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Canaloplasty for Open-Angle Glaucoma

January 13, 2020

Health Problem: Glaucoma is a disease of the optic nerve characterized by loss of retinal ganglion cells; remodeling of the lamina cribrosa; structural changes to the nerve; elevated intraocular pressure (IOP); and progressive, irreversible loss of vision leading to blindness. Open-angle glaucoma (OAG) is associated with partial blockage of the flow of aqueous humor.

Technology Description: Canaloplasty (CP) is a minimally invasive glaucoma surgery that utilizes a specially designed microcatheter to dilate aqueous humor collector channels to reduce IOP. The microcatheter alleviates obstructions in the Schlemm canal (SC) by pushing through them physically and by injecting high-molecular-weight viscoelastic to viscodilate the SC. Additionally, at the end of the procedure, a tensioning suture is placed to stent the canal open.

Controversy: Trabeculectomy (TE), the standard surgical option for treating OAG, is known to be a very efficacious method of reducing IOP. However, TE also relies on a bleb-creating procedure, which can be painful and often leads to secondary complications and vision issues. CP is a minimally invasive blebless procedure that experts suggest could greatly reduce postoperative complications and need for follow-up. However, it is not known if CP can achieve the same efficacy that TE consistently delivers.

Key Questions:

  • Is CP effective in treating OAG?
  • How does CP compare with other treatments for OAG?
  • Is CP safe?
  • Have definitive patient selection criteria been identified for CP?