Outcomes of Combined Phacoemulsification and Ab-Interno Canaloplasty with iTrack Microcatheter versus with the OMNI Surgical System

Abstract

Purpose : Ab-interno canaloplasty (ABiC) is a minimally invasive procedure that has revolutionized glaucoma care through its ability to enact significant reductions in intraocular pressure (IOP) and glaucoma medication dependence, with a safety profile favorable to traditional incisional procedures. We aimed to compare 12-month outcomes of combined phacoemulsification and ABiC with the iTrack Microcatheter versus with the OMNI Surgical System in eyes with mild primary open-angle glaucoma (POAG). Concurrent trabeculotomy was performed in the eyes receiving OMNI surgery.

Methods : This was a retrospective review of 30 eyes diagnosed with mild-stage POAG that underwent combined phacoemulsification and ABiC with iTrack (n=15) or OMNI (n=15) between July 2019 and January 2022. All eligible eyes had 12 months of uninterrupted follow-up. Primary outcomes included changes from baseline in IOP and the number of glaucoma medications taken. Statistical analysis used paired sample t-tests and Pearson’s chi-squared tests.

Results : Baseline IOP (iTrack, 14.9 mmHg; OMNI, 20.8 mmHg) and number of glaucoma medications (iTrack, 1.3; OMNI, 1.3) were established. At 12 months, IOP was reduced by 1.3 mmHg in iTrack (-9%, P=0.2) and 6.6 mmHg in OMNI (-32%, P<0.001). The number of glaucoma medications was reduced by 0.9 meds in iTrack (-68%, P<0.001) and 1.2 meds in OMNI (-95%, P=<0.001). Both groups achieved ≥ 20% IOP reduction (iTrack: 53%; OMNI: 80%; P=0.1), an IOP ≤14 mmHg (iTrack: 60%; OMNI: 53%; P=0.7), and medication burden reduction by ≥1 medication (iTrack: 73%; OMNI: 87%; P=0.4). No vision-threatening complications or device-related adverse effects were observed in either group.

Conclusions : In mild POAG, both procedures appear safe and produce clinical reductions in IOP and medication burdens, for up to 12 months. However, the IOP reduction for the iTrack cohort was not statistically significant. The majority of both groups maintained an IOP ≤14 mmHg and achieved a medication burden reduction by ≥1 medication. Limitations of this study include its small sample size and comparably lower mean baseline IOP observed within the iTrack cohort.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.