Focus of the Report: The focus of this report is phacocanaloplasty (P-CP) for the treatment of concomitant open-angle glaucoma (OAG) and cataract in adult patients.

Technology Description: P-CP combines phacoemulsification (phaco), the standard care cataract extraction and intraocular lens surgical treatment for cataracts, with canaloplasty (CP), a minimally invasive alternative glaucoma surgery that utilizes a specially designed microcatheter to dilate aqueous humor collector channels to reduce intraocular pressure (IOP). The microcatheter alleviates obstructions in the Schlemm canal (SC) by physically pushing through them 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: Phacotrabeculectomy (P-TE), the standard surgical option for treating concurrent OAG and cataract, is associated with reduced IOP and improved visual acuity. However, P-TE relies on a bleb-creating procedure, which can be painful and often leads to secondary complications and vision issues. P-CP is a minimally invasive blebless procedure that may greatly reduce postoperative complications and need for follow-up. However, it is not known if P-CP can achieve the same IOP-lowering efficacy that P-TE consistently delivers.

Key Questions:

  • Is P-CP effective in treating concurrent OAG and cataract?

  • How does P-CP compare with other surgical interventions for cataract and OAG?

  • Is P-CP safe?

  • Have definitive patient selection criteria been identified for P-CP?

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