Abstract
Purpose :
To evaluate the surgical outcome of canaloplasty using Stegmann’s canal expander in open-angle glaucoma (OAG).
Methods :
Prospective, non-comparative, interventional study. We recruited patients with uncontrolled OAG between September 2013 and May 2015. All cases were operated by the same surgeon using a standardized canaloplasty procedure with 360-degree dilatation of Schlemm’s canal (SC) using a flexible ophthalmic microcannula (iScience Surgical Corporation, Menlo Park, CA) followed by the insertion of Stegmann’s expander® (Ophthalmos GmbH, Switzerland) into both surgically created SC ostia. Primary outcomes: mean change in intraocular pressure (IOP) and number of glaucoma medications following surgery. Secondary outcomes: complication rates; percentage of eyes requiring YAG-laser goniopuncture; percentage of eyes with successful insertion of the expander in SC.
Results :
We recruited 44 eyes of 42 consecutive patients. Demographics: 38 (86%) were Caucasians; 32 (73%) female; primary-, pseudoexfoliative-, pigmentary- OAG had 25 (57%), 17 (39%), 2 eyes (4%) respectively; 30 eyes (68%) were pseudophakic; mean age (±SD) was 77 ± 8 years (range: 56-93). All patients reached month-6 follow-up visit (range: 6-24). Mean IOP decreased from 22.4 ± 7.8 mmHg before surgery to 8.4 ± 4.2, 12.05 ± 3.59, 11.07 ± 4.08, 11.3 ± 3.51, 11.2 ± 2.6, 11.1 ± 2.7, 11.6 ± 2.3 at day-1, week-1, month-1, -3, -6, -12, -24 respectively (p < 0.01). Mean number of glaucoma medications reduced from 3.36 ± 0.74 before surgery to 0.15 ± 0.47 at the last recorded visit (p < 0.01, Wilcoxon). No complication was recorded in 20 eyes (45%); a spontaneously-resolving hyphema in 14 eyes (32%); a choroidal detachment in 4 eyes (9%); a Descemet’s membrane detachment and anterior uveitis each in 3 eyes (7%). YAG-laser goniopuncture was performed in 11 eyes (25%), all before month-6 visit (64% at week-1). Uneventful canal expander insertion was achieved in 29 eyes (66%). The expander was trimmed in 2 eyes (4.5%) due to some resistance during insertion whereas, it was inserted only in one side in 8 eyes (18%).
Conclusions :
Canaloplasty with Stegmann’s expander® appears to reduce IOP in OAG with minor and self-limited complications in most cases.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.