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Elisabeth Aponte, Jonathan Eisengart; Surgical Outcomes in First 25 Canaloplasties and Impact of Growing Experience on Complications. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4492. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To review the first 25 canaloplasties of a glaucoma specialist and determine how a single surgeon's growing experience in this procedure affects surgical time, complications and early outcomes.
We retrospectively reviewed the medical records of all patients who underwent canaloplasty by a single surgeon since 2010. Canaloplasties were divided into 2 equal groups of 12, based on the date of surgery, an “early group” G1 and a “late group” G2.
25 canaloplasties were found during this review. One early canaloplasty was converted to trabeculectomy intraoperatively and excluded from IOP outcomes. The remaining 24 canaloplasties were divided into G1 and G2. The average preoperative IOP in G1 was 21.26 mmHg on an average of 2.8 medications while that of G2 was 21 mmHg (P=0.88) on 2.54 medications (P=0.42). In G1, 8 of 12 canaloplasties had successful placement of tensioning suture after canalization with stent compared to 11 of 12 in G2. Perforation of the trabeculo-Descemet’s membrane occurred in 5 patients in G1 and 4 in G2, with 3 in each group being microperforations with no further intraoperative consequence. Combined phaco-canaloplasty averaged 54 and 52.6 minutes in G1 and G2, respectively (P=0.73). IOP on day 1 were 17.9 mmHg and 13.3 mmHg, in G1 and 2, respectively without glaucoma medications (P=0.17). At 1 month, IOPs were 15.5 mmHg (mean = 0.25 medications) and 14.18 mmHg (on no medication) in G1 and G2, respectively (P=0.43). Visual acuity was equal or better than 20/40 at day 1 in 5 of 12 patients in G1 and 8 of 12 patients in G2. Early post-operative complications included 5 hyphemas in G1 and 4 in G2, which all but 1 resolved during the first week. Hypotony (IOP < 6) was found in 1 patient in each group at day 1. Four small flat blebs were seen in G1 at 1 month and five in G2. The average final IOP in G1 was 18.5 mmHg on 1.9 medications and 14.83mmHg (P=0.09) in G2 on no medication (P<0.0001).
Canaloplasty in both the early and late groups resulted in a significant decrease in IOP and need for glaucoma medications. More patients in the later group had successful retention of tensioning suture after canalization with stent and visual acuity better than 20/40 at day 1. IOP at day 1 and final follow-up were also lower in the late group although not statistically significant. Intraoperative time and early complications were comparable between the 2 groups.
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