July 2018
Volume 59, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2018
Combining ab-interno canaloplasty and trabecular bypass stenting lowers IOP more than bypass stenting alone during phacoemulsification
Author Affiliations & Notes
  • Marius Heersink
    Department of Medical Education, University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Mila Heersink
    Pacific Eye Institute, Upland, California, United States
  • Jesse Dovich
    Department of Ophthalmology, Loma Linda University, Loma Linda, California, United States
  • Footnotes
    Commercial Relationships   Marius Heersink, None; Mila Heersink, None; Jesse Dovich, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2018, Vol.59, 2062. doi:
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      Marius Heersink, Mila Heersink, Jesse Dovich; Combining ab-interno canaloplasty and trabecular bypass stenting lowers IOP more than bypass stenting alone during phacoemulsification. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2062.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Trabecular meshwork micro-bypass stenting and ab-interno canaloplasty are increasingly used to control intraocular pressure (IOP) in conjunction with phacoemulsification. This study tested the hypothesis that the combination of canaloplasty and bypass stenting during phacoemulsification is more effective than bypass stenting alone during phacoemsulfication in controlling glaucoma through a retrospective, non-randomized comparative case series.

Methods : This study examined the 6-month outcomes of 71 eyes of 65 patients which underwent combined ab-interno canaloplasty, trabecular bypass stenting, and phacoemulsification compared to 93 eyes of 66 patients which underwent bypass stenting and phacoemulsification alone for treatment of primary open-angle glaucoma. All operations were performed by a single surgeon and all patients were followed postoperatively for a minimum of 6 months. Patient exclusion criteria included previous incisional glaucoma surgery. Main outcome measures were pre- and postoperative IOP, number of glaucoma medications used, best corrected visual acuity (BCVA), and post-operative complications.

Results : By 6 months postoperatively, the average IOP decline was significantly greater in the canaloplasty, bypass stenting, and phacoemulsification group (24±7% IOP reduction) compared to the phacoemulsification and bypass stenting alone group (15±5% IOP reduction, p=0.022). No statistically significant difference was found between the two groups in number of glaucoma medications used (pre- or postoperatively), or BCVA after surgery, and no intra- or postoperative complications (including persistent hyphema or hypotony) were experienced in either group.

Conclusions : Combined ab-interno canaloplasty, trabecular micro-bypass stenting, and phacoemulsification achieved an additional IOP lowering effect compared to bypass stenting and phacoemulsification alone, with no complications experienced in either group. This finding suggests that combining multiple minimally invasive glaucoma surgery (MIGS) modalities is an effective option for lowering IOP in primary open-angle glaucoma.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.

 

Gonioscopy view of ab-interno canaloplasty and trabecular bypass stenting. The blue device on the left (green arrow) is the viscoelastic insertion into the trabecular meshwork. The trabecular bypass stent is visible on the right (black arrow).

Gonioscopy view of ab-interno canaloplasty and trabecular bypass stenting. The blue device on the left (green arrow) is the viscoelastic insertion into the trabecular meshwork. The trabecular bypass stent is visible on the right (black arrow).

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