Kheradiya, L. B. Cantor, D. WuDunn, L. Morgan, J. S. Hoop; Short Term Efficacy and Complications of Canaloplasty in Primary Open Angle Glaucoma (POAG) Patients. Invest. Ophthalmol. Vis. Sci. 2009;50(13):458.
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To assess the efficacy and complications of canaloplasty, with and without combined cataract surgery, in POAG over 6 months postoperative (post-op) follow-up.
Retrospective analysis of 30 eyes (from 23 patients) performed by a single surgeon (LBC) at the Indiana University School of Medicine (Indianapolis, IN, USA). Twenty-six eyes (20 patients) underwent canaloplasty combined with cataract surgery, while 4 eyes (3 patients) underwent canaloplasty alone. Main outcome measures included intraocular pressure (IOP), number of glaucoma medications, visual acuity, Kaplan-Meier survival function, and complications. Kaplan-Meier success was defined as any of the following: IOP less than or equal to 18 mmHg AND greater than 20% decrease in IOP; or greater than 10% decrease in IOP on one fewer medication than pre-operatively (pre-op); or stable IOP on at least two fewer medications than pre-op.
Demographics include mean age of 76.7 +/- 10.4 years; 14 men, 9 women; 21 Caucasians, 2 African-Americans. IOP was significantly reduced from 19.4 +/- 8.8 mmHg pre-op to 13.2 +/- 3.7 mmHg at 3 months post-op (p = 0.001, paired t-test) and to 14.6 +/- 2.6 mmHg at 6 months post-op (p = 0.01, paired t-test). The number of glaucoma medications also significantly decreased from 2.0 +/- 0.9 pre-op to 0.2 +/- 0.6 post-op (p < 0.0001, Wilcoxon matched pairs test). The cumulative probability of survival at 6 months was 0.75. Five patients continued to need topical glaucoma medications and two patients underwent Nd:YAG laser goniopuncture of Descemet’s window post-op. Intraoperative complications included rupture of Schlemm’s canal [1 eye], catheter dehiscence through trabecular meshwork [1 eye] (both converted to trabeculectomy), perforation of Descemet’s window centrally without iris prolapse [1 eye], and dehiscence of superficial scleral flap [1 eye]. Post-op complications included IOP spike after iris prolapsed [1 eye, 3%], sub-Descemet’s hemorrhage [3 eyes, 10%], hyphema [16 eyes, 53%], subconjunctival hemorrhage [9 eyes, 30%], corneal edema [2 eyes, 7%], transient hypotony [5 eyes, 17%], transient bleb [14 eyes, 47%], and Seidel positive leak in the early post-op period [2 eyes, 7%].
Canaloplasty is a safe, effective procedure for lowering IOP and reducing the need for glaucoma medications in POAG patients.
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